**5. Findings**

rising incidence of overweight and obesity and the associated consequences such as hyper‐ tension, cardiovascular disease and diabetes [18]. This high prevalence of under‐nutrition, micro‐nutrient deficiencies and over‐nutrition within a complex agriculture and food system presents a series of challenges which has significant implications for policies and programmes.

To conduct the case study, a South‐African country team was formed representing academics and professionals working in nutrition, food security and the agricultural policy environment. Members of the country team were selected based on their level of involvement in nutrition

As a point of departure, a literature review was conducted on the nutrition situation in South Africa to serve as the background to contextualize the case study. A review of previous nutri‐ tion surveys and data was conducted simultaneously with the collection of primary data in the field. Nutrition information was sourced from the previous nutrition‐related national surveys that have been conducted in South Africa since 1994 namely, the review of the South African Vitamin A Survey (SAVACG) and the National Food Consumption Survey (1999 and 2005). The main nutrition policies at the time were also reviewed and summarised in comparison with the findings of the Landscape Analyses Report performed for the World Health Organization (WHO) in 2010 [19]. The information was discussed and insights were obtained through stakeholder interviews with members from the Directorate of Nutrition of

Secondly, to get a thorough understanding of the South African policy environment, 29 key stakeholders were interviewed. Interviews at the national level involved mainly senior staff (Directors and managers) at key government ministries and agencies, departmental heads of

In addition, a questionnaire was distributed extensively throughout the country to stakehold‐ ers as well as through professional associations, e.g. the South African Association for Food Science and Technology (SAAFOST) and Nutrition Society of South Africa (NSSA)). The ques‐ tionnaire was developed and adapted based on a scientific article from Haddad [20] and a report from the Leverhulme Centre for Integrative Research on Agriculture and Health [21].

Once the policy environment within which programmes are rolled out was well understood, key programmes and policies were identified which do/could impact on the nutrition sen‐ sitivity of agriculture and food systems. A desktop review was done to isolate relevant pro‐ grammes. This was done by means of reviewing the current strategic plans of all the national departments in South Africa, identifying any frameworks and programmes containing the words 'nutrition', 'food security' or 'health' or 'agriculture'. The programmes excluded medical based interventions and programmes such as supplementation programmes by the Department of Health and medicinal programmes such as the Farmer‐to‐Pharma programme

and agricultural activities and frameworks within South Africa.

academic and training institutions and national programme officers.

The questionnaire was adopted to be applicable to the South African situation.

**4. Methodology**

8 International Development

the National Department of Health.

by the Department of Science and Technology.

The national government of South Africa functions through three spheres, i.e. national, provincial and local governmental departments. At the national level, the Bill of Rights in the Constitution of the Republic of South Africa (Act 108 of 1996) states that: *Everyone has the right to have access to sufficient food and water and the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each right* (Section 27); and *Every child has the right to basic nutrition, shelter, basic health care services and social services* (Section 28) [13]. This Constitution is considered the supreme law of the land and cannot be superseded by any other governmental action.

The Medium‐Term Strategic Framework (MTSF) of South Africa is an electoral mandate and a statement of intent identifying the development challenges facing South Africa. It guides planning and resource allocation during a 5‐year cycle. National and provincial departments need to develop their own strategic plans and budgets taking the medium‐term imperatives reported in this document into account. In the 2014–2019 MTSF of the current ruling party, their objectives are:


Based on the MTSF, a set of 14 national outcomes were developed (**Table 1**). These outcomes reflect the desired development impacts the Government seeks to achieve. Each outcome is articulated in terms of measurable outputs and key activities to achieve the outputs. The President of South Africa then proceeds to sign Negotiated Service Delivery Agreements with all Cabinet Ministers, in which they are requested to establish and participate in


**Table 1.** The 14 key outcomes of the 2014–2019 Medium‐Term Strategic Framework.

Implementation Forums for each of the outcomes, prioritise funds and develop the related policies and programmes accordingly.

An organogram summarizing relevant food and agricultural policies, programmes and frameworks and the responsible national levels of power are presented in **Figure 1**.

In 2011, the National Planning Commission (NPC) released a diagnostics report setting out the achievements and shortcoming of SA since 1994. It identified a failure to implement poli‐ cies and an absence of broad partnerships as the main reasons for slow progress and set out nine primary challenges: (1) too few people work, (2) the quality of school education of black people is poor, (3) infrastructure is poorly located, inadequate and under‐maintained, (4) spatial divides hobble inclusive development,(5) the economy is unsustainably resource‐ intensive,(6) the public health system cannot meet demand or sustain quality, (7) public ser‐ vices are uneven and often of poor quality,(8) corruption levels are high and(9) South Africa remains a divided society.

Nutrition-Sensitive Agricultural Development for Food Security in Africa: A Case Study of South Africa http://dx.doi.org/10.5772/67110 11

**Figure 1.** Organogram of the national levels of power responsible for the relevant food and agricultural policies, programmes and frameworks included in this case study.

The National Development Plan (Vision 2030) was released later in 2011 as a broad strategic framework that was set out by the NPC to guide the development of the new cycles of the presidential MTSF. It identified the key challenges South Africa as a country has to face but argues that the country can eliminate poverty and reduce inequality by 2030. It emphasises the importance of hard work, leadership and unity. It furthermore identifies infrastructure development, job creation, health, education, governance, inclusive planning and the fight against corruption as key focus areas and spells out specific projects for each.

In summary, the principal indicators of the NDP are to eliminate income poverty by 2030 (reduce the proportion of households with a monthly income below R419 per person in 2009 prices from 39% to zero) and reduce inequality (the Gini coefficient should fall from 0.69 to 0.06 by 2030). Apart from increased employment from 13 million in 2010 to 24 million in 2030, affordable access to quality health care and household food and nutrition security are listed as specific milestones required for enabling the achievement of these indicators.

Implementation Forums for each of the outcomes, prioritise funds and develop the related

An organogram summarizing relevant food and agricultural policies, programmes and

In 2011, the National Planning Commission (NPC) released a diagnostics report setting out the achievements and shortcoming of SA since 1994. It identified a failure to implement poli‐ cies and an absence of broad partnerships as the main reasons for slow progress and set out nine primary challenges: (1) too few people work, (2) the quality of school education of black people is poor, (3) infrastructure is poorly located, inadequate and under‐maintained, (4) spatial divides hobble inclusive development,(5) the economy is unsustainably resource‐ intensive,(6) the public health system cannot meet demand or sustain quality, (7) public ser‐ vices are uneven and often of poor quality,(8) corruption levels are high and(9) South Africa

frameworks and the responsible national levels of power are presented in **Figure 1**.

**Table 1.** The 14 key outcomes of the 2014–2019 Medium‐Term Strategic Framework.

**Outcome Department responsible for coordination**

Department of trade and industry

Department of higher education

Department of human settlements

Department of cooperative governance

Department of environmental affairs

Department of social development

Department of arts and culture

Department of rural development and land reform

Department of rural development and land reform

Department of telecommunications and postal services

Department of public service and administration

1. Improved quality of basic education Department of basic education

2. A long and healthy life for all South Africans Department of health 3. All people in South Africa are and feel safe Department of defence

4. Decent employment through inclusive economic growth,

5. A skilled and capable workforce to support an inclusive

6. An efficient, competitive and responsive economic

7. Vibrant, equitable and sustainable rural communities

8. Sustainable human settlements and improved quality of

9. A responsive, accountable, effective and efficient local

10. Environmental assets and natural resources that are

11. Create a better South Africa and contribute to a better

12. An efficient, effective and development oriented public service and an empowered, fair and inclusive citizenship

13. A comprehensive, responsive and sustainable social

14. A diverse, socially cohesive society with a common

well protected and continually enhanced

coordinated by the

10 International Development

infrastructure network

with food security for all

growth path

household life

government system

protection system

national identity

and safer Africa and World

policies and programmes accordingly.

remains a divided society.

The results of the findings related to the nutrition sensitivity of the various programmes and policies according to the Food and Agriculture Organization of the United Nations (FAO) guiding principles for linking agriculture and nutrition [22] are presented in **Table 2**.

Already in the early 2000s, lack of coordination was recognised and in 2002, Cabinet approved the Integrated Food Security Strategy (IFSS) to streamline, harmonize and inte‐ grate the diverse food security programmes. The strategy was implemented through among others the Zero Hunger Programme and there have been achievements in many of the



**Nutrition** 

**sensitivity of** 

**Integrated food** 

**Security Strategy**

**Zero Hunger**

**Food Security and** 

**Nutrition Programme**

**Aquaculture**

**Agro‐processing**

**Food Price** 

**Monitoring**

**TAX**

**Fortification**

**Integrated Nutrition** 

**Strategy &** 

**Programme**

**Roadmap to nutrition**

**Regulatory nutrition**

**Recapitilization &** 

**establishment of** 

**farms in distress**

**Land Redistribution** 

**for Agricultural** 

**Development** 

**Programme**

**National School** 

**Nutrition Programme**

**Comprehensive social** 

**security**

**Food banks**

**Grants**

12 International Development

**agriculture policies** 

**and programmes**

1. Have explicit

Yes

Yes

Yes

Partial

Partial

No

Yes

Partial

Yes

Yes

Yes

Partial

Partial

Yes

Partial

Yes

Partial

nutrition objectives

2. Have explicit

Yes

Yes

Yes

No

No

No

No

No

Yes

Yes

No

No

No

Yes

No

Yes

No

nutrition

indicators/link with

nutrition M&E

system

3. Have goals/

Yes

Yes

Yes

No

No

Yes

Yes

No

Yes

Yes

Yes

No

No

Yes

No

Yes

No

activities based in

the local nutrition

context

4. Target the most

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Partial

Yes

Yes

Yes

Yes

Yes

Yes

vulnerable

5. Empower

No

No

Yes

No

No

No

No

No

No

Yes

No

No

No

No

No

No

No

women

6. Increase food

Yes

Yes

Yes

Yes

No

No

No

Partial

Yes

Yes

No

Yes

Partial

Yes

No

No

No

production

6. One of nutrient‐

No

No

Partial

Yes

No

No

No

Yes

Yes

Yes

No

No

No

Yes

No

No

No

rich foods

7. Reduce post‐

No

No

Yes

No

Yes

No

No

No

Yes

Yes

No

No

No

No

No

Partial

No

harvest losses

8. Promote

Partial

Yes

No

Partial

No

No

Partial

Yes

Yes

Yes

No

No

No

Partial

No

No

No

diversification

of agricultural

products

**Table 2.** Summary of the nutrition sensitivity of relevant South African policies and programmes.

Partial

No

Yes

No

**Grants**

No

No

No

No

No

strategic priority areas [i.e. NSNP, INP, EPWP, Working for Water, CASP, Ilema/Letsema, Land Care etc.]. Today SA is able to attain national food sufficiency through a combination of own production and importation, but access to nutritious foods by all households is not yet guaranteed.

Within the context of food security and nutrition, South Africa still faces serious challenges, including inadequate safety nets and food emergency management systems, lack of knowl‐ edge and resources to make optimal food choices by citizens, in cases where land is available, it is not always optimally utilised for food production, limited access to processing facilities or markets for small‐scale primary producers, climate change, undermining of ecosystems, lack of sustainability and no adequate, timely and relevant information on food security and food security programmes.

Although nutrition is frequently included within governments' policies, frameworks and programmes, it is mostly reported upon in terms of 'under‐nourishment', focusing on vulner‐ able people rather than adopting a more integrated approach. Although reference is made to nutrition in many programmes, it is not always clear how they will contribute to better nutri‐ tion as expressed in these goals. There is, in particular, a lack of inclusion of(1) the promotion of diversifying agricultural production, (2) improved processing of foods to retain nutrient value and (3) improved storage of nutrient‐rich foods (**Table 2**).

Apart from the health sector, there seems to be a knowledge gap on the role which essen‐ tial nutrients (in addition to kilojoules/calories) play on the health status of the population. Furthermore, there is still a general lack of understanding of the economic and social burden which malnutrition plays in the country. There is consequently very little coordination across technical areas in relation to nutrition. A deeper understanding of the relevance of the inter‐ linkage between agriculture and nutrition for improved food and nutrition security is still an area that needs more attention.
