Making the most of a good start: How to help families get all the nutrients they need

MAKING THE MOST OF A GOOD START HOW TO HELP FAMILIES GET ALL THE NUTRIENTS THEY NEED

To capitalise on the power of nutrition in early life, families need sustained and reliable access to nutrient-dense food through diverse diets that include enough protein, and all the vitamins and minerals needed for healthy growth. But protein-rich foods and fresh vegetables and fruit are often out of financial reach for many households; they tend to be more expensive than staples such as cereals or maize, or nutrientpoor ultra-processed foods. Although the Child Support Grant is a much-needed poverty alleviation tool, and an increasing number of children have benefited from it over the years, South Africa’s stunting rate remains stubbornly high. This tells us that we also need additional strategies to increase lowincome households’ access to nutritious food.

This third learning brief in a series focused on childhood nutrition looks at broad interventions that can help improve people’s nutritional status, such as making nutritious food cheaper through retail subsidies, large-scale food fortification and helping people grow their own food.

CLOSING THE FOOD GAP

South Africa’s mission to end stunting by 2030 is an ambitious goal — but a necessary one, if we want the country to thrive. More than a quarter of the country’s under-fives are stunted — the result of growing up in an environment where they do not have enough of the right mix of nutrients to support their bodies and brains. That early deficit follows them: it undermines their ability to learn at school and to find good work later. In fact, according to the World Bank, a child born in South Africa today is likely to achieve only 43% of their human capital potential.1 This places the country near the bottom of the global labour productivity curve in terms of per-capita GDP — and largely explains persistent patterns of inequality

undermine national brainpower, and poor-quality teaching and learning outcomes across much of the schooling system, keep the country’s development potential low.

Lowering stunting rates significantly requires two things: helping children consistently get the right mix of nutrients, and ensuring the conditions — health, hygiene, caregiving — that allow their bodies to absorb them. The second component will require systemic change to improve water, hygiene and sanitation infrastructure to reduce repeated exposure to environmental infections. Studies show these infections damage the gut, impair nutrient absorption and are associated with chronic malnutrition and, in turn, a high risk of stunting.2 Fixing the problem also includes strengthening infection prevention and control through improved deworming and schistosomiasis treatment in high-burden areas, routine child health services and prompt

indicator/WB_HCP_HCI?geos=ZAF World Bank. n.d. Human Capital Index Plus: insights. https://humancapital.worldbank. org/hciplus/insights/

and chronic disease. Nature Reviews Gastroenterology and Hepatology 10(4), pp. 220–229. World Health Organization. n.d. Diarrhoeal disease. https://www.who.int/news-room/ fact-sheets/detail/diarrhoeal-disease

THE MISSION TO END CHILD STUNTING BY 2030

INTENSIFY PUBLIC COMMUNICATION ON NURTURING CARE, BREASTFEEDING, DIETARY DIVERSITY AND BEST-BUY FOODS

ENSURE CHILDREN GET ENOUGH NUTRITIOUS FOOD

MAKE PROTEIN-RICH STAPLES MORE AFFORDABLE AND AVAILABLE.

Restore the Child Support Grant to the food poverty line.

Double-discount 10 best-buy foods.

Reduce food waste and distribute surplus foods.

Extend nutrition support in early learning programmes.

Together with enforcement of food fortification of maize meal and wheat flour.

PREVENT MORE BABIES FROM BEING BORN SMALL AND REMEDIATE THOSE WHO ARE.

Maternal Support Grant.

Restrict liquor trading hours, introduce floor price per unit of alcohol and limit container sizes.

Multiple micronutrient supplementation.

Individual and group-based support to all pregnant women and new mothers.

Cash + care model for malnourished pregnant women and low birth weight babies.

Growth monitoring of 0–2-yearolds by all community health workers.

Referral and treatment with nutrient supplements to children who fail to thrive.

SUPPORT FOR THE FIRST 1 000 DAYS

Eliminate vertical transmission of HIV.

Ensure 100% rotavirus vaccination coverage.

Prioritise solid waste management.

Effective water and sewage management.

HELP COMMUNITIES GROW THEIR OWN FOOD.

Build strong links between agricultural extension services and NGOs to sustain local support.

Build links between subsistence farmers and early learning programmes.

TREAT INFECTIONS

Mass treat schistosomiasis and intestinal worms in highinfection zones.

Prompt management of acute infections in pregnant women and young children.

Interventions focused on maternal and childhood nutrition are within easier reach, and can help a country get a good grip on stunting within a reasonable timeframe. Indeed, countries such as Chile, Peru, Brazil and Indonesia managed to get rates down by around 10 percentage points in under a decade by strategically implementing solutions to improve the nutritional status of mothers and their babies in the first 1 000 days of life (on page 10).

To capitalise on the gains of nutrition interventions in early life, families need sustained and reliable access to nutrientdense food. This means they need diverse diets that include enough protein, and all the vitamins and minerals needed for healthy growth. But access to nutritious food is closely linked to affordability, and with roughly half of South Africa’s children under 18 living below the lower-bound poverty line,3 and about 60% of them being in urban areas,4 it’s likely that many miss out on having consistent access to nutritious food.

Protein-rich foods and fresh vegetables and fruit tend to be more expensive than staples such as cereals or maize, or nutrient-poor ultra-processed foods. For example, a basic basket of nutritious food for a household of four costs around R3 787.5 However, a general worker who earns the

3 Statistics South Africa. 2025. Poverty trends in South Africa: An examination of absolute poverty between 2006 and 2023. Pretoria: Statistics South Africa.

4 Hall, K. n.d. Children Count: Housing and services. Urban–rural distribution Cape Town: Children’s Institute. https://childrencount.uct.ac.za/indicator. php?domain=3&indicator=13

5 Pietermaritzburg Economic Justice and Dignity. 2026. Key data from March 2026 Household Affordability Index. 21 May. https://pmbejd.org.za/wp-content/ uploads/2026/05/April-2026-Household-Affordability-Index-PMBEJD_29042026.pdf

people.6 Transport and electricity are usually budgeted for before food and can take up about 55% of someone’s salary, leaving only the balance for groceries and other necessities. It’s far less than what’s needed to buy even a basic basket of healthy food, let alone non-food grocery items like soap and household cleaning products.7 As a result, more expensive items such as meat, eggs, fresh vegetables and milk are often left off people’s shopping lists.8

The Child Support Grant (CSG) is accessed by around 60% of under-18s,9 and modelling shows that the rate of stunting among under-fives receiving the grant is a third lower than among those who are eligible to get it but don’t.10 But the CSG has not kept up with inflation, is not accessed early enough and is well below the food poverty line of R855. Although grants increase purchasing power and economic participation, they need to be complemented by other strategies that reduce food costs on a large scale, improve the diversity and quality of pantry staples consumed by the majority of South Africans, and enable communities to grow their own fruits and vegetables.

6 About 36% of South African households consist of two or three people, and 25% consist of four or five people. See: Statistics South Africa. 2025. General Household Survey 2024. Pretoria: Statistics South Africa. https://www.statssa.gov.za/ publications/P0318/P03182024.pdf

7 The food poverty line is the amount of money someone needs in a month to buy enough food to satisfy their daily energy intake. It is currently set at R855. The lowerand upper-bound poverty lines define the range within which someone’s income must be to afford enough food as well as basic non-food items. The values are currently at R1 415 and R2 846, respectively.

8 Pietermaritzburg Economic Justice and Dignity. 2025. Household Affordability Index – March 2025 https://pmbejd.org.za

Cornelsen, L. et al. 2014. What happens to patterns of food consumption when food prices change? Evidence from a systematic review and meta-analysis of food price elasticities globally. Health Economics 24(12), pp. 1548–1559. https://doi.org/10.1002/ hec.3107

9 Children's Institute. n.d. Children Count. https://childrencount.uct.ac.za/indicator. php?domain=2&indicator=10

Statistics South Africa. 2025. Mid-year population estimates 2025 https://www. statssa.gov.za/publications/P0302/P03022025.pdf

10 Oyenubi, A. and Rossouw, L. 2024. Is the impact of the South African child support grant on childhood stunting robust? An instrumental variable evaluation. Children and Youth Services Review 164, 107829. https://doi.org/10.1016/j.childyouth.2024.107829

Here are four solutions that can help families get the right nutrients to stay healthy and support their children's growth:

MAKING PROTEINRICH FOODS MORE AFFORDABLE

Protein affordability is key to ending stunting, says David Harrison, CEO of the DG Murray Trust, which is why advocating for a double discount on 10 well-liked nutrientdense foods (see box) makes sense, given the roughly 30% gap between what many households’ budgets allow for and what they need for a healthy diet. The gap between the food poverty line — currently defined at R855 — and the value of the CSG — at R580 a month as of April 2026 — hits children of poor families especially hard.

According to the United Nations Food and Agriculture Organization, fiscal subsidies of food that put more buying power in the hands of consumers — instead of producers — are an effective way to make nutritious food more accessible. France and Malaysia have both used price caps as a way of controlling food costs and in Egypt, India and the Philippines, retail subsidies all increased household access to food and reduced the prevalence of underweight children.11

The idea of the double discount on the “10 best buys” is that manufacturers and food retailers agree to forego the markup on 10 items (see box) of one product label, which could mean a saving of 10–15% for the consumer. The government then agrees to pay the food industry a matching amount, upon proof of the discounted sales. Combined, this shared responsibility can give consumers 20–25% more purchasing power in their pocket and help their money go further.

Subsidies for healthy food products and increased taxes on unhealthy choices have been shown worldwide to be effective fiscal strategies to improve the quality of people’s diets.12

HERE’S WHAT THE “10 BEST BUYS” LOOK LIKE:

12 World Health Organization. 2022. Fiscal policies to promote healthy diets: policy brief Geneva: WHO.

The fundamental premise of something like the “10 best buys” campaign is that every child must be nourished, and when this is understood by decision makers in both the public and the private sector, the logic of helping people buy nutritious food becomes simple, says Harrison. “From an economic development perspective, it would be in the food industry’s interest to think about foregoing some profits in the short term to drive sustained profitability for the next 50 years.”

Studies have shown that pricing and consumer behaviour reinforce each other.13 However the authors of a large review of the effectiveness of subsidies when it comes to prompting people to buy healthier food write that “despite the accumulated evidence on the effectiveness of economic incentives in modifying dietary behaviour, policy adoptions remain scarce”.14

It’s no different in South Africa, says Harrison, which is why sustained advocacy is necessary for both the government and the food industry to work together. “We can keep on telling people to have balanced diets and eat enough protein-rich foods, but if they can’t afford it, it won’t happen. We must create a cog for people to help change their behaviour.”

An initiative like the Khulisa Care project (on page 20), a collaboration between the Western Cape Department of Health, the Department of the Premier, DGMT, Grow Great and Shoprite, is an example of how a plan for subsidising selected food products can work in practice, and how it could shape consumer behaviour. “We’re not there yet, but once the data has been analysed, we’ll likely be able to track changes in purchasing patterns, not only for the ‘10 best-buy’ products, but for others as well, which will be interesting in telling us whether the signalling around buying nutritious food is starting to change consumer behaviour,” notes Harrison.

So far, the message from food businesses has been that they’d be willing to buy into a solution such as a double discounting of selected food items, but that they’d like to see the government’s clear commitment before taking action, says Harrison. And there are positive signals that things are moving. President Ramaphosa made a high-level commitment in February 2026 to the urgency of fighting stunting. An interdepartmental committee on poverty alleviation, convened through the Presidency, has recommended

subsidising food products. And Treasury has given early indications that it is looking at how to fund such subsidies. “It can change the calculus, but we have to get leadership in the Presidency,” urges Harrison.

Government has accepted that improving childhood nutrition goes beyond one department’s mandate, which is why the mission to end stunting will be based in the Project Management Office (PMO), alongside teams focused on sorting out energy and logistics in South Africa, he explains. “But the question that we need to answer now is how the same sort of collaborative structures can be created in the PMO as for energy and logistics, and then to start the process of really building consensus around what needs to be done if we’re serious about ending stunting by 2030.”

IMPROVING FOOD QUALITY THROUGH LARGE-SCALE

FOOD FORTIFICATION

Large-scale fortification of staple foods such as maize meal, wheat flour and rice is widely endorsed by international health and nutrition authorities such as the World Health Organization, UNICEF, the Global Alliance for Improved Nutrition, Sight and Life, and the Food Fortification Initiative.15 It involves adding a premix of selected vitamins and minerals to widely consumed foods at the milling or processing stage — that is, before the food source is made into consumerready products. Although this can’t provide people with the full daily amount of micronutrients they need, it can be a reliable mechanism to get people to a better nutritional status, independent of household income.16 Evidence across multiple settings shows that well-implemented programmes can significantly reduce micronutrient deficiencies and related health risks.17 This matters most for women of reproductive age: iron and folate deficiencies raise their risk of anaemia, and increase the risk of neural tube defects, low birth weight and poor early-life outcomes in their babies.18

13 An, R. 2012. Effectiveness of subsidies in promoting healthy food purchases and consumption: A review of field experiments. Public Health Nutrition 16(7), 1215–1228.

14 Ibid.

15 World Health Organization. n.d. Food fortification. https://www.who.int/health-topics/ food-fortification#tab=tab_1

Food Fortification Initiative. n.d. https://ffinetwork.org/

UNICEF. 2023. Large-scale food fortification for the prevention of micronutrient deficiencies in children, women and communities: guidance note. New York: UNICEF.

16 World Health Organization. n.d. Food fortification. https://www.who.int/health-topics/ food-fortification#tab=tab_1

17 Global Alliance for Improved Nutrition (GAIN). 2024. Food fortification: Policy recommendations to strengthen programmes and enhance impact. Large-scale food fortification policy brief. https://www.gainhealth.org/sites/default/files/ publications/documents/lsff-policy-brief-3rd-08dec24.pdf

18 World Health Organization. 2016. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO. https://iris.who.int/server/api/core/ bitstreams/9dccde13-3593-4a22-9237-61abe5a3c6b7/content

When diets rely heavily on staples and contain limited protein, fruits and vegetables — as is the case in many cash-strapped households — it’s difficult to achieve adequate micronutrient intake through diet alone. Indeed, it is estimated that 44% of South African children under five are deficient in vitamin A and 61% are anaemic, as are around a third of women of reproductive age.19 Large-scale food fortification is an obvious lever here, especially given a large systematic review showing that adding iron and folic acid to staple foods in low- and middle-income countries was linked to a 34% drop in anaemia among women and children and a 41% reduction in neural tube defects in babies. deficiencies are estimated to cost poorer countries between 2% and 5% of GDP every year through lost productivity and increased disease burden.

Large-scale food fortification is both cost-effective theory, an easy way to improve nutrient levels because it doesn’t require any behaviour change on the consumer’s part, explains Liezel Engelbrecht, nutrition lead of the Hold My Hand Accelerator, National Strategy to Accelerate Action for Children.

But the system must also work well in practice. A DGMTcommissioned review of South Africa’s fortification system showed that fortification does not currently consistently hit the target24 — despite a well-established policy structure being in place. Fortification was first introduced in 2003, with amendments following in 2008 and 2016. Despite fortification being nationally mandated, accountability are decentralised and uneven. And because getting the micronutrient mix slightly wrong doesn't pose immediate health risks, fortification monitoring often falls through the cracks — crowded out by more urgent food safety

19 Sambu, W. 2019. Children Count: nutrition – micronutrient deficiencies. childrencount.uct.ac.za/indicator.php?domain=4&indicator=97

Global Nutrition Report. n.d. South Africa profile. resources/nutrition-profiles/africa/southern-africa/south-africa/

20 Keats, E.C. et al. 2019. Improved micronutrient status and health outcomes in lowand middle-income countries following large-scale fortification: Evidence from a systematic review and meta-analysis. 1696-1708.

21 Darnton-Hill, I. et al. 2017. and challenges in low- and middle-income countries in 2017 https://micronutrientforum.org/wp-content/uploads/2017/10/2017-09MNForumLargeScaleFortification-FinalReport.pdf

22 Friesen, V., et al. 2025. Impact of large-scale food fortification programs on micronutrient inadequacies and their implementation costs: A modelling analysis. SSRN 5264480.

23 Hold My Hand. n.d.

24 Van der Merwe, M. 2025. A landscape and systems review Town: Hold My Hand and DGMT.

25 Department of Health. 2003. R. 504: Regulations relating to the fortification of certain foodstuffs; Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54 of 1972). Government Gazette document/201409/247150.pdf

Department of Health. 2008. R. 1206: Amendment of regulations relating to the fortification of certain foodstuffs. sites/default/files/gcis_document/201409/315841206.pdf

checks around hygiene standards or disease outbreaks, the study found. Furthermore, the amendments to the original regulation reframed nutrient levels as minimum standards rather than prescribing exact levels, shifting the emphasis from precise dosing to minimum compliance thresholds. In practice, compliance rests on manufacturers' own monitoring — and when inspection capacity gets diverted to more urgent needs, consistent fortification is likely to slip.

Department of Health. 2016. R. 217: Regulations relating to the fortification of certain foodstuffs. Government Gazette,

SUPPORTING COMMUNITIES TO GROW THEIR OWN FOOD, EVEN IN URBAN AREAS

“Growing up in a small village in the rural Eastern Cape, having a vegetable garden was a way of life,” says Yandiswa Mazwana, founder of the Masi Creative Hub in Masiphumelele, a large informal settlement near Fish Hoek in Cape Town.26 Today, her childhood memories of working in her family’s plot and selling fresh produce — beetroot, spinach, lettuce — to neighbours in her village inspire her to help people grow their own food in Masiphumelele.

"Children are at the centre of everything we do," Mazwana says. The garden's vision is that every child should have access to nutritious food, acquire skills to better their future, and contribute to developing their community. Through the Hub’s Nourished Child Project, 22 garden champions teach people about growing their own vegetables such as green peppers, spinach, cabbage, carrots, leeks, lettuce, kale and spring onions in plots at schools, crèches, their local clinic and other public spaces in the community, as well as in so-called “garden strips” in the streets between people’s houses. This model creates wide reach; Mazwana estimates around 5 000 people in Masiphumelele benefit from the food gardens, and people are empowered with skills and knowledge rather than simply buying produce. “Knowing what goes into growing food not only makes people excited about what they put on their plate, but also creates an appreciation for where food comes from,” she says.

Mazwana adds that through their food garden project, “children start to become the advocates for healthy eating”, teaching their parents about packing a nutritious “robot” lunch box that contains yellow, green and red vegetables like lettuce leaves, carrots and tomatoes. “The children’s excitement helps to build adults’ commitment, which helps everyone to eat more nutritious meals.” And, she adds, because people are growing vegetables in the community, they can use the money they would have spent on fresh produce before to buy protein such as chicken, meat, fish or eggs. “It stretches their budget,” she says. But more than that: “People realise that their investment in their gardens today is going to pay them back later.”

TEACHING PEOPLE ABOUT NUTRITIOUS FOOD

When families grow their own food, their money can go further. Angela Larkan, co-founder of Thanda,27 an NGO working in the Umzumbe Local Municipality in the Ugu District of rural KwaZulu-Natal, says members of her team see it first-hand in communities they work with. But she adds that to many people, growing their own food is about not going hungry, rather than feeling nourished. “People talk about the relief of having enough food, but aren’t equating vegetables with having more dietary diversity.”

Observations like these link to research included in a special nutrition-focused issue of the journal Development Southern Africa showing that interventions aimed at ending stunting cannot work in isolation (see the first Learning Brief in this issue). For example, teaching people about nutritious food works better if they have adequate access to food or the budget to make better choices, studies showed.28

That's why Thanda is adding nutrition education to its offering. It complements efforts to help people grow more proteinrich crops like peas and izindlubu (bambara nuts), and a pilot project for rearing an indigenous chicken breed that feeds on scraps rather than expensive feed — and is as good for eggs as for meat.

“Often, food is just food to people. It’s about getting full and not feeling hungry, and it ends there. So we’re starting with a programme in our neighbourhood learning circles to help people connect what they eat with what their bodies need,” explains Larkan. But it’s about more than just teaching people what to eat, she says. It’s also about helping people understand why it’s important to eat many different types of food. Through its nutrition education drive, Thanda is aiming to both create demand for having a varied diet, and empower people to supply diversity by growing their own vegetables.

The bambara nut is an indigenous legume that’s hardy and grows well even in poor soil. It contains a mix of important nutrients: complex carbohydrates, from which energy is

26

https://masicreativehub.org/

27 Thanda. n.d. https://thanda.org/

28 Burger, R. et al. 2025. Priority interventions for reducing stunting in the complementary feeding age group in South Africa. Development Southern Africa 42(6), pp. 885–903.

released in a sustained way during digestion; a fairly high amount of plant-based protein; unsaturated fatty acids; and magnesium, iron, zinc and potassium.29 Earlier research commissioned by DGMT about the enablers of agroecological smallholder farming initiatives (see Issue 32) showed that growing indigenous crops, which are well suited to low-input and marginal environments, can help to improve dietary diversity. 30 Many traditional crops are rich in micronutrients, and may help address “hidden hunger” caused by poor dietary diversity and low fruit and vegetable intake. Hidden hunger refers to a situation in which people get enough calories, but lack the vitamins and minerals their bodies need to function properly — making them more susceptible to disease and poor health.

GROWING VEGETABLES, BUILDING LOVE

Bhekuyise and Nkosazana Mbandlwa, a husband-andwife team of home-garden farmers in the Rosettenville community in the Ugu District of rural KwaZulu-Natal, beam when they talk about their garden, which with Thanda’s support is now “looking the best it has in years”.

“Uthando kuphela [it is only because of love],” says Bhekuyise. “This garden has so much love surrounding it, and the love that Thanda has brought to it too makes it all better. My wife and I use this space to talk and pick each other’s brains about different things. Recently, uMama has been telling me about the different things that they learn in the meetings [learning circles] that she attends. Some of the things she brings, hayi! I have never seen it, but that is good, because it challenges us and introduces us to different types of food. Right now, we have planted beetroot, cabbages, green peppers and izindlubu.”

“I know these nuts to be very nutritious,” adds Nkosazana. “They remind me of the days when I was still a young bride, and even my childhood. We used to prepare the nuts and mix them with beans and corn — we would call it izinkobe [similar to samp]. I was very surprised that Thanda was able to give us izindlubu to grow. To me, it shows that Thanda understands us as people.”

The key to changing people’s behaviour is to create awareness about the problem of stunting, says Larkan. “But many people in our communities don’t see a child being short for their age as a problem; it’s just something that happens.” This is why they’re working to help people better understand the effects of not having enough nutrient-rich foods — so that they’re open to the solution. “And we’re focusing on the first 1 000 days, because it’s a prevention issue,” she says. “But we also realise that teaching people about nutritious diets has to involve everyone in the family looking after a young child — the mother, grandmother or older sibling — so we’re adding nutrition education across our programmes, from the antenatal programme to early learning and youth development programmes, and our neighbourhood learning circles.”

29 Tan, X.L. et al. 2020. Bambara groundnut: An underutilized leguminous crop for global food security and nutrition. Frontiers in Nutrition 7, 601496.

Veldsman, Z, Pretorius, B. and Schönfeldt, H.C. 2023. Examining the contribution of an underutilized food source, Bambara Groundnut, in improving protein intake in Sub-Saharan Africa. Frontiers in Sustainable Food Systems, 7, 1183890. https://doi. org/10.3389/fsufs.2023.1183890

30 Mbhenyane, X.G. 2017. Indigenous foods and their contribution to nutrient requirements. South African Journal of Clinical Nutrition 30(4), pp. 5-7.

LESSONS LEARNT

Families need sustained and reliable access to nutrient-dense food and diverse diets to build on the gains of nutrition interventions in early life.

Here are five lessons to take from efforts to help people have nutritious food every day:

For example, the review of large-scale food fortification in South Africa showed that a strong policy architecture is in place, but that implementation is uneven because of a lack of oversight and accountability, says Engelbrecht. Fortification is an effective and fairly easy way to improve people’s nutritional status, and does not require behaviour change. If the system is improved, real gains are possible.

CHILDREN MUST BE AT THE CENTRE OF DEVELOPMENT

Treasury's R10 billion funding boost for early learning in 2025 (see Issue 33) has created leverage to strengthen advocacy for early childhood nutrition, says Harrison — because the additional budget flows to the ECD subsidy, which has a meals component and so directly links nutrition to the quality of early learning. “The outcome of early learning is brain power development, and brain power development needs food. Early learning and nutrition have to go together. So, we’ve been able to evolve the discussion about nutrition and — in a way — piggyback it onto the other wins for early childhood development. It’s almost like a second wave of the commitment to children.”

WINS TAKE TIME AND ARE A SHARED RESPONSIBILITY

The fight against stunting hasn't had the same success as the push for early learning, Harrison says. “We don’t have R10 billion behind interventions to end stunting. But getting that funding boost for early learning took 10 years of advocacy. With the President’s commitment to end stunting, the window of opportunity is now open, and we have to seize this moment.” That means government, business and civil society must work together to help build South Africa’s future. “It’s critical that everyone understands that ending stunting is not just about economic growth; it’s about human capital development,” says Harrison.

1 2 3

WE’RE NOT STARTING FROM ZERO

South Africa already has many of the tools and programmes needed to reduce stunting, but they currently operate separately and at insufficient scale. The next phase will require stronger coordination across government, business and civil society to improve food affordability, strengthen maternal and child nutrition services, support community food systems, and ensure that existing nutrition interventions work as intended.

Similar challenges exist more broadly across maternal and child nutrition programmes. “We know these interventions work, and how they fit into the bigger picture of improving nutrition. What we need now is stronger implementation, accountability and sustained commitment, to ensure they reach the families and children who need them most. We’re hoping that with the political commitment to end stunting we will see this happening,” says Engelbrecht.

4

A COORDINATED APPROACH IS NEEDED WHEN SYSTEMS ARE FRAGMENTED

When the various components of a system like food fortification aren't working together, the intervention loses effectiveness. Plugging the gaps requires coordination across monitoring, laboratory testing, compliance and inspection — as well as investment in a central data tracking system and regulatory reform. The immediate priority is to restore regulatory integrity and improve monitoring performance. Strengthening monitoring, modernising standards where necessary and clarifying institutional accountability would significantly increase the public-health impact of an already established national programme.

5

PEOPLE HAVE TO UNDERSTAND WHAT HEALTHY EATING MEANS BEFORE THEY ARE READY TO LEARN ABOUT NUTRITION

The experiences of both Thanda and the Masi Creative Hub show that nutrition education works when people understand that food is more than something that fills a stomach. But that understanding has to reach everyone in a community — mothers, children and other family members. In addition, for shared knowledge to hit home, people need to be able to see a difference in their lives, and be supported in practical implementation. Putting children and the potential for a better future at the centre of these efforts helps to drive the message.

WHAT’S NEXT?

Improving food affordability and access will need to become a far more central part of South Africa’s response to malnutrition and stunting. Social grants remain critical for reducing poverty, but many families still cannot consistently afford enough protein-rich, nutrient-dense food to support healthy child growth — and lack the means to grow their own.

For example, engagement with the food industry on reducing the price of the “10 best buys” has to continue, and preliminary data from the Khulisa Care project on consumer behaviour and purchasing patterns could help bring retailers

and manufacturers on board. In addition, work is needed to improve the implementation of large-scale food fortification, and to support community food production, nutrition education and mothers and young children in the first 1 000 days. “The growing national focus on ending stunting by 2030 presents a rare opportunity that can significantly improve the health, development and future potential of millions of children,” says Engelbrecht.

This is the learning experience of: