Community-Led Financial Platforms as Public Health Infrastructure: Leveraging Informal Savings Groups (Stokvels) to Improve Food Security and Dietary Equity in Urban South Africa
1
Health Economics Unit, School of Public Health, University of Cape Town, Cape Town, South Africa
2
Research Centre for Health through Physical Activity, Lifestyle and Sport, Human Biology Department, University of Cape Town, Cape Town, South Africa
3
MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
4
Centre for Economics of Obesity, Department of Applied Health Sciences, University of Birmingham, Birmingham, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A1389
ABSTRACT
BACKGROUND:
Food insecurity and diet-related non-communicable diseases (NCDs) are major public health challenges in low- and middle-income countries. Although social protection and food subsidy programmes are central to public health policy, they often fail to leverage existing community institutions. Informal savings groups, known as stokvels in South Africa, are widespread, trusted, self-governing communities of practice with untapped potential for public health delivery.
METHODS:
We implemented a quasi-experimental intervention among 24 women-led stokvels across three low-income communities in Cape Town. All groups received monthly food vouchers (ZAR2000 per group for three months) to subsidize fruit and vegetable purchases. Of the three arms, two intervention arms addressed structural access barriers: (1) last-mile distribution support for bulk produce purchases, and (2) a bilingual mobile application providing nutrition guidance, food storage tips, and cost-saving strategies. Outcomes included household food insecurity (HFIAS), food purchasing and consumption patterns measured at baseline and over three months.
RESULTS:
A significant decline in household food insecurity was observed across all groups (p<0.003), with the largest effect in the last-mile distribution arm. Fruit and vegetable consumption increased substantially, particularly for citrus, tomatoes, and potatoes, without compensatory increases in unhealthy foods. Qualitative findings indicated shifts in household food priorities, collective problem-solving, and increased confidence in sustaining healthy food practices.
CONCLUSIONS:
Informal savings groups can function as a scalable community-level public health infrastructure by integrating financial, logistical, and informational support for healthy food access. Embedding food and nutrition interventions within existing social institutions offers a cost-effective, equity-enhancing strategy to strengthen food systems, reduce diet-related risk, and advance urban public health policy in resource-constrained settings.
Food insecurity and diet-related non-communicable diseases (NCDs) are major public health challenges in low- and middle-income countries. Although social protection and food subsidy programmes are central to public health policy, they often fail to leverage existing community institutions. Informal savings groups, known as stokvels in South Africa, are widespread, trusted, self-governing communities of practice with untapped potential for public health delivery.
METHODS:
We implemented a quasi-experimental intervention among 24 women-led stokvels across three low-income communities in Cape Town. All groups received monthly food vouchers (ZAR2000 per group for three months) to subsidize fruit and vegetable purchases. Of the three arms, two intervention arms addressed structural access barriers: (1) last-mile distribution support for bulk produce purchases, and (2) a bilingual mobile application providing nutrition guidance, food storage tips, and cost-saving strategies. Outcomes included household food insecurity (HFIAS), food purchasing and consumption patterns measured at baseline and over three months.
RESULTS:
A significant decline in household food insecurity was observed across all groups (p<0.003), with the largest effect in the last-mile distribution arm. Fruit and vegetable consumption increased substantially, particularly for citrus, tomatoes, and potatoes, without compensatory increases in unhealthy foods. Qualitative findings indicated shifts in household food priorities, collective problem-solving, and increased confidence in sustaining healthy food practices.
CONCLUSIONS:
Informal savings groups can function as a scalable community-level public health infrastructure by integrating financial, logistical, and informational support for healthy food access. Embedding food and nutrition interventions within existing social institutions offers a cost-effective, equity-enhancing strategy to strengthen food systems, reduce diet-related risk, and advance urban public health policy in resource-constrained settings.
| eISSN: | 2654-1459 |
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