Using regulation to limit salt intake and prevent non-communicable diseases: lessons from South Africa's experience.

OBJECTIVE: To analyse the policy process for the South African regulation setting upper limits for salt in thirteen commonly consumed food categories, to inform future policy action for prevention of non-communicable diseases.
DESIGN: Semi-structured interviews (n 10) were conducted with key stakeholders from government, academia, non-governmental organisations and the food industry. Interviewees were asked about the content, context, process and actors involved in developing the regulation. Data were analysed according to Walt and Gilson's health policy analysis triangle.
SETTING: South Africa.ParticipantsKey actors and stakeholders in the policy process to develop the salt regulation.
RESULTS: The regulation was a response to research establishing the effectiveness of food supply interventions and to a shared perception that government regulation was the quickest way to address the problem of salt overconsumption. While the regulations were developed through a consultative process, food industry stakeholders perceived the consultation as inadequate. Implementation is currently underway, supported by a health promotion programme. Monitoring and enforcement were identified as the most likely challenges due to capacity constraints.
CONCLUSIONS: Comprehensive mandatory salt limits are an innovative approach to food reformulation. Factors that enabled regulation included robust scientific evidence, strong political and bureaucratic leadership, and the pragmatic use of existing regulatory instruments. The main challenges identified were disagreement over the appropriate nature and extent of food industry participation, and monitoring and enforcement challenges due to capacity constraints.