Browsing by Author "Du Plessis, Lisanne Monica"

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    Exploring stakeholder commitment and capacity to address infant and young child nutrition in the capital of the Breede Valley, Western Cape Province, South Africa
    (Stellenbosch : Stellenbosch University, 2015-12) Du Plessis, Lisanne Monica; McLachlan, Milla; Drimie, Scott; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY: There is experience with - and documented evidence on multi-stakeholder processes (MSPs) on a global - and national level and on how to build and assess commitment and capacity to address infant and young child nutrition (IYCN) at these levels. Little experience and documented evidence, however, exist for such processes at local level. In countries with a decentralised government system, part of the lack of experience and evidence on MSPs lies in the challenge of building commitment and capacity at various political and bureaucratic levels. There is, thus, a need to build an evidence-base of how to engage stakeholders at implementation level and to assess and advance their commitment and capacity to implement responses to address IYCN. There is also a call to better define enabling environments for successful action in this field. In this research, a qualitative study design and selected participatory research methods were used to explore a diversity of perceptions, willingness, abilities, relationships and powers of key stakeholders to address IYCN at sub-district level in the Breede Valley, Western Cape Province, South Africa. The study built on baseline research in the Community-based Nutrition Security Project (CNSP), which provided insight into maternal and child nutrition challenges in the Breede Valley. Stakeholders were identified and categorised during a focus group discussion (FGD) with individuals who knew the sub-district well. Subsequently, the researcher conducted semi-structured interviews with twenty seven key stakeholders to explore their perspectives, commitment and capacity concerning IYCN. Hereafter, they were invited to participate in a workshop to map stakeholder relationships and power related to IYCN governance. Lastly, FGDs were held to reflect on the research process and to explore elements of an enabling environment conducive to action on IYCN at implementation level. Main themes from the overall research findings include: the value of local knowledge and information; the appeal of the 1000 days message and its link to development; the urgent need for IYCN advocacy; the value of stakeholder engagement and seeing the broad IYCN stakeholder landscape; the need for multi-sectoral work, while recognising the difficulty in functioning across sectors; realising the capacity inherent in “people” as a resource, the need for a “whole of society approach” in advancing the IYCN agenda and the importance of strategic capacity in local forums, combined with national legislation, to advance action for IYCN. The study provides insight into the elusive concepts of commitment and capacity in relation to IYCN governance at local level. The personal and professional perspectives of key stakeholders involved at this level offered distinct information about the unique challenges they experienced as well as practical responses required to ensure action. The barriers to multi-sectoral work at the sub-district level hinged on narrow sector-specific focus areas, mandates and budgets leading to poor integration around the social determinants of health, lack of resources and lack of targeted advocacy. The core conclusion of the study is that a detailed exploration of initial stages of an MSP is a valuable practice - and research model to create awareness of IYCN as a development issue of crosscutting importance at implementation level. This process, though time and resource intensive, has supported the development of commitment and revealed collective capacity that could be unlocked to address IYCN at the sub-district level in the Breede Valley. Such an approach, appropriately adapted to local conditions, could be helpful in scaling-up efforts to improve IYCN at sub-district level elsewhere in the country. The next phase of the CNSP should involve joint planning and concrete action to improve IYCN in the Breede Valley. The proposed expansion of the definition of the enabling environment and adaptation of the nutrition governance framework could be introduced into international debates and agendas for continued deliberation, research and action to improve IYCN as a global, national and local priority.
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    A qualitative analysis of perceptions of various stakeholders on nutrition-sensitive agricultural interventions, including the taxation on sugar-sweetened beverages (SSBs), to improve overall health and nutrition in South Africa
    (BioMed Central, 2020-09-03) Kaltenbrun, Tayla Ashton; Du Plessis, Lisanne Monica; Drimie, Scott
    Background: As a low-middle income country, South Africa has seen an upsurge in the double burden of malnutrition (DBM). Owing to the rising costs of obesity on healthcare in South Africa, the National Treasury implemented a fiscal policy for the taxation of SSBs, known as the Health Promotion Levy, in line with the WHO recommendation. Potential negative impacts of the policy on the sugar cane industry and economic and rural development have been voiced by different sectors. By including a subsection in the SSBs fiscal policy and aligning the goals with existing policies, government could have made provisions for sugar cane farms to substitute crops with alternatives, including nutritional alternatives where possible, while supporting existing small-scale farms to produce nutrient-dense, local and culturally acceptable crops. Thus, the purpose of the study is to understand the perceptions of the various stakeholders on combining nutrition-sensitive agricultural interventions with the taxation on sugar-sweetened beverages (SSBs) to improve overall health and nutrition in South Africa. Methods: Semi-structured, in-depth interviews were conducted with each participant. The interviews were audiorecorded, transcribed intelligent verbatim, and cross-checked against the audio-recordings by the principal researcher. ATLAS.ti 8 software was used to navigate the data and assist with thematic analysis. Results: Perceptions of combining SSB taxation with agricultural policies to improve food and nutrition security were positive. The participants found it to be an innovative idea in theory but questioned the feasibility of combining policies. Participants highlighted education as an essential element for successfully changing behaviour to ensure a positive impact of the combined policy approach. Participants believed that before government could scale up nutrition-sensitive agricultural interventions, basic services and government functions would first need to run optimally. Conclusion: Overall, perceptions with regard to combining the taxation on SSBs with nutrition-sensitive agricultural policies to improve overall health and nutrition in South Africa were positive. Although participants questioned the feasibility of combining these policies, it was viewed as a way to combat alleged collateral damage linked to the tax, with a specific focus on developing small-scale farmers. More research into these combined policy approaches in a South African context is required.