The increasing burden of non-communicable diseases (NCDs) in sub-Saharan Africa is causing further burden to the health care systems that are least equipped to deal with the challenge. Countries are developing policies to address major NCD risk factors including tobacco use, unhealthy diets, harmful alcohol consumption and physical inactivity. This paper describes NCD prevention policy development process in five African countries (Kenya, South Africa, Cameroon, Nigeria, Malawi), including the extent to which WHO “best buy” interventions for NCD prevention have been implemented. The study applied a multiple case study design, with each country as a separate case study. Data were collected through document reviews and key informant interviews with national-level decision-makers in various sectors. Data were coded and analyzed thematically, guided by Walt and Gilson policy analysis framework that examines the context, content, processes and actors in policy development. Country-level policy process has been relatively slow and uneven. Policy process for tobacco has moved faster, especially in South Africa but was delayed in others. Alcohol policy process has been slow in Nigeria and Malawi. Existing tobacco and alcohol policies address the WHO “best buy” interventions to some extent. Food-security and nutrition policies exist in almost all the countries, but the “best buy” interventions for unhealthy diet have not received adequate attention in all countries except South Africa. Physical activity policies are not well developed in any study countries. All have recently developed NCD strategic plans consistent with WHO global NCD Action Plan but these policies have not been adequately implemented due to inadequate political commitment, inadequate resources and technical capacity as well as industry influence. NCD prevention policy process in many African countries has been influenced both by global and local factors. Countries have the will to develop NCD prevention policies but they face implementation gaps and need enhanced country-level commitment to support policy NCD prevention policy development for all risk factors and establish mechanisms to attain better policy outcomes while considering other local contextual factors that may influence policy implementation such as political support, resource allocation and availability of local data for monitoring impacts.

The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors. The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process. The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources. MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes.

Shifting to dietary patterns rich in plants and low in animal-source foods could substantially lower emissions from the food sector while reducing the global burden of non-communicable diseases. The EAT-Lancet Commission proposed the planetary health diet (PHD) to emphasise plant-forward diets and set global targets to guide an urgently needed food-system transformation. However, the PHD's meat-reduction approach has attracted criticism and prompted debate on the potential micronutrient shortfalls of the plant-forward dietary approach. Since the planet simply cannot sustain human diets defaulting towards animal-based solutions, the objective of this Viewpoint is to provide recommendations that address the shortfalls of the PHD, with an emphasis on plant-based sourcing of food. Using a socioecological approach, along with an Integrative Sustainability Framework to evaluate dietary guidelines, in this Viewpoint we recommend seven key thematic areas for further development of the PHD. These themes relate to the bioavailability of micronutrients from plant-based foods, the inclusion of indigenous foods and practices, fortification and supplementation, cultural inclusiveness, and gender-based differences, a broader perspective on processed foods, and strengthening the concept by integrating the One Health approach.

Redressing structural inequality within the South African society in the post-apartheid era became the central focus of the democratic government. Policies on social and economic transformation were guided by the government’s blueprint, the Reconstruction and Development Programme. The purpose of this paper is to trace the evolution of non-communicable disease (NCD) policies in South Africa and the extent to which the multi-sectoral approach was utilised, while explicating the underlying rationale for “best buy” interventions adopted to reduce and control NCDs in South Africa. The paper critically engages with the political and ideological factors that influenced design of particular NCD policies. Through a case study design, policies targeting specific NCD risk factors (tobacco smoking, unhealthy diets, harmful use of alcohol and physical inactivity) were assessed. This involved reviewing documents and interviewing 44 key informants (2014–2016) from the health and non-health sectors. Thematic analysis was used to draw out the key themes that emerged from the key informant interviews and the documents reviewed. South Africa had comprehensive policies covering all the major NCD risk factors starting from the early 1990’s, long before the global drive to tackle NCDs. The plethora of NCD policies is attributable to the political climate in post-apartheid South Africa that set a different trajectory for the state that was mandated to tackle entrenched inequalities. However, there has been an increase in prevalence of NCD risk factors within the general population. About 60% of women and 30% of men are overweight or obese. While a multi-sectoral approach is part of public policy discourse, its application in the implementation of NCD policies and programmes is a challenge. NCD prevalence remains high in South Africa. There is need to adopt the multi-sectoral approach in the implementation of NCD policies and programmes.

Community family planning programmes in South Africa arose from the controversial apartheid history of controlling the African population while encouraging the growth of European migrant population. Post-apartheid population policies shifted away from population control to aligning policies to the global agenda that placed emphasis on the link between population and development. The focus on population and development polices in post-apartheid South Africa is on social equality, justice and peace rather than controlling sections of the population. Given the shift, this paper interrogates the conceptions of contraceptive use among rural communities in KwaZulu-Natal. Our primary objective is to understand the dynamics surrounding access to and use of family planning services in peri-urban and rural areas of KwaZulu-Natal. Using focus group data, the findings of the study suggest that different social categories interact with the family planning programmes differently. How teenagers and married women perceive the value of family planning differs. Gender differences regarding the use of condoms are also evident. The paper attempts to grapple with the non-use of condoms despite the knowledge that these prevent pregnancy and provide protection from sexually-transmitted diseases. The contribution of this paper lies in its identification of socio-cultural factors and the political economy underlying the different attitudes towards contraceptive use in rural KwaZulu-Natal.

Tobacco use is the world’s leading preventable cause of illness and death and the most important risk factor for non-communicable diseases (NCDs), particularly cardiovascular and chronic respiratory diseases (heart attack, stroke, congestive obstructive pulmonary disease, and lung cancer). Tobacco control is one of the World Health Organization’s “best-buys” interventions to prevent NCDs. This study assessed the use of a multi-sectoral approach (MSA) in developing and implementing tobacco control policies in South Africa and Togo. This two-country case study consisted of a document review of tobacco control policies and of key informant interviews (N = 56) about the content, context, stakeholders, and strategies employed throughout policy formulation and implementation in South Africa and Togo. To guide our analysis, we used the Comprehensive Framework for Multi-Sectoral Approach to Health Policy, which is built around four major constructs of context, content, stakeholders and strategies. The findings show that the formulation of tobacco control policies in both countries was driven locally by the political, historical, social and economic contexts, and globally by the adoption WHO Framework Convention on Tobacco Control (FCTC). In both countries, the health department led policy formulation and implementation. The stakeholders involved in South Africa were more diverse, proactive and dynamic than those in Togo, whereas the strategies employed were more straightforward in Togo than in South Africa. The extent of understanding and use of MSA in both countries consisted of an inter-sectoral action for health, whereby the health department strove to collaborate with other sectors within and outside the government. Consequently, information sharing was identified as the main outcome of the interactions between institutions and interest groups within and across three critical sectors of the state, namely the public (government), the private and the civil society. Tobacco control policies in South Africa and Togo were formulated and implemented from an inter-sectoral approach perspective, which relied heavily on information transfer between stakeholders and less on collaborative problem-solving approach. Incorporation of multiple stakeholders allowed both countries to formulate policies to meet FCTC goals for tobacco control and NCD reduction.