Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa
Background: Despite global recommendations to prioritise policies that create healthy environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa in introducing a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable
... comparable contexts. Methods: We used a qualitative case study approach, underpinned by policy science theory. We conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle supplemented by other policy theories relevant to policy process. Results: Samoa's school food policy operationalizes international 'best practice' recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted on the policy's effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community level leaders as potentially pivotal stakeholders, particularly in a context where school governance draws heavily on community representation.Conclusions: Despite previous commitment to the issue, political and community leaders need to be re-engaged to identify the institutional and operational changes required to improve the implementation of healthy school food policies. Strong incentives for compliance and effective enforcement mechanisms are likely to be crucial to success.