CAPE TOWN: In a race against the clock to eradicate childhood stunting by 2030, the Presidency has kickstarted an interdepartmental task team that anti-hunger advocates hope will break down silos of fragmented operations within government.
South Africa has one of the highest stunting rates in the world, which the task team puts at 28.8% for children under five – above the global average. This means almost one in three young children is affected by chronic undernutrition.
Stunting has significant consequences as it affects children’s cognitive development, learning ability and impacts their later lives in terms of work and productivity.
Experts say children must get sufficient nutrients in the early phase of life, which is the critical phase of development.
Delivering his State of the Nation Address in February, President Cyril Ramaphosa announced that the government was planning to eradicate child stunting by 2030. He characterised stunting as “a massive crisis” that demands attention and resources, saying allocations for what needs to be done would be set out in the Medium-Term Budget Policy Statement (MTBPS) later this year.
Following up on his pledge, Ramaphosa established the special task team chaired by Saul Musker, the Presidency’s head of strategy and delivery support.
In an interview, Musker acknowledged that 2030 is an ambitious target, but “we think it is achievable”.
Saul Musker, head of strategy and delivery support in the Presidency, is chairing the task team developing the government’s plan to eradicate child stunting by 2030.
To reach its goal, the team is developing a detailed, funded action plan cutting across multiple departments. The team hopes to finalise the action plan by September for adoption by the Cabinet before a budget allocation in the MTBPS.
According to Musker, one of the reasons it is difficult to address child stunting is its many different causes. These include undernourished pregnant women who have a higher chance of a low birthweight baby, which impacts stunting. There is also alcohol use during pregnancy and Foetal Alcohol Syndrome, which is a significant problem in South Africa and is also connected to stunting. Lack of access to nutritious protein-rich foods is another major problem.
Among its focus areas, the task team is considering a Maternal Support Grant which would extend the current child support grant into pregnancy from the second trimester.
“It is critical that we make sure children get the nutrients they need in the very early phases – during the first 1000 days, which is the critical phase of cognitive development, so that they can thrive later in life,” said Musker.
“If we are able to address this challenge, then we would also reduce the burden on the education and health systems, which at the moment have to shoulder that burden. That is the scale of the challenge.”
Proposals for a maternal grant are not new but the issue has remained on the back burner of policy change.
Musker’s task team is also engaging the Western Cape government, which is running a pilot project called Khulisa Care, which started in July 2025 and in which undernourished pregnant women and mothers of low-birth-weight babies receive a monthly R525 voucher for protein-rich foods that support foetal brain development. The first results are expected later this year.
The team is also looking at augmenting supplements for pregnant women, who currently receive iron and folate, by introducing multiple micronutrients. “This needs to be considered at a technical level through the department of health’s processes, but it is an option on the table.”
Expanding access to nutritious food during the first two years of a child’s life is another focus area. In this regard, Musker said they were also looking at “food fortification,” which would include vital vitamins and minerals.
Routine height measurements help healthcare workers monitor children’s growth and development. This is an illustrative image and does not depict a child diagnosed with stunting. Photo: Wikimedia
According to Dr David Harrison, CEO of the DG Murray Trust, which advocates for child nutrition, the establishment of the interdepartmental task team headed by the Presidency is “an absolutely critical breakthrough”.
“Part of the reason we have not made progress on stunting and on issues of nutrition in South Africa is that nutrition is every department’s responsibility, but nobody’s responsibility. It’s an issue that falls between the cracks, precisely because so many departments have responsibility for components of it,” said Harrison.
He said the responsibility for stunting has previously been relegated to fairly junior officials in government departments. Many were committed, but they lacked the authority to influence their own departments, let alone the ability to convene an across-government engagement needed to drive progress.
“So, centralising it in (the Presidency) provides clear leadership and a mechanism to be able to honestly collect the methods of the departments, but also to enable them to understand that what they’re doing is not sufficient.”
Highlighting the critical importance of the first 1,000 days – which includes nine months of pregnancy – Harrison said the “lifelong potential of a child is really concentrated or crammed” into this period.
“That is not to say the rest is unimportant. It sort of sets the rate of return for any further investments in a child. It’s an incredibly powerful and important phase of life and that’s why it’s important that we get it right.”
“If we don’t, children are exposed to a vicious set of dominoes; moms don’t have enough nutrition, they’re exposed to alcohol during pregnancy, exposed to HIV during pregnancy that’s untreated by ARVs or lack of food and exposed to dirty water and poor sanitation – all of these are cumulative insults; each of them is like a domino knocking down the next.
“We’ve got to move away from these vicious dominoes, to a virtuous domino whereby putting all of these positive things in place, we create a positive chain reaction,” he said.
Harrison drew on studies in India that found that stunted children have an IQ deficit of about four to five points on average, compared to non-stunted children.
“What happens is even from birth, those children are not able to respond to parents’ stimulation or engagement with them. They’re already starting off on the lower path. Even if they get to an early learning programme, their ability to benefit from the programme is limited.”
If we are able to address this challenge, then we would also reduce the burden on the education and health systems, which at the moment have to shoulder that burden. That is the scale of the challenge.
While there is catch-up growth and development, it’s harder for these children to learn. “They are the children that are more likely not to be able to read for meaning … drop out of school and ultimately are not going to be able to get jobs.”
Harrison also emphasised the role of the private sector as the producer, distributor, and seller of food. Civil society also plays a critical role by working with local communities on local food production and linking community efforts to agricultural extension offices.
Harrison’s observations coincided with the publication of a global report by the Food and Agriculture Organisation (FAO) on food and nutrition security, which reiterated the need to focus on affordability of nutrient-dense foods. The highest-cost foods are those that are particularly protein-rich with required nutrients.
Basic Education Minister Siviwe Gwarube’s spokesperson Lukhanyo Vangqa pointed out that the department spends over R10 billion a year on the National School Nutrition Programme to provide 9.7 million meals per day. The programme starts in primary school when children turn six. For ECDs, the department is providing a subsidy of R24 per child per day to qualifying centres, which includes at least one meal a day. “The DBE is now piloting an ECD nutrition programme in the Eastern Cape; the view is to roll this out to all ECD centres in the country,” he said.
He quoted a Thrive by Five index statistic that 7% of children enrolled in Early Childhood Development (ECD) centres in South Africa are affected by stunting.
“The minister has maintained that child stunting is a blight on our collective consciousness,” he said.
