This study employed a scoping review methodology to systematically map child health and development policies and related implementation evidence in South Africa. The review was conducted according to the Joanna Briggs Institute guidelines and is reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (ScR).¹⁵ The purpose was to map available literature and policy documents regarding child health and development in South Africa over the last 15 years. The review consisted of five stages: (1) identifying the research question, (2) identifying relevant studies and policies, (3) study and policy selection, (4) charting the data and (5) collating, summarising and reporting the results.

A comprehensive literature search was conducted in the following sources: (1) academic databases: MEDLINE, Google Scholar, African Journals Online (AJOL), (2) government reports: South African Department of Health, National Planning Commission, and (3) grey literature: reports from the United Nations Children’s Fund (UNICEF), WHO and non-governmental organisations. A combination of keywords and Boolean operators was used to identify relevant literature. Key terms included: (‘child health’ OR ‘childhood development’) AND (‘policy’ OR ‘strategy’ OR ‘framework’ OR ‘implementation’) AND ‘South Africa’. Filters applied: date range (2008–2023), study design (policy reviews, empirical studies) and language (English). The date range was selected to include studies that reflect current policies and contemporary evidence following the introduction of key policies, ensuring relevance to current practice and maintaining feasibility and rigour. Three reviewers conducted the screening and selection, resolving disagreements through consensus or consulting an expert reviewer. The study selection process is presented in a PRISMA-ScR flow diagram (Figure 1).¹⁵ The flow diagram clearly represents the volume of evidence identified and the screening stages applied, enhancing the transparency and rigour of the review process.

For independent review, all the authors were involved in the screening process and conducted study selection and data extraction by examining study titles and abstracts to identify studies that potentially met the inclusion criteria. The authors conducted a rigorous selection to ensure that the studies selected aligned with the scoping review’s research question and scope. A structured process was undertaken to reach an agreement, and over 90% of the agreement included relevant articles.

Children and caregivers, including maternal and household contexts relevant to child health and development in South Africa.

A standardised data extraction form was used to capture policy details (e.g. name, year, scope and impact), key health indicators and findings on child health and development. The data extraction form was developed based on the key indicators (Appendix 1) that were targeted for review in this scoping review.

Data were synthesised qualitatively and quantitatively – a thematic synthesis approach was employed to analyse and interpret the included sources. Initial codes were developed inductively from both policy documents and empirical studies, focusing on key policy domains and features related to implementation. Through an iterative process of comparison and collaborative discussion, these codes were consolidated into broader thematic categories. Policy documents were mainly analysed to understand policy intent and design features, while peer-reviewed empirical studies provided contextual insights into how policies were interpreted and implemented in practice, including challenges reported in different settings. Instead of hierarchically weighting sources, the synthesis drew on the complementary contributions of each to build a comprehensive, system-level picture of child health and development policy implementation in South Africa.

Policy areas were categorised into areas, such as food provision; maternal, newborn and child health, child growth and development; economic well-being; caregiver mental health and well-being; child psychosocial well-being; and access to resources. Each policy area was graded based on the (1) availability of prevalence data and (2) policy implementation (see Table 1).¹⁶

The NSNP plays a crucial role in improving child nutrition, school attendance and cognitive performance among over nine million learners in South Africa. The programme ensures that children receive at least one meal per school day, which helps alleviate short-term hunger and supports overall health. However, inconsistencies in meal quality and infrastructure challenges in food storage and preparation limit the programme’s effectiveness. Additionally, food security remains a significant concern, especially outside the school environment, where many children still experience inadequate access to nutritious food (Table 2). Using the current evidence, a grade B has been assigned to food provision for the availability of prevalence data.⁵ Although national, available and regional data from the latest general household survey (GHS) on food security are available, they do not cover all age groups of children, particularly those aged 5 years and above. A grade B has been assigned for policy and implementation, as the policy faces implementation inconsistencies in urban-rural settings^17,18 (Table 2).

The Strategic Plan for MNCWH and Nutrition outlined priority interventions to ensure every mother and child in South Africa receives a comprehensive package of services to reduce maternal, newborn and child mortality and illness. These interventions include services such as antenatal care, improved access to care during labour, intrapartum care, postnatal care of the mother and newborn within 6 days of delivery, and immunisation. However, the successful implementation of these interventions continues to be hampered by substandard care, such as the uneven distribution of appropriately skilled healthcare workers, obstetric care for urban versus rural areas and the public versus private health system.³ Given the current evidence, a grade A has been assigned for the availability of prevalence data because the most recent data for maternal, newborn and child health indicators are available at the national and regional levels.¹⁹ However, a grade B has been assigned for policy and implementation because the policies (MNCWH, Nutrition and EPI) face implementation challenges across provinces and districts, particularly in rural settings^3,13 (Table 2).

Efforts to reduce child malnutrition and end under-five year old mortality have led to policies focused on growth monitoring to assess child growth and development. Key indicators such as height, weight and mid-upper arm circumference (MUAC) highlight ongoing concerns regarding stunting and undernutrition. Despite national initiatives, chronic conditions such as childhood diabetes and obesity receive insufficient policy attention. Furthermore, there is a lack of comprehensive school-based growth-monitoring systems, limiting early detection and intervention for undernourished children (Table 2). Based on the current evidence, a grade A has been assigned for the availability of prevalence data because national and regional data are available for the indicators of child growth and development.⁵ However, a grade B has been assigned for policy and implementation, as the policies face implementation challenges in under-resourced settings¹¹ (Table 2).

Financial relief measures, particularly the Child Support Grant (CSG), serve as essential poverty alleviation tools, supporting children in low-income households. The grant ensures that children have access to necessities, reducing financial stress on families. However, long-term economic stability remains unaddressed because income support policies are not integrated with broader child development strategies. Additionally, there are no substantial mechanisms to transition grant recipients towards sustainable financial independence, leaving families reliant on continued aid (Table 2). Using the current evidence, a grade A has been assigned for the availability of prevalence data because the most recent data at the national and regional levels are available for economic and material well-being.⁵ Although the CSG policy is implemented across all regions, a grade B has been allocated for policy and implementation because there is a lack of integration of income support policies with broader child development strategies and long-term economic stability policies for families²⁰ (Table 2).

Caregivers play a critical role in child health and development, yet many experience high levels of stress and depression, especially in disadvantaged households. While some policies provide access to mental health services, such access remains limited, particularly in rural areas. The lack of a structured support system for caregivers impacts both their well-being and their ability to provide adequate care for children. Strengthening caregiver-focused mental health policies and ensuring widespread availability of support structures are necessary to improve overall family stability (Table 2). Using current evidence, a grade C has been assigned for the availability of prevalence data, as there is a lack of data on caregiver mental health indicators.²¹ A grade C has been assigned for policy and implementation because the current proposed policy is not a standalone policy solely dedicated to caregivers²² (Table 2).

Exposure to economic hardship, violence and instability negatively affects children’s mental and emotional well-being. Some policies address psychosocial support and resilience-building; however, they remain fragmented and inadequately integrated into broader child health programmes. There is insufficient attention to the long-term psychological effects of poverty and violence, leaving many vulnerable children without proper mental health interventions. Strengthening policies that promote resilience and mental health support is essential to mitigate these adverse effects (Table 2). Based on current evidence, a grade C has been assigned for the availability of prevalence data because regional data on child psychosocial well-being indicators are lacking.¹⁶ A grade C has been allocated for policy and implementation because the policies have minimal support structures and poor implementation^10,16 (Table 2).

Basic infrastructure, including safe housing, clean water, electricity and sanitation, remains a crucial determinant of child well-being. Although housing policies have improved access in some areas, significant disparities persist, particularly in rural and low-income communities. Limited policy focuses on resource insecurity, which further exacerbates challenges in child development, as inadequate living conditions contribute to poor health outcomes. Ensuring equitable access to essential services is necessary for closing infrastructure gaps and improving overall child well-being (Table 2). Using current evidence, a grade A has been assigned for the availability of prevalence data because national and regional data for access to resources indicators are available from national surveys.^5,23 However, a grade C has been allocated for policy and implementation because access to basic services like housing, water, electricity and sanitation remains a challenge in rural South Africa, with significant disparities compared to urban areas^1,5 (Table 2).

Given these challenges, several key policy recommendations can be made. The review highlights the need for targeted and achievable reforms to strengthen policy implementation for child health and development in South Africa. Priority actions include enhancement of provincial delivery capacity by establishing minimum service standards, providing targeted technical support, and clarifying accountability mechanisms between national and provincial levels. Improved intersectoral collaboration is also essential, particularly through formalised joint planning platforms that bring together health, education, social development and local government sectors. Strengthening monitoring and evaluation systems – such as integrated child data platforms and routine tracking of caregiver mental health and psychosocial indicators – would further support more responsive implementation. To advance child health outcomes, policies should reinforce school-based nutrition and growth-monitoring services, expand community-level psychosocial and caregiver mental health interventions, link the CSG to livelihood and skills-building initiatives and prioritise infrastructure investment in rural and underserved areas. Achieving these reforms requires coordinated efforts across government sectors, adopting a child-centred approach to service integration, investing in reliable data for monitoring and accountability and aligning budgets with evidence-based priorities while tailoring global guidance to local realities. Collectively, these system-level shifts – supported by improved financing alignment, stronger district authority and more coordinated service delivery – offer practical pathways for translating South Africa’s strong policy ambitions into equitable and effective implementation.

This scoping review has several limitations. Firstly, the analysis draws on publicly accessible policy documents and grey literature, which may introduce bias, as these sources often present programmes favourably and may lack methodological detail. Secondly, routine data systems remain weak in key domains, including caregiver mental health, psychosocial well-being and service quality, restricting the ability to assess these areas comprehensively. Finally, because the review synthesised a diverse body of literature rather than evaluating programme effectiveness directly, the findings describe patterns of policy design and implementation rather than causal impacts.