While rural child malnutrition remains unacceptably high, rapid urbanisation is creating new malnutrition patterns and challenges in cities. Especially in low- and middle-income countries, where the most rapid urbanisation is expected in the next decades, cities have seen significant increases in the prevalence of overweight/obesity and related non-communicable diseases (NCDs) among adults and schoolchildren, and a largely unchanged number of child stunting.
Local governments and city policymakers are well placed to address urban malnutrition by virtue of their access to a wide variety of policy-level entry-points. Effective urban governance for nutrition -- the process of making and implementing decisions, policies and programmes that shape food systems to deliver better nutrition in cities -- requires coordinated action across sectors within city governments, with involvement of a variety of urban stakeholders, such as the private sector, civil society, and academia.
Studies on urban governance for nutrition are still scarce but three newly released working papers by the Global Alliance for Improved Nutrition (GAIN) examine initiatives in India, Pakistan and Tanzania which have successfully prioritised (urban) governance aiming to increase food safety and nutrition. All three examples use multi-stakeholder and multi-level approaches to facilitate decision-making, translating policies to actions on the ground, sharing responsibilities, improving coordination and defining shared goals.
Examples of urban governance for improved nutrition
Here, we highlight lessons learned, insights and options to take action from these case studies, in the hope that it inspires city-level leaders around the world take action to help address urban malnutrition in their own communities.
The Clean Street Food Hubs Initiative (CSFHI)
There are more than 1.6 million street vendors in Indian cities, of those an estimated 30% are street food vendors providing a significant proportion of the daily food for millions of consumers from diverse socio-economic backgrounds. Working paper #3 highlights India’s Clean Street Food Hubs Initiative – a different approach to regulating street food vendors by working jointly with groups of vendors to improve food safety and hygiene in cities across India. The initiative forms clusters of up to 50 street food vendors under one hub, connecting them to financial and logistical sponsorship from other private-sector partners, market associations and civil society organisations. These partners facilitate training and install infrastructure, helping to improve health and hygiene. Based on successful compliance with basic hygiene and sanitary requirements, the hubs can be certified, contributing to increased consumer trust in street foods and improving the viability and sustainability street food vending as a livelihood. The Kankaria Lake area in Ahmedabad was declared the first clean street food hub in September 2018.
The Punjab Food Authority
The Punjab Food Authority (PFA) operates in all 36 districts of the province, including the cities of Lahore, Faisalabad, Rawalpindi and others. The authority is the first of its kind in Pakistan that regulates the food market and enforces rules and regulations on food safety and hygiene in the province (Working paper #4). The PFA has invested in training food safety teams and food technologists to ensure the rigour and effectiveness of its work. As part of this scheme these trained food safety and inspection teams conduct efficient food business checks to ensure food market staff remain up to date on appropriate procedures and practices. The PFA’s structure and authority includes both standards and enforcement. This allows them to operate as a unified organisation while also ensuring sufficient separation between managing food business licencing and enforcement of food safety regulations.
The National Multisectoral Nutrition Action Plan (NMNAP)
The NMNAP is the first plan of its kind in Tanzania that addresses high levels of urban malnutrition and aims to accelerate the scaling up of nutrition-specific and -sensitive interventions in all urban and rural areas throughout the country. Working paper #5 describes the lessons learned from implementing the action plan which calls on different sectors to join the Tanzania’s fight against malnutrition at all levels and provides a strong system for other sectors to participate, making nutrition a national priority. The case of Ilala District, one of the five districts of Dar-es-Salaam Region, illustrates an example of the functioning of the NMNAP governance mechanism in an urban area.
Overcoming challenges to governance for nutrition actions
During the process of implementation all three examples faced and solved several challenges. Some of these included:
- Mistrust from stakeholders. In India there was initial mistrust by street food vendors on the benefits of training and the certification scheme as they suspected this would result in additional costs for them. To assure street food vendors that training and certification would be beneficial, the initiative had to understand the vendors needs and communicate the procedures properly. To achieve this, street food hub-leads played a crucial role in informing street food vendors on possible benefits.
- Limited compliance with standards from business partners and low levels of consumer trust. The PFA initially faced resistance from food businesses to comply with new food safety standards as they feared immediate closure of their companies. To overcome these issues, the PFA implemented awareness training for businesses in each area, to decrease the resistance of food companies to implement changes and undergo inspection. Establishing credibility with the public was another challenge for the authority. To understand public concerns and to increase consumer’s trust, the PFA established a helpline and the possibility for online feedback, and they disseminated information on food safety and quality issues using print media and door-to-door outreach.
- No previous experiences in multisectoral working. For the NMNAP, time used to re-organise existing working mechanisms created a significant challenge. Since NMNAP governance mechanisms at district level did not previously exist, district officers and others needed time to adjust to working in a multisectoral way. Those involved in the NMNAP implementation have now largely come to understand that the NMNAP does not imply more work but rather better coordination towards multisectoral, shared nutrition goals.
Achievements of these urban initiatives
Despite the challenges described, all three case studies demonstrate considerable achievements in prioritising nutrition through their targeted urban governance actions. Since its start in 2018, the CSFHI has certified eight hubs in India, where hub re-certification and audits suggest sustained improvements in the food safety and hygiene. The PFA increased inspections and the amount of licensed food businesses and became a model for the entire country. The authority was also instrumental in changing misleading label information and adding warning labels on “energy” drinks. In Tanzania, due to continued advocacy, the government’s financial commitment to nutrition has increased over time, nutrition officers are in place at regional and district levels and NMNAP impact targets are being gradually reached.
These examples from India, Pakistan and Tanzania show how food-related urban governance mechanisms can be comprehensive and effective. While the working papers highlight individual examples that are context-specific, the studies offer useful insights on enabling factors and barriers to improve urban governance for nutrition and create better food systems and nutrition in different geographies.
Kathrin is a Technical Specialist at GAIN, advising the Urban Governance for Nutrition team and their city projects in Indonesia, Tanzania, Tunisia, and Mozambique. Kathrin has previously worked in the scientific team of the Malabo Montpellier Panel at Imperial College London and as research associate for the interdisciplinary training group ‘GlobalFood’ at the University of Goettingen, Germany. Kathrin holds a PhD in Agricultural Economics, as well as a MSc in Nutritional Sciences.