Using urban food system governance to drive healthy food procurement for cities in low- and middle-income countries: Case studies on Addis Ababa Students Feeding Agency and Pune Sassoon General Hospital Meal Programme

This project provides recommendations for how the Global Alliance for Improved Nutrition (GAIN) can assist urban governments and stakeholders to implement institutional healthy food procurement in low- and middle-income countries (LMIC). Public food procurement refers to when governments purchase and provide food to defined populations. Institutional food procurement refers to food purchasing and provision by organizations like schools, hospitals, care homes, youth clubs, prisons, and workplaces. Urban governments often manage public food procurement at these institutions, serving food to students, patients, employees, and their families. Institutional food provision can benefit an individual’s experience at that institution while improving their health and nutritional status. For instance, a student’s nutrition status affects school performance. A hospital patient’s food access may affect their recovery. Healthy food procurement refers to designing food procurement to prioritize the purchase and provision of nutritious food. Since food procurement programmes serve a high volume of people, healthy food procurement represents an opportunity for institutions to promote nutrition, whilst also reshaping the broader food system to be healthier and more sustainable. Many countries face the double burden of malnutrition, with high rates of undernourishment and obesity, especially in urban areas. Urban policymakers are increasingly recognizing institutional healthy food procurement as an opportunity to address malnutrition. However, there is a need to share more experiences and best practices on healthy food procurement among urban stakeholders in LMIC. This report presents a synthesis of literature analysis and key stakeholder interviews on urban public food procurement. This report discusses:

1. Why urban public food procurement is an important tool to improve food and nutrition security

2. A proposed implementation framework / menu of actions for healthy food procurement, with key themes on design and implementation of healthy food procurement policies taken from literature analysis and interviews on successful examples such as New York City and Brazil

3. Two urban public food procurement case studies to explore enabling factors and barriers for healthy food procurement: A city government-led school feeding programme in Addis Ababa, Ethiopia and a hospital feeding programme at Sassoon General Hospital in Pune, India. This section discusses the two case studies through the lens of the proposed implementation framework. These two case studies were selected because they demonstrate success stories in LMIC and illustrate key policy considerations around healthy food procurement.

Key Messages

1. GAIN can support urban healthy food procurement with a nutrition-sensitive approach.

2. Best practices in healthy food procurement include dedicated food procurement governance, use of dietary guidelines in menu-planning, universal coverage and inclusivity, and private sector participation.

3. Invest in institutional food safety; water, sanitation, and hygiene (WASH); and cold chain infrastructure for fresh foods.

4. Create political buy-in for healthy food procurement by highlighting win-win opportunities from perspectives of “customers” and non-nutrition sectors.