Alcohol policies in Malawi: inclusion of WHO “best buy” interventions and use of multi-sectoral action

Abstract

BackgroundHarmful use of alcohol is one of the most common risk factors for Non-Communicable Diseases and other health conditions such as injuries. World Health Organization has identified highly cost-effective interventions for reduction of alcohol consumption at population level, known as “best buy” interventions, which include tax increases, bans on alcohol advertising and restricted access to retailed alcohol. This paper describes the extent of inclusion of alcohol related “best buy” interventions in national policies and also describes the application of multi-sectoral action in the development of alcohol policies in Malawi.MethodsThe study was part of a multi-country research project on Analysis of Non-Communicable Disease Preventive Policies in Africa, which applied a qualitative case study design. Data were collected from thirty-two key informants through interviews. A review of twelve national policy documents that relate to control of harmful use of alcohol was also conducted. Transcripts were coded according to a predefined protocol followed by thematic content analysis.ResultsOnly three of the twelve national policy documents related to alcohol included at least one “best buy” intervention. Multi-Sectoral Action was only evident in the development process of the latest alcohol policy document, the National Alcohol Policy. Facilitators for multi-sectoral action for alcohol policy formulation included: structured leadership and collaboration, shared concern over the burden of harmful use of alcohol, advocacy efforts by local non-governmental organisations and availability of some dedicated funding. Perceived barriers included financial constraints, high personnel turnover in different government departments, role confusion between sectors and some interference from the alcohol industry.ConclusionsMalawi’s national legislations and policies have inadequate inclusion of the “best buy” interventions for control of harmful use of alcohol. Effective development and implementation of alcohol policies require structured organisation and collaboration of multi-sectoral actors. Sustainable financing mechanisms for the policy development and implementation processes should be considered; and the influence of the alcohol industry should be mitigated.

Noncommunicable Diseases Prevention Policies and Their Implementation in Africa: A Systematic Review

“…One study considered policy response to NCDs in five African countries [ 34 ]. A mere three studies measured policy implementation on the four major NCD risk factors such as tobacco use, harmful alcohol use, unhealthy dietary practice, and physical inactivity [ 35 , 36 , 39 ]. Three studies considered opportunities and challenges to implementing NCD policy to combat the developing burden of NCDs [ 12 , 37 , 40 ].…”

“…The extent of understanding and use of a multi-sectoral approach in both countries consisted of an inter-sectoral action for health, whereby the health department struggled to collaborate with other sectors within and outside the government [ 40 ]. A study in Ethiopia indicates that the country has ratified and is underway to implement tobacco control policies and strategies [ 39 ]; however, its application is challenging, with tobacco consumption currently ever-increasing [ 39 ].…”

“…The main barriers to policy formulation and implementation were industry interference, lack of resources, poor enforcement, and clear roles [ 37 ]. Insufficient resource allocation and barriers associated with poor collaboration among multiple sectors [ 33 , 39 ], financial constraints, high personnel turnover in different government departments, role confusion between sectors and some interference from the alcohol industry further exacerbate the problem [ 34 , 40 ].…”

Achieving high-quality universal health coverage: a perspective from the National Health Service in England

“…Too often LMICs have been unable to overcome these obstacles to take action to adopt prevention policies, such as those evidence-based ‘best-buy’ interventions recommended by WHO 13. However, there are positive examples where governments have introduced primary disease prevention programmes, for instance, the 2017 alcohol taxation and drink-driving laws in Malawi,14 or a 2009 obesity prevention programme that addressed food formulation and advertising regulations for children in Brazil 15…”

Introduction: Non-communicable disease prevention policies in six African countries

“…Four papers address tobacco control policy development processes in Cameroon [4], Kenya [5], Nigeria [6] as well as Togo and South Africa [7]. These papers highlight the tobacco policy processes, application of multi-sectoral action in the policy development and implementation process as well as the key barriers and facilitators in developing and implementing the tobacco policies in the countries Another paper describes Malawi's unique approach to alcohol policy formulation and implementation [8]. Although the most recent comprehensive policy was only approved at the time data collection was almost complete, Malawi's alcohol policy process is the most elaborately documented.…”