Objectives
This paper assesses micronutrient policy processes in Zambia, contrasting with parallel studies in Malawi and South Africa. The analysis concentrates on Vitamin A policy, and comparisons are drawn with iron and iodine.
Methods
The Kaleidoscope Model of policy change traces causal forces leading to key micronutrient policy decisions in each country. To complement a review of literature and of Zambian policies, interviews were conducted with policy stakeholders. These data permitted assessment of several Kaleidoscope hypotheses about factors driving change in policy agenda setting, design, decision making, implementation and monitoring.
Results
Zambia’s vitamin A policy encompasses supplementation and fortification initiatives. To get micronutrient policies onto Zambia’s agenda required effective advocates armed with strong evidence and, frequently, a focusing event to gain attention. At the design stage, Zambia’s policies drew on existing global best-practice, adjusted somewhat to context. Decision-making outcomes revolved around the relative power of policy actors, particularly donors as proponents; private sector and political interests vetoed the fortification of maize, the key food security crop, but the sugar industry embraced vitamin A fortification as a means of limiting import competition and sustaining higher domestic prices. Policy reform has occurred regularly in Zambia, driven primarily by changing conditions and by empirical information about these changes.
Conclusions
Zambia both mirrors and contrasts with its neighbors, Malawi (which agreed, against industry opposition, to fortify sugar, but 17 years later than Zambia) and South Africa (which refused to fortify sugar and instead fortified maize). This work starts to explore reasons for the differing policy decisions and outcomes.
