Policy options to transform food systems for affordable and healthy diets in South Africa: a systematic review with stakeholder prioritization.

INTRODUCTION: South Africa's food system is struggling to deliver nutritious, affordable diets, leaving many people unable to access healthy food. Furthermore, the country lacks a comprehensive food system policy, relying instead on policies that address specific components of food security. This study investigated cost-effective, feasible, and adaptable policy options to transform South Africa's food system towards affordable, healthy diets. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scopus, PubMed, Web of Science, and other sources were searched for English-language publications from 2013 to 2023. Of the 340 records identified, 20 food systems transformation reports met the eligibility criteria, with 70% focusing on global contexts and 30% on Africa. The identified prioritised policy options were subsequently validated through an online survey of food system stakeholders. RESULTS: Agricultural policy options were prioritised most frequently (25%), followed by supply chain and governance interventions (20% each), regulatory measures (15%), and education and awareness interventions (10%). Financial, research, technology, and innovation policy options were least prioritised (5% each). Overall, 20 prioritised policy options were identified. The findings indicate that no single policy option is sufficient to improve the affordability of nutritious diets in South Africa. Instead, a coordinated package of complementary interventions across agriculture, governance, supply chains, regulation, finance, education, and research and innovation is required. CONCLUSION: These prioritised policy options provide policymakers with an evidence-informed framework for identifying and prioritising interventions that can support healthier diets and contribute to the transformation of South Africa's food systems.