Description of included studies

In total, thirty-three studies were included in this review (Fig. 2) in nine of the forty-six SSA countries (Fig. 3). Most studies were conducted in either South Africa (n 10) or Ghana (n 9), followed by Ethiopia (n 4), Namibia (n 4) and Zambia (n 2). Only one study was identified in each of Botswana, Kenya, Nigeria and Tanzania. All nine countries reported having national SMP. Most studies focused on primary schools (n 27), while four studies^{(Reference Abizari, Ali and Abdulai29–Reference Rector, Afifa and Gupta32)} included secondary schools, and three studies^{(Reference Fernandes, Folson and Aurino33–Reference Rendall-Mkosi, Wenhold and Sibanda35)} included both. The thirty-three studies comprised eighteen journal articles, ten master-level theses, three international reports, two doctoral theses and one working paper. Excluded studies at the data extraction stage are available (see online supplementary material, Supplemental Material 3).

Fig. 2

PRISMA diagram detailing the screening process

Fig. 3

Map showing the distribution of research of publicly procured school meals programmes and nutritional outcomes in sub-Saharan Africa

Seven studies elucidated the first research objective: to synthesise the evidence of the impact of publicly procured SMP on nutritional outcomes and school food environments of children/adolescents (5–18 years) in SSA (Table 1). All seven studies used quantitative methods, including two randomised control trials^{(Reference Gelli, Aurino and Folson36,Reference van der Hoeven, Faber and Osei37)} , two longitudinal cohorts with multiple points of cross-sectional data collection^{(Reference Desalegn, Gebremedhin and Stoecker38,Reference Oyela, Ogunfowokan and Olodu39)} , two single collect cross-sectional studies^{(Reference Abizari, Ali and Abdulai29,Reference Faber, Laurie and Maduna40)} and one non-randomised trial^{(Reference Neervoort, von Rosenstiel and Bongers41)}, spanning Ethiopia, Ghana, Kenya, Nigeria and South Africa.

Table 1

Characteristics of studies assessing the impact of procured school meals programmes (SMP) on nutritional outcomes

BAZ, BMI-for-age Z-score; Hb, Haemoglobin; HAZ, height-for-age Z-score; RCT, randomised controlled trial; SMP, School Meal Programme.

* WHO standards used.

Twenty-six studies, using qualitative methods, shed light on the second research objective to identify challenges and facilitators to implementing effective procurement in SMP in SSA (Table 2). These studies were conducted in seven countries: Botswana, Ethiopia, Ghana, Namibia, South Africa, Tanzania and Zambia. There was some overlap between challenges and facilitators and was often context dependent (Table 3).

Table 2

Characteristics of studies identifying challenges and facilitators of school meal programme implementation

*PhD thesis; †master’s thesis.

Table 3

Challenges and facilitators to implementing publicly procured school meal programmes (SMP)

Included studies varied in quality, with quantitative studies scoring Green = 1^{(Reference Gelli, Aurino and Folson36)}, Amber = 4^{(Reference Abizari, Ali and Abdulai29,Reference van der Hoeven, Faber and Osei37–Reference Oyela, Ogunfowokan and Olodu39)} and Red = 2^{(Reference Faber, Laurie and Maduna40,Reference Neervoort, von Rosenstiel and Bongers41)} , warranting careful interpretation and extrapolation of study findings. Qualitative studies mostly used acceptable/good methodological and research practices (Green = 7^{(Reference Moepeng23,Reference Daitai, Tshifhumulo and Mukwevho30,Reference Mafugu31,Reference Banda42–Reference Molotja45)} , Amber = 15^{(Reference Rector, Afifa and Gupta32–Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Darko46–Reference Yendaw and Dayour56)} , Red = 4^{(Reference Ellis57–Reference Zenebe, Gebremedhin and Henry60)} (see online supplementary material, Supplemental Material 4).

The impact of procured school meals programmes on nutritional outcomes

Overall, the results are mixed with some evidence of positive impact of publicly funded SMP on nutritional outcomes (Table 1). Subgroup analysis by gender, geography, age, socio-economic status and family composition also produced mixed results for micronutrient status, anthropometric status and dietary outcomes. Only one study reported an impact of SMP on diet and the school food environment, respectively.

Challenges, facilitators and authors’ recommended solutions for implementing public food procurement policies in sub-Saharan Africa schools

Facilitators were reported in twenty-three studies across the steps: production of food (n 2), wholesale and trading (n 9), transportation and storage (n 2), processing and distribution (n 11), food preparation (n 9), distribution to students (n 5), student stakeholders (n 13), community involvement (n 10) and infrastructure support (n 3) (Table 3; illustrative quotes available in online supplementary material, Supplemental Material 5). Barriers were reported in twenty-six studies in each step: production of food (n 3), wholesale and trading (n 13), transportation and storage (n 13), processing and distribution (n 12), food preparation (n 17), distribution to students (n 20), student stakeholders (n 11), community involvement (n 11) and infrastructure support (n 15). Recommendations from authors of included studies were made for policy action: production of food (n 5), wholesale and trading (n 9), transportation and storage (n 5), processing and distribution (n 2), food preparation (n 15), distribution to students (n 7), student stakeholders (n 9), community involvement (n 8) and infrastructure support (n 25). Facilitators, barriers and authors’ recommended solutions (Table 4) are reported for each step of the school food system framework.

Table 4

Author policy-focused recommendations on implementing publicly procured school meal programmes (SMP)

Production of food

Switching SMP from centrally sourced to domestically grown crops was a challenge for countries, like Namibia, where imported food makes up the majority of available food^{(Reference Ellis57)}. Promoting local procurement in Botswana sought to create more reliable market access for farmers^{(Reference Mensah and Karriem34)} increasing economic activity and sometimes crop diversification^{(Reference Moepeng23)}. However, government budgets for local production were low, and only individual farmers (not farmer groups) could apply for contracts, making it difficult to supply sufficient quantities of crops that met set quality standards^{(Reference Moepeng23)}.

Authors’ recommended solutions include creating links with farmers to promote more local and sustainable procurement approaches^{(Reference Moepeng23,Reference Faber, Laurie and Maduna40,Reference Desalegn, Gebremedhin and Stoecker43,Reference Darko46,Reference Fernandes, Galloway and Gelli48,Reference Sichala54)} . Examples include supporting local agriculture production of micronutrient rich vegetables and incorporating them in meals served^{(Reference Desalegn, Gebremedhin and Stoecker43)} and including tools, such as ‘The School Meals Planner Package’ in Ghana, to include local produce in weekly menus^{(Reference Fernandes, Galloway and Gelli48)}.

Wholesale and trading

In terms of wholesale and trading, no consensus on best type of procurement model was reached. Centralised procurement was challenging when the food supply was disrupted, as it impacted the entire programme^{(Reference Banda42)}. However, moving away from centralised to decentralised procurement was also cited as a challenge^{(Reference Khama49,Reference Langsford50)} . For example, including or increasing the percentage of locally procured food for SMP was difficult, particularly due to the seasonality, quality or scale of local production, especially in non-agricultural regions^{(Reference Moepeng23,Reference Daitai, Tshifhumulo and Mukwevho30,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Molotja45,Reference Ellis57)} . Alternatively, non-local procurement was problematic as it failed to support the local economy, with school menus composed of non-traditional and international foods such as tinned fish and soya.

Depending on the context, some sources reported that centralised procurement was a SMP facilitator, as the directives of the overall programme came from one source, facilitating programme management, purchasing, implementation and reporting^{(Reference Moepeng23)}. Competitive market prices, offered to those buying large quantities, often reduced financial burden of schools, thus ensuring equal access to food, even among remote schools^{(Reference Moepeng23,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Molotja45)} . Other sources reported the advantages of decentralised procurement models, which allowed schools to have more flexible procurement criteria. Decentralised models allowed SMP to set budgets in advance, which helped reduce corruption^{(Reference Rector, Afifa and Gupta32,Reference Mensah and Karriem34,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Langsford50)} . Meanwhile, some centralised models included local food, allowing schools to manage SMP independently, encouraging local purchasing and reducing costs for food-related transportation^{(Reference Moepeng23,Reference Mensah and Karriem34,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Desalegn, Gebremedhin and Stoecker43,Reference Mensah51)} . Freshness of local food was positively associated with locally grown crops, with some studies noting that students preferred these foods^{(Reference Moepeng23,Reference Mensah and Karriem34,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Desalegn, Gebremedhin and Stoecker43,Reference Mensah51)} . Additional challenges included delayed contracts, supplier payments and changing class sizes and enrolments throughout the year, making food orders complex^{(Reference Moepeng23,Reference Khama49)} . On the other hand, establishing contracts with food providers helped ensure on-time deliveries, food quality and financial transparency, such as a public record of purchasing to facilitate SMP’ implementation^{(Reference Mafugu31,Reference Molotja45)} .

Authors’ recommended solutions included changes to current procurement models, such as a shift from centralised to decentralised modalities to promote, or require, locally produced food in SMP^{(Reference Moepeng23,Reference Daitai, Tshifhumulo and Mukwevho30,Reference Mensah and Karriem34,Reference Banda42,Reference Khama49,Reference Sulemana, Ngah and Majid59)} . Creating farmer cooperatives and grain banks was also suggested to support smallholder/local farmers^{(Reference Moepeng23,Reference Mensah51)} .

Transportation and storage

Irregular, inadequate and/or late food deliveries represented real challenges that disrupt SMP and make nutritional gains difficult to achieve and record^{(Reference Moepeng23)}. Irregular deliveries were linked with poor food procurement processes and seasonality^{(Reference Daitai, Tshifhumulo and Mukwevho30,Reference Mensah and Karriem34,Reference Banda42,Reference Langsford50,Reference Sibanda58)} . However, large food deliveries and improved infrastructure could safeguard against delays^{(Reference Hamupembe44,Reference Sichala54)} . The poor quality of food delivered was concerning, with four studies^{(Reference Moepeng23,Reference Desalegn, Gebremedhin and Stoecker43–Reference Molotja45)} detailing that food was often spoiled upon delivery, highlighting logistic challenges of food storage during transportation in local and national supply chains^{(Reference Moepeng23,Reference Khama49)} .

Authors’ recommended solutions included developing applications to communicate and track food delivers, monitor the quality of food deliveries, monitor store room inventories and improve storage facilities^{(Reference Moepeng23,Reference Mafugu31,Reference Faber, Laurie and Maduna40,Reference Desalegn, Gebremedhin and Stoecker43,Reference Molotja45)} .

Processing and distribution

Facilitators for processing and distribution included good programme coordination, motivated and dedicated school staff, adequate food storage and contracting food suppliers trained in food safety and hygiene^{(Reference Moepeng23,Reference Daitai, Tshifhumulo and Mukwevho30,Reference Rector, Afifa and Gupta32,Reference Mensah and Karriem34,Reference Molotja45,Reference Dei47,Reference Khama49,Reference Sanousi53)} . Record-keeping also helped to ensure adequate food supply by facilitating monitoring efforts and increasing the frequency of reports. Inadequate on-site school storage was cited as a challenge in twelve studies^{(Reference Daitai, Tshifhumulo and Mukwevho30,Reference Mafugu31,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Banda42–Reference Molotja45,Reference Dei47,Reference Khama49,Reference Xie and Brownell55,Reference Ellis57,Reference Zenebe, Gebremedhin and Henry60)} . While some schools described on-site storage facilities, these were often poorly adapted for hygienic food storage. Poor ventilation, storing food on the floor and using classrooms as makeshift storage spaces were listed as unsafe food storage practices, creating opportunities for food spoilage, theft and burglary. In addition, school gardens were also viewed as facilitators, contingent on land availability and production rates (i.e. enough fruit and vegetables to complement SMP)^{(Reference Rector, Afifa and Gupta32,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Molotja45)} , but as a burden when poorly maintained and not included in educational activities^{(Reference Daitai, Tshifhumulo and Mukwevho30,Reference Rector, Afifa and Gupta32,Reference Banda42,Reference Sanousi53,Reference Ellis57)} .

Authors’ recommended solutions detailed developing or improving existing school gardens to supplement fruit and vegetable procurement in SMP and budgeting for upkeep^{(Reference Faber, Laurie and Maduna40,Reference Sanousi53)} .

Food preparation

In many countries, mothers of children attending the school became the school cook. These mothers were often viewed as unpaid volunteers. However, not paying wages resulted in delays in meal preparation and even programme suspension. Among paid food handlers, delayed payments from the government posed a challenge for purchasing food, in turn causing delayed payments to suppliers^{(Reference Mensah51)}. Training on safe food handling was not uniform or compulsory and thus, an additional challenge. Concerns among parents and students were raised about the lack of training on food safety among food handlers in nine studies^{(Reference Mafugu31,Reference Rector, Afifa and Gupta32,Reference Banda42–Reference Hamupembe44,Reference Khama49,Reference Langsford50,Reference Okae-Adjei, Akuffo and Amartei52,Reference Xie and Brownell55,Reference Zenebe, Gebremedhin and Henry60)} . Meal preparation often represented a large workload, demanding time and energy to cook. Some students in Zambia were tasked with meal preparation when food handlers were absent, taking them away for their studies^{(Reference Banda42)}. Additional food preparation challenges reported were a lack of school meal guidelines and infrequent record-keeping of meals prepared and ingredients used. Food preparation was facilitated by reliable infrastructure, such as well-designated and clean spaces to store and cook food, reliable and paid food handlers, food safety training, medical certifications, food measurement and school guidelines, such as weekly menus^{(Reference Fernandes, Galloway and Gelli48)}.

Authors’ recommended solutions comprised hiring trained and paid food handlers for food preparation to ensure safe and uninterrupted meal service^{(Reference Abizari, Ali and Abdulai29,Reference Fernandes, Folson and Aurino33,Reference Gelli, Aurino and Folson36,Reference Neervoort, von Rosenstiel and Bongers41,Reference Mensah51,Reference Sulemana, Ngah and Majid59)} . Several studies also recommended infrastructure improvements, specifically for kitchen equipment and designated cooking spaces^{(Reference Desalegn, Gebremedhin and Stoecker38,Reference Desalegn, Gebremedhin and Stoecker43,Reference Molotja45,Reference Khama49,Reference Ellis57,Reference Sulemana, Ngah and Majid59)} ; one study suggested establishing a partnerships with local funders^{(Reference Hamupembe44)}. School feeding manuals and platforms to input attendance records and ways to track student participation during meals were also recommended^{(Reference Mafugu31,Reference Hamupembe44)} . Improvement of meal quantity and nutritional quality, including nutritionally adequate and diverse food groups, such as fruit and vegetables, was widely advised^{(Reference Moepeng23,Reference van der Hoeven, Faber and Osei37,Reference Faber, Laurie and Maduna40,Reference Hamupembe44,Reference Khama49,Reference Yendaw and Dayour56)} .

Distribution to students

Overall food distribution challenges included irregular meal services, meals served in unhygienic and unsafe spaces and a lack of programme monitoring and record-keeping of food distributed and consumed. Designated school canteen spaces were rare, resulting in students eating outdoors, often on the ground. A major challenge during meal distribution was poor nutritional quality, diversity and quantity, with portions getting smaller towards the end of lunchtime^{(Reference Moepeng23,Reference Daitai, Tshifhumulo and Mukwevho30,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Desalegn, Gebremedhin and Stoecker43,Reference Molotja45–Reference Dei47,Reference Khama49,Reference Okae-Adjei, Akuffo and Amartei52–Reference Sichala54,Reference Ellis57,Reference Sulemana, Ngah and Majid59)} . Establishing a dedicated school breakfast or lunch period was also a challenge. In several studies, school staff complained that SMP reduced teaching time or added to their overall workload, while others reported that lunch periods were too short for students to eat a full meal. This challenge was also linked to students not having proper cutlery and bowls, with some waiting for their friends to finish before borrowing them for use.

Conversely, food distribution was facilitated when daily attendance and daily meal participation were recorded^{(Reference Desalegn, Gebremedhin and Stoecker43)}, utensils/crockery were provided^{(Reference Ellis57)} and leftover/take-home rations were given to vulnerable students^{(Reference Sanousi53)}. Distributing food to students increased daily food intake and motivated students to stay at school for the entire day, avoiding travelling home for lunch, especially when meals were varied throughout the week^{(Reference Fernandes, Folson and Aurino33,Reference Sanousi53)} . Universal eligibility among children was reported to reduce the stigma associated with eating free meals^{(Reference Xie and Brownell55)}.

Authors’ recommended solutions to improve food distribution included enhancing serving and dining facilities and providing bowls and cutlery for all students^{(Reference Desalegn, Gebremedhin and Stoecker43,Reference Molotja45,Reference Khama49,Reference Ellis57)} . Monitoring handwashing before meals and allocating a designated mealtime were also recommended^{(Reference Hamupembe44,Reference Khama49,Reference Ellis57)} .

Student stakeholders

Students’ dislike of some school meals (e.g. beans, soya-based), resulting in reduced participation, was cited in eight studies^{(Reference Moepeng23,Reference Daitai, Tshifhumulo and Mukwevho30,Reference Mafugu31,Reference Banda42,Reference Hamupembe44,Reference Langsford50,Reference Xie and Brownell55,Reference Ellis57)} . Poor hygienic practices, such as not washing hands before eating, were also a barrier to programme implementation^{(Reference Molotja45)}. Considering student preferences when creating school menus and offering membership to school gardening clubs encouraged student participation, allowing them to become active stakeholders and facilitating implementation^{(Reference Rector, Afifa and Gupta32,Reference Xie and Brownell55)} . Inversely, eight studies reported that students liked having a school meal^{(Reference Moepeng23,Reference Rector, Afifa and Gupta32,Reference Desalegn, Gebremedhin and Stoecker43,Reference Molotja45,Reference Khama49,Reference Sanousi53,Reference Ellis57,Reference Zenebe, Gebremedhin and Henry60)} , and increased participation was observed when students perceived links with positive educational, health or nutritional outcomes^{(Reference Molotja45)}.

Authors’ recommended solutions included revising the school curriculum to include nutrition education^{(Reference Sulemana, Ngah and Majid59)}, with specific content on hygiene practices^{(Reference Rendall-Mkosi, Wenhold and Sibanda35)}, agriculture and food production^{(Reference Faber, Laurie and Maduna40,Reference Molotja45,Reference Khama49)} and school gardens^{(Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Khama49,Reference Xie and Brownell55,Reference Sibanda58)} . One study also recommended regularly assessing students’ nutritional status^{(Reference van der Hoeven, Faber and Osei37)}.

Community involvement

Communities had negative perceptions of SMP when parents considered meals to be of low nutritional quality (e.g. few fruit and vegetables served) and quantity^{(Reference Moepeng23)}. However, among communities where nutritional and educational gains were observed, particularly in reducing short-term hunger, SMP were more successful. The role of SMP as a social security net to support household food security was also discussed^{(Reference Okae-Adjei, Akuffo and Amartei52)}. Little to no information sharing led to low levels of parental involvement and unengaged community members^{(Reference Sibanda58)}. Hiring community members, often mothers, to work in SMP provided local employment opportunities and further promoted household food security^{(Reference Xie and Brownell55)}. In addition, working with external funders in the community helped improve SMP infrastructure, by constructing permanent kitchens or purchasing cutlery^{(Reference Rendall-Mkosi, Wenhold and Sibanda35)}.

Authors’ recommended solutions consist of introducing national and local awareness campaigns on SMP objectives to increase community support and engagement^{(Reference Sichala54,Reference Yendaw and Dayour56,Reference Sulemana, Ngah and Majid59)} .

Infrastructure support

Lack of policy and legislation for funding, coordination, implementation, monitoring, corruption, eligibility and technology were notable challenges. Inadequate programme funding was cited as a challenge by nine studies^{(Reference Moepeng23,Reference Banda42,Reference Hamupembe44,Reference Molotja45,Reference Langsford50,Reference Okae-Adjei, Akuffo and Amartei52,Reference Yendaw and Dayour56,Reference Sulemana, Ngah and Majid59)} . At the national, regional and school levels, SMP coordination was cited as a challenge, especially when no dedicated coordinating agency or branch of government was charged with programme oversight. Poor programme coordination led to gaps in implementation, leaving room for incorrect food orders, late deliveries, corruption and placing more responsibility on school staff^{(Reference Moepeng23,Reference Rector, Afifa and Gupta32,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Hamupembe44,Reference Khama49,Reference Langsford50,Reference Okae-Adjei, Akuffo and Amartei52,Reference Sibanda58,Reference Sibanda58)} . Large distances between schools and damaged and/or bottlenecked roads created additional logistical challenges for SMP staff. Furthermore, in programmes with policies and guidelines, monitoring and evaluation efforts revealed low levels of implementation^{(Reference Moepeng23,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Banda42,Reference Hamupembe44,Reference Molotja45,Reference Langsford50,Reference Okae-Adjei, Akuffo and Amartei52)} . Corruption was also cited as a challenge, mainly attributed to large SMP budgets. In South Africa, where eligibility was based on the quintile system, classifying schools by proxy of children’s socio-economic status was a barrier to ensuring that all children in need qualified for school meals^{(Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Sanousi53)} .

Infrastructure support facilitated implementation when financial and technical support from the government, such as capacity building workshops, food handler training and programme monitoring, was provided. Additionally, using models of best practice, successful programming and guidelines, like national nutrition requirements, facilitated procurement^{(Reference Rector, Afifa and Gupta32,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Xie and Brownell55)} . Additionally, tools to measure standard quantities, records of attendance and software applications, like the School Meals Planner in Ghana, helped food handlers design menus to meet nutrition requirements and procurement officers determine the correct quantities to purchase within allocated budgets^{(Reference Fernandes, Galloway and Gelli48)}.

Authors’ recommended solutions encompassed all aspects of infrastructure support. Overall political will and leadership commitment to SMP were key recommendations^{(Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Sulemana, Ngah and Majid59)} . High-level political champions of SMP, such as the First Lady of Ethiopia, also encouraged success^{(Reference Xie and Brownell55)}. Introducing national awareness campaigns on SMP objectives and the importance among programme beneficiaries and stakeholders was also proposed^{(Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Hamupembe44,Reference Ellis57–Reference Sulemana, Ngah and Majid59)} . Four studies recommended developing a national policy to guide their SMP^{(Reference Moepeng23,Reference Hamupembe44,Reference Khama49,Reference Ellis57)} , while two additional studies recommended implementing a unified procurement framework and/or guiding document to help tailor policy design to focus on children/adolescents^{(Reference Fernandes, Folson and Aurino33,Reference Xie and Brownell55)} .

In terms of recommendations to strengthen governance, one South African study suggested requiring national regulations for food sold in/around schools^{(Reference Faber, Laurie and Maduna40)}. Others recommended revising educational curricula to include SMP and local food production^{(Reference Moepeng23,Reference Rector, Afifa and Gupta32,Reference Molotja45,Reference Sichala54)} and working with qualified nutritionists, health professionals and/or professional chefs, to create nutrition-based recommendations and SMP guidelines^{(Reference Molotja45,Reference Okae-Adjei, Akuffo and Amartei52)} . Recommendations for improved monitoring and evaluation included establishing public records of transactions to reduce corruption^{(Reference Daitai, Tshifhumulo and Mukwevho30,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Desalegn, Gebremedhin and Stoecker38,Reference Oyela, Ogunfowokan and Olodu39,Reference Banda42,Reference Hamupembe44,Reference Molotja45,Reference Khama49,Reference Ellis57–Reference Sulemana, Ngah and Majid59)} , as well as suggestions to streamline monitoring meal quantity and quality^{(Reference Darko46,Reference Sanousi53)} . These recommendations go alongside the need to improve platforms for interaction and ways to make policies and actions coherent between different levels of government^{(Reference Daitai, Tshifhumulo and Mukwevho30,Reference Molotja45)} ; perhaps developing national nutrition guidelines and food composition tables^{(Reference Rector, Afifa and Gupta32,Reference Fernandes, Galloway and Gelli48)} or using information management systems^{(Reference Moepeng23,Reference Molotja45)} could be used to achieve these goals.

Finally, recommendations were made to ensure that funding and resources were sufficient to employ and train more personnel to meet programme needs^{(Reference Moepeng23,Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Desalegn, Gebremedhin and Stoecker43,Reference Molotja45,Reference Khama49,Reference Ellis57,Reference Sibanda58)} . Funding infrastructure improvements in schools, including sanitation and agricultural inputs^{(Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Hamupembe44,Reference Sulemana, Ngah and Majid59)} and on-time payments to food suppliers and food handlers, could allow SMP to run smoothly^{(Reference Mafugu31,Reference Hamupembe44,Reference Darko46,Reference Khama49,Reference Mensah51,Reference Sulemana, Ngah and Majid59)} . Increased technological support for SMP officers and school staff was proposed to ensure the proper use of online ordering systems and programme coordination tools^{(Reference Darko46,Reference Okae-Adjei, Akuffo and Amartei52)} . Additionally, revising SMP eligibility criteria for funding to ensure the long-term viability across varied contexts and expanding programme reach was recommended^{(Reference Oyela, Ogunfowokan and Olodu39,Reference Desalegn, Gebremedhin and Stoecker43,Reference Darko46,Reference Sanousi53,Reference Sibanda58,Reference Zenebe, Gebremedhin and Henry60)} . Creating partnerships with NGO and other stakeholders to fundraise or increase support was also suggested^{(Reference Rendall-Mkosi, Wenhold and Sibanda35,Reference Mensah51,Reference Sulemana, Ngah and Majid59)} .