Assessment of the multi-sectoral approach to tobacco control policies in South Africa and Togo

Abstract

BackgroundTobacco use is the world’s leading preventable cause of illness and death and the most important risk factor for non-communicable diseases (NCDs), particularly cardiovascular and chronic respiratory diseases (heart attack, stroke, congestive obstructive pulmonary disease, and lung cancer). Tobacco control is one of the World Health Organization’s “best-buys” interventions to prevent NCDs. This study assessed the use of a multi-sectoral approach (MSA) in developing and implementing tobacco control policies in South Africa and Togo.MethodsThis two-country case study consisted of a document review of tobacco control policies and of key informant interviews (N = 56) about the content, context, stakeholders, and strategies employed throughout policy formulation and implementation in South Africa and Togo. To guide our analysis, we used the Comprehensive Framework for Multi-Sectoral Approach to Health Policy, which is built around four major constructs of context, content, stakeholders and strategies.ResultsThe findings show that the formulation of tobacco control policies in both countries was driven locally by the political, historical, social and economic contexts, and globally by the adoption WHO Framework Convention on Tobacco Control (FCTC). In both countries, the health department led policy formulation and implementation. The stakeholders involved in South Africa were more diverse, proactive and dynamic than those in Togo, whereas the strategies employed were more straightforward in Togo than in South Africa. The extent of understanding and use of MSA in both countries consisted of an inter-sectoral action for health, whereby the health department strove to collaborate with other sectors within and outside the government. Consequently, information sharing was identified as the main outcome of the interactions between institutions and interest groups within and across three critical sectors of the state, namely the public (government), the private and the civil society.ConclusionTobacco control policies in South Africa and Togo were formulated and implemented from an inter-sectoral approach perspective, which relied heavily on information transfer between stakeholders and less on collaborative problem-solving approach. Incorporation of multiple stakeholders allowed both countries to formulate policies to meet FCTC goals for tobacco control and NCD reduction.

Health Taxes on Tobacco, Alcohol, Food and Drinks in Low- and Middle-Income Countries: A Scoping Review of Policy Content, Actors, Process and Context

“…33,50,59,73,86,89,90 Industry advocates also commonly highlight perceived unintended consequences of fiscal measures. Commonly identified consequences include cigarette smuggling 33,42,45,48,54,56,57,61,67,70,73,81,[90][91][92][93][94][95][96][97] ; a shift towards informal home-brewed alcohol 48 ; and food and beverage unaffordability, nutrient deficiency and dehydration. 64,91 Findings from Abedian et al and Coriakula et al 53,98 suggest strategic links to the media, or indeed media ownership itself, to perpetuate this framing in the public sphere.…”

“…Common techniques include fostering and embracing ties to the political and economic elite 46,75,77,81,84,86,87,99,100 ; funding or supporting political parties 86 ; and establishing lobbying and front groups prone to deception, disputing evidence and directly interfering in policy process. 15,42,46,47,49,51,53,55,56,59,60,63,65,66,68,71,73,79,85,86,94,[96][97][98][99][101][102][103][104] Industry interference often results in stalled or diluted fiscal mechanisms; undermining the strength and sustainability of measures. 45,49,51,53,61,66,68,73,79,81,…”

“…80 Further, while few papers explicitly acknowledged the central role of political process on the design and implementation of measures, a handful of papers did recognise what is best surmised by Chantornvong et al 105 : that policy success depends as much on forms of "political evidence" as it does the application of health and economic specific knowledge. 33,48,51,73,80,97,105 However, even amongst papers where political considerations were acknowledged, there remained limited empiric analysis and continued reliance on commentary, with the noteworthy exception of Kaiser and colleagues' 48 political economy insights from the Philippines. As Sanni et al 97 attest, technical evidence alone is insufficient to address politically contentious issues.…”

Trends in the proportionate mortalities attributed to noncommunicable diseases in sub‐Saharan Africa for the period 2000 to 2016

“…Under the MSA approach, interventions for NCDs in SSA requires collaborative efforts of multiple stakeholders such as government, civil sectors, academia, industry, private sector, and nongovernmental organizations. [14][15][16][17] For example, policies on tobacco control, exercise, and healthy diets will require concerted efforts of lawmakers, private sector and food processing companies. However, one bottleneck in MSA for NCDs in SSA is that some nontraditional public health stakeholders are not aware of the problem of NCDs and do not know their potential contribution to NCD prevention and control.…”

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

“…The remaining papers address in more details, the NCD prevention policies from individual 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].…”