Table 4 Mapping of Zambian policy provisions related to the food environment against global policy recommendations

Category I: Strategies to promote food and nutrition education and awareness of healthy diets

 1. Include nutrition (health literacy) in the curricula offered in primary and secondary schools [27,28,29,30]

Schools shall ensure institutionalized health and nutrition education and initiate nutrition clubs in schools and communities [42] to promote consumption of healthy food, educate learners and the community on how to read and understand food labels and symbols and how to make good food choices when buying [43, 44] and disseminate dietary guidelines and nutrition education and counseling materials [44]

 2. Develop national food or nutrient based guidelines [30]

Zambia developed food-based guidelines [45]

 3. Implement mass media/public and social marketing campaigns based on national dietary guidelines to promote healthy diets and consumption of nutritious foods including traditional foods [28, 31, 32]

Promote population health education programmes to raise awareness of NCDs and their risk factors, to empower individuals, families and communities with appropriate knowledge to develop and practice healthy lifestyles and behavior change and improve the health status of adolescents [42, 46,47,48,49,50,51]

Encourage consumption of nutrient rich food including traditional foods such as edible insects and caterpillars to improve dietary diversity [46, 52]

Category II: Regulatory and legislative tools

 4. Implement tax measures on unhealthy foods [28,29,30, 32]

Advocate for public policies that support and promote health by reforming the legal and regulatory framework for food and nutrition to support healthy environments, good nutrition and prevent NCDs risk factors [47, 48]

 5. Provide incentives such as subsidies for production of healthy food options including reformulation [28,29,30, 32, 33])

 6. Implement comprehensive policy on labeling of food [28,29,30, 32]

Promote mandatory nutrition labeling for all prepackaged foods [52]

Prohibition of deception in labeling, packaging and selling of food. A person shall not label, package, sell or advertise any food in a manner that is false, misleading or deceptive as regards its character, nature, value, substance, quality, composition, merit or safety or in contravention of this Act [53]

A product that is sold in Zambia shall have a label to clearly indicate the product name, the ingredients used in the product, the date of manufacture and expiry of the product, the manufacturer’s name, the physical location of the manufacturer, the telephone number and any other contact details of the manufacturer [54]

 7. Regulate marketing of food and non-alcoholic beverages to children including in schools [29, 30, 32,33,34,35]

Prohibition of sale or advertisement of food as treatment for diseases: A person shall not—(a) advertise any food as treatment, preventative or cure for a disease, disorder or abnormality; or (b) sell any food that is presented on the label or is advertised as a treatment, preventative or cure for a disease, disorder or abnormality [53]

Category III: Strategies to promote production of and access to healthy food

 8. Strengthening of agriculture policy to improve supply of locally grown nutritious food [27,28,29,30, 33]

Develop and/or advocate for policies and programmes that will ensure food and nutrition security, food quality and safety at individual household, community and national level [46, 55]

Government shall promote cultivation and consumption of indigenous crop varieties [46, 55]

 9. Strengthen linkages between production, demand and consumption of nutritious food through value chain development [27, 33]

Enhance agriculture value chains through investment in production, agro-processing and marketing, including export market and distribution mechanisms. Value chain development will promote the participation of small and medium enterprises, coupled with provision of business development services to enterprises along different value chains. Emphasis will be placed on promotion of citizen participation in agri-business and linking local to regional and international value chains [47]

 10. Adopt policies that support healthy diets at school by engaging food retailers and caterers including school tuck-shops to improve the availability, affordability and acceptability of healthier food products [32, 33] and limit the availability of products high in salt, sugar and fats [29]

To improve feeding and eating practices, schools shall:

1) establish a tuck shop which should be selling healthy foods

2) encourage the family to prepare and pack healthy foods for leaners

3) ensure that learners are counseled on good feeding practices

4) encourage consumption of traditional food [43]

Promote the provision and availability of healthy foods in all public and private institutions including schools, other education institutions and work places [52]

Government shall ensure that food production units are revitalized in all learning institutions; and are used to teach children improved food production methods and agro entrepreneurship skills [42]

 11. Explore potential of urban and peri-urban agriculture initiatives such as school and community gardens and issuing contracts to local food growers to supply fresh produce and support the diversification of school meals and diets of schoolchildren and adolescents in cities [27, 29]

Improve Dietary Diversification through Nutrition-Sensitive Agriculture by increasing production and consumption of dietary-diverse nutrient-dense foods by

1) Develop and scale up a comprehensive homestead food production model

2) Support school demonstration gardens in production of micronutrient rich foods [44]

Develop urban and peri-urban economies with a priority on development and implementation of Integrated Development Plans. The policy focus will be on promoting entrepreneurship, creating urban industrial clusters, strengthening value-chain linkages and improving infrastructure in formal settlements [47]

 12. Develop and enforce national food safety legislation and regulations ensure that food producers and suppliers throughout the food chain operate within internationally recognized standards, guidelines and codes of practice on food safety and quality [28,29,30]

Government enacted the Food Safety Act of 2020 which contains provisions for the

production, manufacture, handling, preparation and storage of food in a manner that prevents food related diseases and harm [53]

Implement programmes aimed at promoting maintenance of a clean, healthy

environment and good nutrition including food safety regulation to ensure safe drinking water and sanitary conditions [47]

Category IV: Social protection strategies

 13. Incorporate nutrition objectives into social protection measures for vulnerable populations e.g. cash transfer and school feeding program [28, 34]

Enhance food security and nutrition through programmes such as supplementary and school feeding enhancement and nutritious foods and household food security promotion through improved targeting and coverage of social protection programs like social cash transfers [42, 43, 47, 56]

Category V: Guiding principles for governments

 14. Governance

  • Provide political will and commitment to nutrition [28, 30]

  • Coordinate action and ensure policy coherence across sectors such as agriculture, youth, recreation, sports, education, commerce and industry, finance, transportation, media and communication, social affairs and environmental and urban planning [28,29,30, 34, 35]

  • Establish nutrition coordinating mechanism such as task force or advisory bodies [29, 34]

  • Develop responsive, culturally appropriate policies to the specific country context [27, 28, 32, 35]

  • Provide means and platform for monitoring progress towards targets [28, 30, 36]

Government should establish a national NCD coordinating committee (or equivalent) with membership by all ministries and a national multi-sectorial NCD Action Plan, with full participation of non-health ministries and non-state actors. Government should strengthen leadership for enforcing existing legislation and regulations [57]

Government should enhance leadership and governance for the social determinants and risk factors for NCDs by establishing and maintaining an efficient institutional arrangement and strong nutritional networks to strengthen nutrition programming [48, 49, 57]

Government will facilitate the ratification and domestication of all international and regional agreements, conventions, declarations and protocols on health to which the country is a signatory to [48]

 15. Multisectoral collaboration

  • Engage all relevant stakeholders including NGOs, civil society, communities, the private sector and the media pupils, parents [27, 29, 30, 36]

  • Manage potential conflicts of interests [35, 36]

  • Integrate nutrition objectives into food and agriculture policy, programme design and implementation, to enhance nutrition sensitive agriculture, ensure food security and enable healthy diets [30, 36]

The second phase of the Most Critical Days Program (MCDP) will, therefore, continue to advance the multi-sector approach initiated under the first phase in order to encourage simultaneous roll out and implementation of the high impact nutrition interventions by the line ministries and the range of stakeholders involved in the MCDPII implementation [44]

Ministry of Education will cooperate closely with agencies that work to improve the nutritional, health, sanitary and environmental health status of communities to which the school pupils belong to [42]

Promote awareness among Government employees and the community at large that, health problems can only be adequately solved through multi-sectoral collaboration involving such sectors as Education, Agriculture, Water, Private Sector, including not for profit and faith based organisations [48]