Inertia or unanticipated bottlenecks? Exploring the implementation determinants of the national alcohol policy five years post-enactment in Zambia

Abstract

Background Alcohol use accounts for a huge proportion of the global burden of disease, and many countries grapple with its severe negative social and health consequences. In 2018, Zambia adopted a national alcohol policy with the aim to reduce the prevalence and impact of harmful alcohol use. However, five years post-adoption, the policy implementation has been slow. This study sought to explore the implementation determinants of the national alcohol policy five years post-enactment. Methods We employed an exploratory qualitative case study using data collected from 25 in-depth interviews targeting government ministries, civil society, and agencies responsible for enforcing the alcohol policy. We applied both inductive and deductive manifest thematic analysis using Bullock’s analytical framework for understanding the determinants of implementing evidence-based policies. Results The alcohol policy provided a comprehensive framework for action, yet its policy directives remained unclear. A restructured policy coordination committee rejuvenated the momentum to implement the policy. However, weak collaboration between the council and state police hampered the enforcement of alcohol laws. Implementing agencies faced obstacles such as lack of financial and human resources, absence of rehabilitation services, and misapplication of alcohol selling licences. Further, community indifference, inaction, and resistance to alcohol control laws affected the policy implementation. The socio-political environment contributed to implementation challenges through framing alcohol as an economic development issue and culturally tolerating harmful alcohol use. Additionally, changes in government affected policy ownership while unregulated illicit alcohol production and the sale of traditional and imported spirits further hampered the implementation of the policy. Conclusion Overcoming implementation hurdles for contentious health policies demands comprehensive strategies such as engaging communities, challenging cultural norms, strategically assigning funding, and fostering collaboration among implementing agencies. In the case of Zambia's national alcohol policy, this may take the form of leveraging enablers such as stakeholder recognition of the policy framework and the restructured committee for the coordination of policy implementation, now under local government oversight. Key actions should include empowering local government to enforce measures to reduce unregulated alcohol availability and ensure adequate resource allocation for alcohol control activities among implementation agents, including those providing treatment and rehabilitation services.