Dr Renay Weiner, Public Health Medicine Specialist and Director Research and Training for Health and Development, Johannesburg South Africa 

With the extension of the State of National Disaster and plans to avert fatalities from COVID‑19 over the coming months, a continued social response remains key. While economic activity has resumed, with the closure of many small businesses, jobs losses are increasing resulting in pressure on household resources. The reality of food insecurity and threat of malnutrition is likely to remain, now and in the future. Already high levels of childhood stunting in South Africa could rise further if interventions are not put in place urgently.  Stunting is associated with greater infection risk and impacts negatively on children’s brain development, limiting their ability to fulfil their potential. Diminishing incomes forces households to stretch limited resources, which often means buying relatively cheaper starches rather than more nutritious options.  Food parcel distribution by government and civil society sector has helped alleviate the crisis during the past four months, but we urgently need fresh approaches that are efficient and sustainable. One solution that holds promise is digital food vouchers as has been demonstrated by the DGMT/Grow Great pilot. This approach is simple, efficient and limits the risks and costs associated with food parcel This approach is simple, efficient and limits the risks and costs associated with food parcel distribution while simultaneously leveraging  the widespread mobile phone coverage. Notable features are that vouchers are redeemable at local Spaza shops and  general dealers, which minimizes transport costs while promoting local economies, and linked to information about  healthy food buys. Also, beneficiaries —those most vulnerable— are identified by trusted local NGOs.  Vouchers are mostly sent directly to  beneficiary cell phones though paper vouchers are also available. Key target groups for scaling up such an intervention are  pregnant or post-natal women who could be  identified  by existing networks such as ante/post-natal clinics, Grow Great Flourish groups and/or potentially through the National Department of Health’s MomConnect mHealth programme which registers some 63% of pregnant women attending their first ante-natal visit at government clinics to receive pregnancy related health information. In addition, households with children under five could be identified for receipt of vouchers that could come with a nutrition message for caregivers such as a reminder to take their child for growth monitoring. As we look toward a healthier society, creative ways are needed to increase and sustain food security. Digital vouchers appear to be practical and effective, and could form part of existing social protection mechanisms such as a component (or add on ) of existing social grants, COVID‑19 grant and/or the proposed pregnancy grant to ensure that funds are used to purchase food.  

† Barron P, Peter J, LeFevre AE, et al. Mobile health messaging service and helpdesk for South African mothers (MomConnect):history, successes and challenges. BMJ Glob Health 2018;3:e000559. doi:10.1136/bmjgh-2017-000559

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