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Category: Health Promotion Levy

Healthy Living Alliance steering conversations about healthy food and healthy living

Posted on by Zukiswa Zimela

The Healthy Living Alliance (HEALA) held its quarterly panel discussion at the Clico Boutique Hotel. HEALA advocates for communities to organize and mobilize around policy and the right to affordable, nutritious food.

The discussion presented the media with an opportunity to learn about the role the big food plays in frustrating the implementation of lifesaving health policies and thwarting HEALA’s goal of ensuring “equitable access to healthy food” for all South Africans. The panel, led by HEALA’s programme manager Nzama Mbalati, legal researcher and PHD candidate Petronell Kruger, and Policy and Research Manager Angelika Grimbeek, was facilitated by Newzroom Afrika news anchor, Michelle Craig.

With South Africa under threat from the proliferation – and preference – for Ultra Processed Foods (UPFs) packaged and marketed by major food industry players, it is critical for organizations like HEALA to redirect the conversation to the dangers posed by noncommunicable diseases (NCDs) including obesity, diabetes, hypertension, and other risk factors associated with unhealthy food choices.

Some of these include consuming an unhealthy diet high in sugary meals, salty foods, and fatty foods. The World Health Organization (WHO) has recommended that countries implement interventions for Front of Package Labels (FoPL), strict marketing restrictions, and taxation as a means of fostering a culture of responsible food production and processing by large food producers, marketing institutions, and government agencies in order to steer consumers towards adopting healthy food choices and avoid NCDs.

Big Food Producers and marketing

According to Zukiswa Zimela, Communications Manager at HEALA, most of the non-communicable diseases such as diabetes, hypertension, and some cancers can be attributed to the overconsumption of foods high in salt, sugar and saturated fat.

However, attempts to reduce the overconsumption of these foods are made difficult due to the proliferation of these foods in our supermarkets and the persuasive nature of the media and brand marketing strategies employed by the food and beverage industry through “sleek” marketing.

Angelika Grimbeek, manager of policy and research, says that a lot of people are unaware that common foods may in fact be harmful to their health.

For years, adverts and “health” claims have been utilized by large food corporations to sway consumer choices. Big bucks have been generated off of selling consumers foods and drinks loaded with sugar, salt, fat, and artificial sweeteners. Diseases like Type-2 diabetes and high blood pressure, which can lead to stroke or heart disease, are becoming increasingly common in our communities, added Grimbeek.

“Big food businesses have used adverts and health claims to influence what we eat for years. Massive profits have been made selling us products high in sugar, salt, fat and added sweetener. We are seeing more and more people in our communities suffering from diseases like Type-2 diabetes and high blood pressure that can lead to stroke or heart disease,” she said.

Healthy living is expensive: truth or myth?

For Patronell Kruger, the notion that a diet high in unhealthy foods is more expensive than one rich in nutritious foods is false.

“We must face the high cost of unhealthy diet and the consequences of noncommunicable diseases. The monetary burden of caring for noncommunicable diseases (NCDs) like diabetes has both immediate and far-reaching consequences. The cost of insulin is high. South Africans lose an average of R2,700 per year due to NCD, according to a study done by Wits University. That’s an eight-month COVID-19 award,” Kruger calculated.

South Africa became the first African nation to tax suger sweetened beverages on April 1, 2018. This regulation has caused beverage corporations to lower sugar-sweetened drink intake, but it will take more to shift behaviours.

The WHO studies demonstrate that a correctly planned tax that raises retail prices by 20% or more can reduce consumption proportionally and encourage healthier alternatives.

Mbalati noted that the food and beverage industry historically resisted new regulations and policies since major corporations are profit-driven. This makes advocacy a battleground between big industry, the government, and organizations like HEALA that advocate good policy.

Mbalati said the government sometimes speaks alone and the big industry sometimes misrepresents information to deceive consumers.

HEALA said that a South African HPL study indicated that the food and beverage industry misrepresents evidence and confuses the public by changing packaging.

Mbalati has urged media to present genuine and practical stories of persons recovering from terrible dietary choices.

“More human stories are needed. We must cease intellectualizing the problem with scholarly opinion pieces. I want to read about a diabetic. I want to know about her problems, food, transportation, and medication. “We need to humanize these stories,” Mbalati says.

Ends

WE ARE HIRING: Finance and Admin Intern

Posted on by Zukiswa Zimela

Position:  Finance and Admin Intern

Location:  Rosebank, Johannesburg

Contract duration:  9 months

Closing date:  24th May 2023

 

About us:

Healthy Living Alliance (HEALA) is a coalition of civil society organisations advocating for equitable access to affordable, nutritious food in South Africa by building a more just food system.  HEALA’s vision is a South Africa in which all people have equitable access to healthy food to unlock their full potential.

The Role:

An exciting opportunity exists for a Finance and Admin Intern who will assist in managing the financial and administrative duties of HEALA. This role includes managing monthly reconciliations, daily administrative duties and supporting programme team.

Who we’re looking for: 

The ideal candidate should be educated with a Diploma in Accounting; or have a BCom Accounting degree. They should  have the ability to apply their knowledge of financial management; proficient knowledge of Generally Accepted Accounting Principles and Internal Control Fundamentals; have knowledge of Microsoft Word and Excel, a thorough knowledge of external regulations as well as internal corporate policies and procedures; excellent oral and written communication skills as well as excellent quantitative and analytical skills; strong critical thinking and problem solving skills, the Ability to analyse and interpret financial data, identify/resolve errors and prepare reports and the ability to motivate and work well with others.

In addition to this the candidate should have the ability to analyse financial transactions, to review and determines compliance with laws and regulations and make recommendations for approval; review and analyse recommendations be strong on attention to detail.

The candidate should also have strong commitment to HEALA values and ethos.

The duties and responsibilities for the role are as below:

  • Prepare payment requests together with supporting documents;
  • Load payments on the online banking;
  • Process cashbook and bank reconciliations;
  • Closely work with the Finance Manager together with Programme Manager in order to manage cash flow effectively;
  • Maintain tracking tool for expenses;
  • Ensure all statutory payments are paid on time;
  • Credit Card Reconciliations;
  • Responsible for bringing any official and legal correspondence to the attention of the Senior Management Team and assist with adequate responses;
  • Engage travel agent with regard to travelling arrangements;
  • Maintain the asset register

What we offer:

HEALA is committed to providing a welcoming, supportive workplace where we recognise a job well done, encourage close collaboration and sharing power.

How to apply:

Suitably qualified candidates are required to email their updated CV’s and cover letter clearly explaining their suitability against the essential criteria in the job profile to info@HEALA.org   by 11.59 GMT on 25th May 2023 . 

Please check your application and make sure you meet all the essential criteria listed in the person specification. In addition, your application will be stronger if you meet at least some of the desirable criteria.

Due to high volumes of applications received, we can only correspond with short listed applicants. Should you not have received feedback on your application within three weeks of the closing date, please consider your application as unsuccessful.

HEALA will not consider unsolicited candidates from recruitment agencies. We reserve the right to modify or withdraw any of our vacancies at any time.

 

HEALA is an equal opportunities employer. HEALA promotes affirmative action in policies and practices for the hiring, training, retention and promotion of all staff. HEALA will monitor its staff complement against the national Employment Equity statistics. All applicants must be in possession of the appropriate and valid rights to work in South Africa.

 

HEALA collects and processes personal data relating to job applicants as part of their recruitment process.

A healthy economy needs a healthy population.

Posted on by Zukiswa Zimela

A stunted population means a stunted economy. It is a fact that food justice and economic development go hand in hand. The unbelievable cost of healthcare imposed by the upsurge of non-communicable diseases has a detrimental effect on our already struggling economy. And it is about to get worse.  

 According to the Global Obesity Observatory, in 2019, “the economic impact of overweight and obesity was estimated to be US$5.5billion. This is equivalent to US$95 per capita and 1.6% of GDP. Direct costs and indirect costs made up 44.8% and 55.2% of total costs, respectively.” 

 By 2060, the Global Obesity Observer estimates that economics impacts are predicted to increase to US$27.5billion. This is equivalent to US$352 per capita and 2.6% of GDP and represents a five-fold increase in total costs. 

Why we need a healthy economy.

 Reducing morbidity and mortality for all South Africans is an urgent matter that requires an approach that transcends access to health services. Strong decisive public policy is needed to address the broader social determinants of health by designing and implementing interventions that improve people’s health more effectively than individual interventions within the health sector, explains Nzama Mbalati, Programmes Head of the Healthy Living Alliance (HEALA). 

 These include, but are not limited to, raising the Health Promotion Levy, also known as the sugar tax, from 11 percent to 20 percent.  

 The high consumption of unhealthy sugary drinks increases the risk of health conditions such as diabetes, high blood pressure, tooth decay and obesity.  

 “SSB taxes were associated with reduced sugary drink intake in a low-income population within a middle-income country,” found the Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: A before-and-after study. 

Don’t let the industry win

 Instead of kowtowing to the demands of the sugar industry, HEALA is calling for decisive action from government to safeguard the health of the nation. The threat of job losses is a well-known tactic used by the sugar industry to stop government from making much needed decisions to safeguard the wellbeing of the country’s citizens.  

 “There is a deep historical roots of the South African sugar industry and its influence on dietary sugar consumption at the population level. The sugar industry is a prime example of a colonial activity shaping the economy, polity, penetration of sugar content into food products, and diets over an extended historical period. In the modern, and specifically the post-apartheid, period the sugar industry has proved resilient,” Mbalati says.  

 Currently, the South African Sugar Association estimates the local sugar industry to be worth an eyewatering R18 Billion. It is now time for government to put people over industry profits.  

STATEMENT: We can’t rely on food and beverage industry to safeguard our health

Posted on by Zukiswa Zimela

A cursory walk around the supermarket shows that South African shops are inundated with pre-packaged foods that are processed with high levels of added sugars, salt, and saturated fats. South African’s who want to make better health choices are thwarted by incomprehensible and food labels.  Nutrition illiteracy and the availability of these foods is wreaking havoc on the health of South Africans.

More than six out of 10 women above the age of 15 in South Africa are overweight or obese, putting them at risk of developing life-threatening illnesses, shows data from the most recent South African Demographic and Household in 2016. Overall, the World Health Organisation estimates that almost one in three South Africans were obese in 2016. About 13% of children in South Africa are also over weight – more than twice the global average.

Despite there being a strong need for increased nutrition literacy and easy to read labels that warn consumers that some of the food they are eating can be harmful to their health, recent research by PRICELESS SA at the University of Witwatersrand School of Public Health found that there is no evidence that voluntary actions by the food and beverage industry can safeguard public health.

Why government needs to step in

 According to the findings, “[w]hen governments do allow (voluntary actions) VAs and other forms of self-regulation to replace mandatory regulatory interventions, robust monitoring is required to ascertain whether these VAs are effective in improving food environments.

Despite clear, research based evidence that solid financial and regulatory interventions work well to improve food environments by limiting the amount of unhealthy foods flooding the food system, the food and beverage industry has hit back in favour of voluntary actions.

This is why The Healthy Living Alliance (HEALA) is calling for easy to read Front-of-pack labels. “High in” front-of-pack warning labels, which clearly identify products that are high in things like sugar, salt, saturated fat  — what experts call “nutrients of concern” — are the most effective at helping consumers spot unhealthy foods.

“The dominance of these unhealthy products in stores, incomprehensible food labels and aggressive advertising by the food industry undermine the consumers’ ability to choose healthier food options. FOPL will help raise awareness on unhealthy food, make it easy at a glance warning of unhealthy products and impower consumers to make informed decision on food they purchase,” explains Nzama Mbalati HEALA’s Head of Programmes.

At least 10 countries, including Brazil, Mexico and Chile, have already switched to front-of-package labelling or will in coming years. South Africa desperately needs to join this link. HEALA is asking concerned parents, caregivers, and ordinary citizens to join our call to The National Department of Health (NDoH) to open public comment for front-of-pack labels.

For more information, visit www.whatsinmyfood.org.za to get more information on how you can be a part of the cause, or add your voice by sending a WhatsApp to: 079 751 9751.

 Ends –

The Healthy Living Alliance (HEALA) is a coalition advancing food justice in South Africa. 

For interviews contact

Zukiswa Zimela

Communications Manager: HEALA

zzimela@heala.org

0745210652

Treasury chooses special interests over people

Posted on by Zukiswa Zimela

16 May 2022

For interviews, contact:
Nzama Mbalati, HEALA
082 734 5414
Nzama@heala.org

16 May 2022

Treasury’s postponement of a planned 4.5% increase to the health promotion levy, announced in the 2022 Budget, raises concerns about who calls the shots on the country’s national economic and health policy. The increase, initially announced to go into effect 01 April 2022, was a long overdue but welcomed action to curb the high consumption of unhealthy sugary drinks, reducing the risk of health conditions such as diabetes, high blood pressure and obesity. The levy has the additional benefit of generating revenue to support the Budget Review’s stated intent “to extend support to poor and vulnerable South Africans”.

“This delay calls into question the government’s appreciation of our current economic and health crises and looks like an attempt to appease short-term interests at the expense of the long-term health of our nation, says Nzama Mbalati, head of health advocacy organisation HEALA.

South Africa introduced a health promotion levy of 11% on sugary beverages to help curb the country’s sugar consumption fuelling a rise in noncommunicable diseases. The increase would raise the levy from 2.21 cents to 2.31 cents per gram of sugar for sugar-sweetened beverages above the threshold of 4 grams of sugar per 100 ml.

“We know that by reducing the amount of sugar people consume, the levy creates a healthier South Africa, reducing the cost of treating noncommunicable diseases and creating a healthier and more productive workforce, Mbalati explains. But the levy’s benefits are only possible if it keeps pace with inflation, and Treasury hasn’t meaningfully increased the levy since it was introduced in 2018. This delay shows that Treasury has chosen special interests over the health of our country.”

Treasury’s announcement did not explain how or why the government decided to postpone the increase to the current levy, only stating that the 12-month postponement of the increase is proposed to allow consultation on the expansion of the HPL to include fruit juices and lower the 4g threshold of the levy.

“An increase to the existing levy is unrelated to whether the government decides to expand the levy to include fruit juices or lower the sugar threshold. Treasury is deliberately mixing these two issues to appease special interests while at the same time slashing health, education and social support budgets and eroding our socio-economic rights. How long until our government realises that our nation will never meet its economic potential without investment in health and social protection programmes?” says Mbalati.

HEALA is calling for National Treasury to immediately:

  • Stop budget cuts that impactsocioeconomic rights provisions such as health and education;
  • Overturn the proposed postponement and implement the 4.5% increase to the HPL immediately, alongside consultations for expanding the HPL.
  • Indicate whether public commentary on the Revised Draft Rates and Monetary Amounts and Amendment of Revenue Laws Bill can be made and provide a deadline for comments.
  • Explain why a postponement of the increase is now considered an essentialrequirement to enable consultations to expand the levy and reduce the threshold, especially when the announcements made in the 2022 Budget indicated no conflict between the two processes.
  • Release the intended process for consultations, including timeframes andstakeholders, as soon as possible to ensure transparencyand help build public confidence and participation.

HEALA wrote an official letter to National Treasury dated 04 April 2022 to engage on this issue and made several attempts to follow up and secure a meeting with the Department to no avail.  

For media enquiries, contact:
Nzama Mbalati, HEALA
082 734 5414
nzama@heala.org

HEALA: 2022 Division of Revenue Proposals

Posted on by earth

Submission to Standing Committee on Appropriations

1. Background

Introduced in 2018, the Health Promotion Levy (HPL) is a tax designed to precisely target the sugar content added to sugar sweetened beverages (SSBs) beyond acceptable thresholds. This lowers overall sugar consumption via SSBs through incentivising companies towards reformulating their products and affecting a reduction in demand and consumption of such goods by consumers. This levy is essential to enforce industry accountability for public health in the South African context; where excessive and increasing consumption of SSBs, driven by aggressive market behaviour, significantly contributes to our spiralling rates of obesity and diet-related non-communicable-diseases (NCDs) such as type 2 diabetes, cardiovascular diseases, certain cancers and tooth decay.

Despite its relatively short period of existence, and the watered-down rate at which it was introduced, its positive impact on sugar consumption is already evident. By arresting this trend, the longer-term effects will bring a massive saving of lives, as well as billions in healthcare costs and related economic burdens otherwise incurred.

While not the primary goal of the HPL, the additional positive impact is the raising of significant revenue for the state budget. For a struggling healthcare system that is increasingly financially constrained and overburdened, the availability of such funding is invaluable. However, the potential impact of these funds is currently limited by a lack of dedicated and effective oversight as to their use. Within the context of many competing socio-economic needs, policymakers are obligated to prioritise usage of the revenue raised in a manner that can most effectively advance rights to health and wellbeing of the most vulnerable people living in South Africa.

2. Assessment of Current HPL Collections & Usage

Currently, the HPL sets a levy-free threshold of four grams of sugar per 100ml in non-alcoholic SSBs produced or imported for domestic consumption (excluding certain items such as fruit juices and dairy products), levying a fixed rate per gram of sugar that exceeds this. National Treasury commendably raised this rate by 4.5% to 2.31 cents per gram in 2022 – while further consultations may see the welcomed inclusion of fruit juices and reduction of levy-free threshold. In practice, this amounts to a tax of 10% to 11% on the price of 1 litre of the average sugar-sweetened beverage.

From its inception to March 2021, the cumulative revenue raised from both domestically produced and imported SSBs amounts to R7.9 billion. This represents a collection of R3.2 bn, R2.5bn and R2.1bn across financial years 2018/19, 2019/20, and 2020/21 respectively. Declines in revenue collected are potentially expected as producer and consumer behaviour respond positively to the HPL. The impact of COVID-19 on the market also played a significant factor in the decrease over the previous two years. National Treasury estimates annual HPL collections to increase over the coming financial years due to market recovery and growth; increasing up to R2.8bn by 2024/25.

Here, we should note that the compromise with business to reduce the levy rate from the proposed 20% to 11% has meant not only massively restricting its positive impact on public health, but also forfeiting billions in potential revenue.

Nonetheless, even the current rate produces a substantial source of revenue; annually accounting for around 0.2% of the state’s total budget revenue. Yet the ongoing concern is the use thereof.

At present, neither the entirety nor simply a portion of this tax revenue is earmarked for any particular purpose, going instead to the National Revenue Fund for general government expenditure. Treasury’s explanation for this is that “the legislative earmarking of revenue is not supported as it will introduce rigidities in the budgeting process”.5 Rather it can be referred to as being ‘soft ring-fenced’. In this, the government has stated commitment for additional budgetary support for health promotion and chronic disease prevention programmes, as identified by the National Department of Health (NDoH). Presumably supported from this revenue, the 2021 Medium Term Expenditure Framework raised NDoH’s budget allocation for health promotion to around R50 million per annum. By 2021, actual expenditure under health promotion totalled a mere R34 million over 2019/20 and 2020/21.

It is deeply inadequate that from the Health Promotion Levy raising R7.9 billion over 3 years, the very justification for its existence receives such a miniscule budget allocation; which is then underspent at that. Meanwhile, the entire health budget faces cuts of over R50 billion in real terms over the next 3 years. This needs to be changed.

3. A More Comprehensive Approach to Health Promotion

Restructuring how the tax revenue from the HPL is allocated and spent, whether partially or entirely, is a necessary, beneficial and strategic consideration. The presence of unallocated funding in the National Revenue Fund may be seen as desirable for potential rainy days or administrative ease. Yet policymakers are obligated to weigh this choice against tangible alternatives to evaluate which route, or what compromise between them, best protects South Africans’ Constitutional rights while prioritising the most vulnerable.

South Africa struggles with a double burden of malnutrition – especially seen in children. The reality is that 1 in 4 children (27%) are stunted (chronically malnourished) which is coupled with an increasing child and adolescent overweight and obesity – all increasing the growing burden of NCDs. The need to intervene early is vital. The first 1000 days from conception to two years old is a critical time to address immediate undernutrition and consequent overweight or obesity later in life. Although this time is vital for long term results, addressing the current issue of childhood hunger must be prioritized. Positive results of good nutrition during early childhood may be reversed by poor nutrition
during adolescence. The reality is that 30% of South African children live in households living below the food poverty line – where adequate nutrition needed for optimum growth and development is out of their reach.7 The NIDS-CRAM reports, found that during the pandemic child hunger had risen to 14% (1 in 7 people indicated a child in their household had gone hungry in the prior week) and that 400 000 children lived in households that experience perpetual hunger (hunger every day or almost every day) during each of the waves.

The need to invest in food and nutrition security initiatives in South Africa that can protect children from both under and over nutrition is pertinent to creating a thriving population that can reach their physical, mental and economic potential. This can be done through increasing funding of existing interventions such as the National School Nutrition Programme (NSNP) to expand the programme and provide more meals to school learners and expanding existing social protection measures.

These alternatives should be identified by their alignment with the holistic intent of the HPL, and furtherance of its goals. This entails not only support for the NDoH’s health promotion programme, but other high impact areas that can contribute to decreasing the burden of obesity and diet related NCDs. Effectively, by linking the majority expenditure of HPL collections from the goals of the HPL itself, we are creating a far more comprehensive policy that can more directly funnel resources from unhealthy economic and behavioural activities into opposingly healthier ones for much greater overall impact. This strengthens the HPL into a far more impactful policy with greater measurable benefits. An inevitable result of this is the deepening of public trust in and support for the HPL and policy-makers’ intentions behind it; an invaluable resource in the event of widening or raising the HPL.

4. Potential Strategies for Utilisation

Proactive dedication of the levy’s revenue offers many benefits, but how and where. Our key proposals are as follows:

Proposed Strategies:

  • Increasing support for NSNP
  • Supporting nutrition of children in the critical first 1000 days: Maternity Grant
  • Improving nutrition in households: Basic Income Support
4.1 Increasing Support for the National School Nutrition Programme (NSNP)

The National School Nutrition Programme (NSNP) is a lifesaving feeding scheme that benefits over 9 million learners aged four and above every day. The programme’s objectives include providing all learners one nutritious meal to enhance learning, strengthening nutrition education in schools to promote healthy lifestyles with the use of food production initiatives (school gardens). This programme allows learners to realise their constitutional rights to basic nutrition (Section 28(1)(c)) and basic education (Section 29(1)(a)) and aims to improve their ability to learn through reducing hunger, combating malnutrition and improving school attendance. The NSNP is an effective poverty alleviation intervention, reaching some of the most vulnerable children in South Africa by targeting schools in the socio-economic quintiles one, two and three or the “no fee-paying schools”).

The NSNP is guided by a conditional grant framework (CGF) with specific budget allocations according to the following, at least 96% of the budget should be spent on school feeding and purchasing cooking, education including deworming should be a minimum of 0.5%and administration a maximum of 3.5%.

Although the NSNP can improve punctuality, school attendance, mental concentration, and learners’ general well-being – it has fallen short in implementation. In 2017, the Legal Resources Centre compiled an analysis of the NSNP in the Eastern Cape. The daily nutritious meal should provide 30% of the recommended daily allowance (RDA) of energy; however, the report found that the meals served only provided 16% of the RDAs – equivalent to a snack rather than a meal. The Department of Education (DOE) evaluation of the implementation of the NSNP in 2016 found that only half of the schools received balanced meals including three food groups (starch, protein, and vegetables) and 42.4% of schools only served two food groups, often omitting vegetables.

Schools argue that they cannot meet the NSNP’s nutrition requirements without sufficient funding, while most Provincial DBEs have underspent on their budgets for the NSNP implementation. In order to be a more effective program and meet the nutritional needs of many vulnerable children, the NSNP should be expanded to also include breakfast. Evidence shows that breakfast has positive benefits for children’s academic performance and attention in school. Using the funds from the HPL to strengthen and expand this existing national intervention could be an effective way to address child hunger.

Providing nutritious meals to learners contributes to the children’s health in the long term. Effectively decreasing socio-economic impacts of poor childhood nutrition such as non communicable diseases. Thus, decreasing the burden on the state’s public health burden. Consequently, investing in childhood nutrition also provides financial benefit to the state in the long term.

4.2 Supporting nutrition in the critical first 1000 days (Maternity Support Grant)

Intervening in a child’s nutrition in the first 1000 days can have positive lifelong results. Stunting arises from chronic malnutrition in pregnancy and the early years of life and impairs the physical and cognitive development of young children. Stunting from macro and micronutrient deficiencies in pregnancy and the early years of life casts a long shadow on children’s health, education and employment prospects across their life course. Improving the wellbeing and nutritional status of pregnant women during this critical period when the growth of the developing foetus is wholly dependent on the nutritional status of the mother, would go a long way towards shifting the needle on stunting in South Africa. At present however, pregnancy poses significant health, social and economic challenges for women. Many women working in the informal sector (which is where the majority of poor women work) have to give up paid work during pregnancy, while incurring additional costs related to the increased volume and variety of food they need to consume to support pregnancy, travel costs for healthcare and costs of a new child. Local surveys find that as many as forty percent of pregnant women report going to bed hungry, 15% of babies are born with low birth weight and 40% of poor children do not access the child support grant in the first year of life. Extending the Child Support Grant into pregnancy, in the form of a Maternal Support Grant, would help ensure that poor and vulnerable pregnant women have access to much needed income support to enable attendance of antenatal check-ups, healthy nutrition and improved mental health. In addition, enabling uptake of income support during pregnancy would support seamless transition to the Child Support Grant once the baby is born and mitigate against the access barriers to the Child Support Grant many poor and vulnerable women face immediately after their baby is born.

The idea of a Maternal Support Grant is not a new one. Different types of pregnancy support are available in many other countries. Maternity and early childhood support is presently provided in over 30 countries. Such support has also been discussed for at least a decade in South Africa.

An investment case on the MSG estimates that extending the CSG into pregnancy will cost a maximum of R2, 227 million at current CSG levels. This constitutes only 1,2% of the total grant budget. Considering that economic models suggest that stunting places a penalty of 9% of GDP per capita on African and Asian, the return on investing in extending the CSG into pregnancy and reducing SA’s high stunting prevalence, would far outweigh the costs.

4.3 Improving nutrition in households: Basic Income Support

Globally, Social safety net programmes that provide sufficient levels of cash transfers over long periods can be effective in breaking the intergenerational cycle of poverty, improving the living standards of the poor, reducing food insecurity, and can improve undernutrition outcomes. These programs have the potential to reach millions of people that can spend the money given on nutritious food and have better access to health care including nutritional and health education. In turn, social support can help reduce the risk of childhood undernutrition, obesity, and non-communicable diseases (NCDs).

Poverty, inequality and unemployment are not mere challenges, they are the most profound crisis confronting democratic South Africa. These are all drivers for the double burden of malnutrition we see in children. Households struggle to afford nutritious food, leaving their children and members hungry. Social grants are vital in mitigating the effects of poverty for households and children.

The South African government needs to create a society of greater equality by strengthening the social protection system. One that will guarantee sufficient nutrition for all families and provide access to quality healthcare and education. Cash grants reduced hunger and malnutrition and improved food sufficiency. The evaluations of Basic Income Support a Case for South Africa showed that grant recipients were significantly more likely to have enough income for their daily food needs than those in the control group. The grants also led to more varied diets, with greater relative consumption of fruit and vegetables. The number of households that reported that their income was sufficient for their food needs increased from about 50% in the baseline to about 78% and a further 82%. Lastly, income grants were associated with an improvement in children’s weight-for-age, with the most considerable effect being among young girls.

During the pandemic – Although the R350 was not enough to make households and beneficiaries food secure, those who did not receive it, and those who received it late, experienced hunger and food insecurity more frequently (Black Sash Social protection in a time of COVID Lesson for Basic Income Support). The Department of Social Development has acknowledged that the COVID-19 SRD grant was primarily used to buy food.

The implementation of a Basic Income Support (BIS) in South Africa is feasible, affordable, would contribute to economic growth and job creation, and similar to social grants. The BIS would ensure many households in the country have improved food security, health and educational outcomes, resulting in long-term impact on poverty reduction.

The Black Sash and HEALA demand that the government implement a permanent Basic Income Support for those aged 18 to 59 years who have no or little income that meets the upper-bound poverty line (R1335 per month). Unemployed Caregivers who receive the CSG must also qualify. Although the extension of the COVID-19 Social Relief of Distress (SRD) grant is welcomed, it must be increased to at least the Food Poverty Line (R624) until social assistance for the unemployed is made permanent.

5. Way Forward

If we are to improve the health of all South Africans – we need to start with helping our children thrive into their best potential. As there are limited funds it is not a possibility to embrace new programmes however there are existing effective programmes that reach millions of hungry children everyday such as the NSNP and child support grant. In order to address the food and nutrition insecurity that our children experience we must prioritise; including breakfast in the NSNP more children will reach their daily nutritional needs, addressing the intergenerational transfer of malnutrition through the expansion of the child support grant into pregnancy & acknowledging that households that include vulnerable children and women need additional resources through basic income support.

6. Recommendations

By directly confronting excess sugar consumption, the Health Promotion Levy currently serves as one key preventative policy against rampant health conditions such as obesity, type 2 diabetes and other diet related NCDs. Its ability to create effective impact is already evident despite its constraints. Yet without strengthening the levy, along with introducing additional measures, South Africa is unlikely to resist its current trajectory towards increasingly catastrophic loss of life and crippling economic costs.

To do so, requires not only raising the levy and widening its scope, but finding ways to maximise the use of funds it raises to protect and enhance South Africans’ rights to health, nutritious food and a decent quality of life. To this end, we propose that:

  • Usage of HPL tax revenue as general revenue must be reprioritised via earmarking the entirety or majority thereof towards projects in line with the HPL’s vision.
  • Regulate and subsidise daily staple and healthy foods and reduce food prices.
  • Key projects to be considered for this should include:
    • Increasing support for NSNP
    • Supporting nutrition of children in the critical first 1000 days: Maternity Grant
    • Improving nutrition in households: Basic Income Support
7. About HEALA

HEALA is a coalition of civil society organisations that advocate for equitable access to affordable, nutritious food in South Africa by building a more just food system.

For further information contact:

HEALA: Nzama Mbalati
Email: Nzama@heala.org
Cell phone: 082 734 5414

Rural Health Advocacy Project: Nathan Taylor
Email: NTaylor@rhap.org
Cell phone: 082 406 1208

Grow Great: Dr Kopano Matlwa Mabaso
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South African Council of Churches: Reverend Parkson Mohlala
Email: lechipishaparksonm@gmail.com
Cell phone: 082 547 6434

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Email: pdlamini@vitaminangels.org
Cell phone: 079 806 5406

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Stacey, N., Edoka, I., Hofman, K., Swart, E. C., Popkin, B., & Ng, S. W. (2021). Changes in beverage purchases following the announcement and implementation of South Africa’s Health Promotion Levy: an observational study. The Lancet Planetary Health, 5(4), e200-e208.

Manyema M, Veerman LJ, Tugendhaft A, Labadarios D, Hofman KJ. Modelling the potential impact of a sugar sweetened beverage tax on stroke mortality, costs and health-adjusted life years in South Africa. BMC Public Health 2016;16(1):405

Question to the Minister of Finance Standing Committee – NW1300 | PMG

Budget Review 2021

Final Response Document on the 2017 Rates and Monetary Amounts and Amendment of Revenue Laws Bill – Health Promotion Levy

Kristie L. Watkins, Donald A. P. Bundy, Dean T. Jamison, Günther Fink, and Andreas Georgiadis “Evidence of Impact of Interventions on Health and Development during Middle Childhood and School Age”, pages 99 – 106

South African Child Gauge 2020: Food and nutrition security

NIDs CRAM Wave 5: Synthesis Report

National School Nutrition Programme – SECTION27

Hazell E. Report on the Implementation Evaluation of the National School Nutrition Programme. Pretoria: JET Education Services. 2016

National Treasury, (2015), Frameworks for conditional grants to provinces. Government Gazette, 38869, 12 June 2014: Part 2: 126-127
Bulman A. Realising Every Child’s Right to Nutrition: An analysis of the National School Nutrition Programme in the Eastern Cape. Grahamstown: Legal Resource Centre. 2017.

Hazell E. Report on the Implementation Evaluation of the National School Nutrition Programme. Pretoria: JET Education Services. 2016

Hazell E. Report on the Implementation Evaluation of the National School Nutrition Programme. Pretoria: JET Education Services. 2016

The effects of breakfast on behavior and academic performance in children and adolescents

Basic Income Support. 2020. Black Sash.

Fact Sheet: Evidence to support increasing South Africa’s Health Promotion Levy (HPL) to 20% in 2021

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South Africa implemented its Health Promotion Levy, or HPL, in April of 2018. The HPL is a sugar-sweetened beverage (SSB) tax of approximately 11%, based on sugar content. Initial research on the price impact of the HPL has shown prices increased commensurate with the tax for taxed beverages but did not change for non-taxable beverages and reduced consumption.

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