Benchmarking public policies to create healthy food environments to prevent the double burden of malnutrition in West African countries using the Healthy Food Environment Policy Index: a cross-country study

Background West Africa is faced with all forms of malnutrition and there is an urgent need to address this public health issue through strengthening food environment policies. Objective This study conducted a regional comparison on the level of implementation of policies aimed at creating healthy food environments in five countries in West Africa Method The INFORMAS healthy food environment policy index (Food-EPI) was adapted to take into account the double burden of malnutrition (12 indicators added), and used to assess the level of food environment policy and infrastructure support implementation in Senegal (2017–2019), and in Togo, Burkina Faso, Benin and Ivory Coast (2020–2023). Evidence on the implementation of 47 or 59 good practice indicators of Food-EPI was compiled in each country and validated by government actors. Subsequently, in each country, a series of workshops with a panel of national experts were conducted to evaluate public policies, identify and prioritize actions recommended to governments to create healthy and sustainable food environments. Based on this process, our study compared the process and results. Results Countries obtained a higher level of implementation of food environment policies linked to the 12 new indicators of double burden unlike the indicators of the original Food-EPI (n = 47) which were focused mostly on obesity and NCD prevention. Burkina Faso and Ivory Coast obtained the highest number of indicators at a "medium" level of implementation; 42.8% (n = 24/56) and 38.9% (n = 23/59) respectively, while Senegal, Togo and Benin obtained the highest proportion of indicators judged at “low or very low” level of implementation. Policies relating to food promotion, food retail and health in all policies were identified as the main gaps in all five countries. Across the five countries, stakeholders recommended common actions, such as the implementation of an integrated school feeding policy and regulating of the marketing of unhealthy foods to children and adolescents. Conclusions In addition to mobilizing national stakeholders and strengthening their capacities, the study demonstrated that countries political priorities focused more on undernutrition, while overnutrition continued to increase in these countries. In this way, it’s crucial to establish a regional agenda of priority actions focus on strengthening existing policies and addressing gaps to reduce malnutrition in all its form in West Africa.