BCG Urges African Governments to Integrate Food and Health Systems to Cut Healthcare Costs

A new report from Boston Consulting Group (BCG), Integrating Food and Health Systems in Africa: A High-Return Investment in Health, argues that food should be treated as a form of health infrastructure and that integrating food and health systems could become one of Africa’s most powerful tools for improving public health, reducing long-term healthcare costs and strengthening economic resilience.

The report highlights a practical opportunity for governments to address rising diet-related disease while supporting agricultural growth: using institutional feeding programmes, particularly school meals, to improve nutrition at scale.

Health systems are already under fiscal strain and cannot afford to pay for negative outcomes unintentionally fueled by food systems,” said Zoë Karl-Waithaka, Managing Director and Partner at BCG and co-author of the report. “Across Africa, we’re facing a dual challenge of rising rates of diet-related disease and increasingly constrained health budgets. If we want healthier populations and more sustainable public finances, we need to look beyond healthcare delivery and address one of the root causes, what people are eating every day.”

The urgency is growing as while undernutrition remains a concern across many African countries, diet-related non-communicable diseases (NCDs), including diabetes, hypertension and cardiovascular disease are rising rapidly. The report notes that one in ten adolescents in sub-Saharan Africa already has elevated blood pressure, creating a significant future burden for health systems as populations age.

“This is not only a health issue but an economic and fiscal issue,” said Karl-Waithaka. “Every finance minister in Africa is looking for ways to bend the cost curve. Food is one of the few levers that can improve health outcomes, strengthen food security and reduce future healthcare spending at the same time.”

The report identifies school feeding programmes as the most practical and scalable starting point for integrating food and health systems.

Across Africa, school meal programmes reach more than 85 million children, around one-third of all enrolled learners. With more than 80% of funding already provided by domestic governments, school feeding is one of the continent’s largest and most established public food platforms.

BCG highlights the significance of school feeding beyond nutrition, confirming that these programmes create predictable institutional demand, influence dietary habits early in life and provide a ready-made mechanism for connecting health, agriculture and economic development objectives.

“Kenya is demonstrating that school feeding can be far more than a social programme. It can be a catalyst for better health, stronger local food systems and inclusive economic growth,” said David Kamau, Managing Director at Fortified Whole Grain Alliance. “Our experience shows that when nutritious school meals are delivered consistently and at scale, children are healthier, more engaged in learning and better positioned to reach their full potential.”

“At the same time, locally sourced procurement creates opportunities for farmers, aggregators and food businesses across the value chain. As countries seek practical solutions to rising diet-related disease and growing pressure on public health systems, school feeding offers one of the most proven and scalable platforms for driving long-term impact.”

The report focuses particularly on grains because they account for as much as two-thirds of calories consumed in many African diets and institutional meals. Replacing refined grains with whole grains and indigenous crops offers one of the most practical opportunities to improve dietary diversity without fundamentally redesigning school feeding systems.

Rwanda demonstrates the business case

Using Rwanda as a case study, BCG modelled the potential impact of transitioning school meals from refined maize flour and polished rice to healthier alternatives including whole-grain maize, unpolished rice and indigenous grains such as sorghum.

The findings suggest such a transition could generate between USD120 million and USD155 million annually in combined health, fiscal and environmental benefits.

Direct annual monetary savings alone are estimated at USD50 million to USD60 million, equivalent to 7-8% of Rwanda’s health expenditure in FY2022/23. According to the report, these savings would result from reduced rates of diet-related disease, lower import dependence, procurement efficiencies and environmental gains.

These findings challenge the perception that healthier food necessarily comes at a higher cost. The report finds that investments in better nutrition can generate measurable returns for governments, households and businesses alike.

It further highlights strong consumer acceptance of healthier food alternatives from Rwanda and Kenya. In pilot programmes, more than 90% of children and parents preferred whole-grain meal options to refined alternatives, challenging assumptions that healthier meals require difficult behavioural shifts.

New opportunities for agriculture and food businesses