RT Journal Article SR Electronic T1 Implementation of School Nutrition Policies to Address Noncommunicable Diseases in Uzbekistan and Kyrgyzstan JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP e2300442 DO 10.9745/GHSP-D-23-00442 VO 12 IS 4 A1 Alonge, Olakunle A1 Homsi, Maysam A1 Rizvi, Mahnoor Syeda A1 Malykh, Regina A1 Geffert, Karin A1 Kasymova, Nazokat A1 Tilenbaeva, Nurshaim A1 Isakova, Lola A1 Kushubakova, Maria A1 Mavlyanova, Dilbar A1 Mamyrbaeva, Tursun A1 Duishenkulova, Marina A1 Pinedo, Adriana A1 Andreeva, Olga A1 Wickramasinghe, Kremlin YR 2024 UL http://www.ghspjournal.org/content/12/4/e2300442.abstract AB Key MessagesSchool nutrition policies (SNPs) are a major approach to addressing the growing burden of noncommunicable diseases. However, pathways for their large-scale implementation in low- and middle-income countries are not clear.In Uzbekistan and Kyrgyzstan, the large-scale implementation of SNPs involves multiple activities, including contracting provision of school meals at specific composition and caloric standards, direct provision of meals through collaboration between public schools and communities, and coordination among various agencies and actors, including the health and education ministries.The absence of a consistent coordination mechanism among various agencies and actors, lack of an effective food contracting process and a standard approach for food sourcing to ensure stipulated nutrient standards may hamper implementation of SNPs.Noncommunicable diseases (NCDs), including cardiovascular diseases, cancer, and diabetes, account for over 80% of mortality in Uzbekistan and Kyrgyzstan in 2019, and unhealthy dietary behaviors are a major risk factor for NCDs in both countries. In 2021, national stakeholders, in consultation with the World Health Organization, identified school nutrition policies (SNPs) as a major approach to reducing the burden of NCDs in both countries. The SNPs included interventions implemented through a multistakeholder and multisectoral arrangement that aimed to improve the health and nutrition status of children and young people by providing healthy food/beverages and restricting unhealthy foods or beverages in schools. We used a multimethod approach of document review, participatory workshops, and key informant interviews to generate theories of change for the large-scale implementation of SNPs and describe the implementation processes to date, including key implementation and health system challenges, salient implementation strategies, and implementation outcomes in both countries. Multiple pathways for enacting and implementing SNPs successfully were identified. However, significant health system challenges, such as the lack of accountability for contracting and tender processes and coordination among different sectors, continue to hamper the large-scale implementation of these policies in both countries. The pathways, theories, and implementation outcomes identified will facilitate the development of implementation strategies and systematic learning and evaluation around SNPs for NCD prevention and control programs in the Central Asian region and other low- and middle-income countries more broadly.