From Savings to Nutrition: How Stokvels Currently Operate and How They Could Enable Nutrition-Sensitive Interventions: A Realist Evaluation in South Africa

OBJECTIVE: We examined how informal rotating savings and credit associations influence food purchasing and nutrition-related behaviors in urban communities with low income, and we explored their potential as platforms for adding nutrition value to purchasing decisions and behavior change interventions. DESIGN: We conducted a qualitative realist evaluation guided by an Initial Programme Theory. We analyzed interview and focus group discussion data thematically to identify context-mechanism-outcome configurations shaping decision-making and food choices. SETTING: Two urban communities with low income in Cape Town, South Africa. PARTICIPANTS: Sixty individuals from 20 grocery stokvels participated, including 20 leaders interviewed individually and 40 general members in 4 focus group discussions. ANALYSIS: Thematic analysis examined governance structures, collective decision-making, food purchasing practices, and mechanisms relevant to nutrition-focused education and interventions. RESULTS: Stokvels comprised 10-30 members contributing ZAR200-ZAR1500 monthly. All operated under formal constitutions, with 85% enforcing penalties for rule breaches. Bulk purchasing of staple foods, sugar, and processed meats occurred in 95% of stokvels, whereas only 1 group considered nutritional value. Stokvels were predominantly women-led (95%). CONCLUSIONS AND IMPLICATIONS: Stokvels are well-governed and socially cohesive groups. While governance and collective systems generate economic leverage, they also shape purchases toward shelf-stable, nutrient-poor foods.