Engaging with those directly affected by policy is one way to accelerate progress in malnutrition.

South Africa’s strategy for the health system includes public consultation. Public participation is limited to public meetings after a draft policy has been developed. It isn’t easy to make significant revisions. How funds are allocated for child and mother nutrition is another example of the lack of meaningful engagement by the public. Policymakers make decisions, and people on the ground have little input.

Understanding what people value is essential to ensuring that policies are tailored to meet their needs.

We are a team of social scientists from the University of the Witwatersrand. We have been researching ways to engage the public. We created a study to put communities in the shoes of policymakers. We asked members of the community which programs they would prioritize if given a limited budget for health.

RespondentsRespondents from Soweto, a township with limited resources in South Africa, did not focus on the health system. They focused more on the causes of malnutrition. They proposed a number of measures to help mothers and their children eat well: school breakfast, paid maternity leaves, improved food safety and the establishment of community gardens and clubs.

This article presents a method of public engagement. We recommend that policymakers, researchers, and funders take into consideration programmes that communities consider essential to improving mother-and child nutrition.

The study

We modified CHAT to engage communities. CHAT is an exercise that simulates a game, similar to a board game. It is a way for the public to be involved in healthcare decisions. The aim is to demonstrate not only what programs people prioritize, given a limited budget, but also the values that underlie those priorities (assumptions or beliefs).

Our research team adapted CHAT to the Soweto context. The community was invited to choose a set of programs that they considered most important to improve nutrition for mothers and children. 54 men and women over the age of 18 volunteered to take part in this exercise. In real life, policymakers have to make tough decisions about what programs to include, what not to include (given the limited budget), and why. They had to debate and discuss their choices in order to convince each other that one program was better than another.

Participants selected 14 programmes in small groups. Five of the programmes were “nutrition specific” (affected the immediate causes for malnutrition directly) and provided through the healthcare system. (pregnancy supplement). Nine programs were “nutrition-sensitive” (addressed the underlying causes of nutrition) and accessed in non-health sectors (extended paid maternity leave).

The results

The top three priorities of community members were:

• The provision of school lunch
• Extension of paid maternity leave up to six months for those who are in informal employment
• Ensure that the food served by street vendors, in schools, and in creches is prepared safely.

Participants deemed important programmes such as finding work, affordable healthy food, and community gardens to improve the nutrition of mothers and children in their communities.

Community gardens are beneficial to everyone. You can grow vegetables, sell them, and earn money. Also, you can teach children and older people how to garden.

The choices made by the community reflect values such as fairness, equality, social justice, and children’s well-being. Participants were willing to listen to other perspectives and consider the implications of their decisions for the community.

It was important to develop programs that would break the intergenerational poverty cycle. They could increase their self-reliance, which would also help the most vulnerable people.

In South Africa, where unemployment rates are astronomical ( over 60% for young adults), solutions such as establishing community gardens can provide a path to a livelihood and economic empowerment and support the most vulnerable in the community.

Public engagement translated into action.

The constitution and other policy documents include provisions for public engagement. There are still gaps. There are gaps.

In order for South Africa to maintain its commitment to equity in healthcare, engaging with the public about ethical and social values must be part of an organized process in setting government priorities.

Malnutrition is a problem that will require coordinated action across multiple sectors. Our findings indicate that not all possible solutions (such as community gardens or extended maternity leaves) would fall under the already overburdened healthcare system.

Cross-sectoral coordination is already an objective of the South African National Food and Nutrition Security Plan for 2018-2023, through the creation of a multisectoral council that will oversee policy alignment, and coordinate and implement programs. Integrating public participation using tools such as CHAT, can complement these efforts.