Rising against alcohol harm: So near yet so far for Uganda
For the last three decades, World Health Organisation (WHO) surveys have classified Uganda among the leading alcohol consumers, globally. Besides the widespread hazardous crude alcohol, greedy businessmen introduced alcohol packed in small polythene bags (as low as 25mls) and costing just 6 to 25 cents of US dollars to target low income earners who make up the bulk of the population. The wide accessibility and affordability of these alcohol sachets – highly toxic spirits (40-45%) – became a growing concern for sustainable development as it increasingly lured young people into alcohol use and escalated alcohol-related problems.
In this article I’d like to highlight the state of the alcohol policy development in my country, Uganda and discuss the efforts behind recent progress made. I’d also like to offer insights into the next steps of alcohol policy formulation and implementation.
Hope as Ugandan Government announces new alcohol control measures
WHO recommends authoritative decisions for preventing and reducing alcohol-related harm – especially since the adoption of the 2010 Global Alcohol Strategy. And yet Uganda has been relying on an outdated colonial ‘Enguli (Portable liquor) Act’ which was enacted in 1965 to regulate the manufacture and licensing of alcohol.
Several other laws exist but are scattered, making it difficult to assess their implementation and impact. In the absence of consistent, comprehensive and evidence-based alcohol control legislation, alcohol harm has been a major obstacle to development in Uganda.
Fortunately, this situation is likely to change with the Ugandan cabinet’s recent approval of the first ever alcohol control policy for the country. The pronouncement of the National Alcohol Control Policy (NACP) was made just five months after the government’s ban on the production and sale of alcohol in sachets and other containers in quantities lower than 200mls took effect.
On September 24, 2019, an official statement released by the Uganda Media Center indicated the arrival and purpose of the NACP:
… is expected to raise awareness about the magnitude and determinants of health, social and economic problems associated with harmful use of alcohol”.
The policy provides for:
- Evidenced-based interventions,
- Enhancement of capacity and increase of technical support for preventing harmful use of alcohol and
- Management of associated disorders.
The NACP is further aimed at strengthening coordination and collaboration among stakeholders for increased mobilization of resources required for concerted action and strengthening the regulation of alcohol production, packaging, distribution, marketing and consumption.
Finally, the policy is also intended to improve monitoring and surveillance systems and to facilitate effective dissemination and application of information for advocacy, policy development and evaluation.
The battle for prioritization of alcohol policy goals: Public interests versus private interests
Formulating a public health-based alcohol control policy has not been a smooth ride due to alcohol industry interference. A major struggle has been about the very core of the policy: Should it promote private profit interests or should it promote the public interest in health and development for all? Alcohol industry versus public health.
To be effective in preventing and reducing alcohol-related harm, WHO recommends that public policies and interventions should be guided and formulated by public health interests and based on clear public health goals and the best available evidence. According to the WHO Global Alcohol Strategy, the protection of populations at high risk of alcohol harm and those exposed to harm from other people’s alcohol use should be an integral part of alcohol control legislation. Another guiding principle according to the WHO is that alcohol policy formulation should aim at supporting alcohol abstainers, especially the right of children, adolescents, young people and adults who choose not to consume alcohol beverages.
However, in 2010 a study published in Addiction showed Uganda to be among countries where alcohol industry lobbying attempted to supplant the government’s role in alcohol policy formulation. According to Bakke and Endal – two members of the Norwegian IOGT movement – alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies (the global alcohol industry lobbying arm, now replaced by the IARD) were promoting a ‘partnership’ role with several sub-Saharan governments to design national alcohol policies. Bakke and Endal’s analysis showed that Big Alcohol’s preferred model of national alcohol policy ignored, or chose selectively from the international evidence base on alcohol prevention developed by independent alcohol researchers. Big Alcohol attempted to derail or replace a public health approach to alcohol harm in Uganda and other African nations.
For example, Big Alcohol lobbyists propagated policies measures geared at maintaining a narrow focus on the economic benefits from the trade in alcohol.
In terms of alcohol problems (and their remediation) the documents focus upon individual alcohol users, ignoring effective environmental interventions.
The proposed policies serve the alcohol industry’s interests at the expense of public health by attempting to enshrine ‘active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process’,” found Bakke and Endal.
Role of civil society in policy formulation in Uganda
Over time, civil society in Uganda became better at and more involved in contributing to the formulation of policies and laws in different sectors. A recent example is the Uganda National Health Consumers Association and Uganda National Tobacco Control Association who championed formulation of the 2011 Patients charter and the 2015 tobacco bill respectively.
Aware that Uganda’s initial draft policy heavily promote strategic and political objectives of the multi-national alcohol industry, civil society came together to form the Uganda Alcohol Policy Alliance (UAPA) in 2009, with the support of the Swedish IOGT-NTO movement in East Africa. UAPA aim was to promote public health and evidence-based alcohol policies.
The mission of UAPA was seen to be unique as it revealed the enormous potential to unite local, national and international partners in stimulating the Ugandan population to demand and constructively advocate for policies and practices essential in protecting the society from alcohol harm.
In 2009, UAPA strongly rejected the proposed alcohol policy leading to a rift between UAPA and Ministry of Health (MoH). But thanks to continuous and constructive advocacy efforts, the late Dr Sheila Ndayanabangi, the then Principal Medical Officer of the mental health division at the MoH saw the light and dropped the proposed policy. Eventually, it was decided to leave the alcohol industry out of the further policy making processes.
With the removal of the alcohol industry from the policy making process, a vacuum of leadership became evident and resources for policy development suddenly ran dry. It is at this point that UAPA was able to fill the void. We commended close collaboration with the MoH to establish a Technical Working Group (TWG) composed of academics, as well as civil society advocates and other public health practitioners to draft a new policy.
Guided by the WHO’s Global Alcohol Strategy, the new draft was finally completed in 2017. However, it appeared that parallel efforts to write the country’s policy were taking place at the Ministry of Trade, Industry and Co-operatives (MoTIC). The struggle for mandate to present the country’s policy continued between MoH and MoTIC and became heated. All this slowed down the approval process.
UAPA stepped up its efforts in support of the MoH and continued to advocate for MoH leadership in alcohol policy affairs. Our advocacy campaign was extended to the public through TV appearances, press conferences, media releases and direct letters to the editors of leading newspapers, as well public demonstrations and exhibitions.
In November, 2018 UAPA issued the National Alcohol Report and with our partners organized the first Alcohol Policy Conference, again supported by the IOGT-NTO movement’s regional office. The conference participants issued a strong call urging for speedy adoption and enactment of the policy.
In the same year, a Regulatory Impact Assessment of the proposed draft policy was sanctioned by MoH.
In July 2019, consensus was reached by cabinet to allow the MoH to present the alcohol policy, and a certificate of financial implication for the newly drafted policy was issued from the Ministry of Finance and Economic Planning paving the way for its discussion and eventual approval.
Is it time to celebrate success?
In the words of a government media spokesperson:
… realization of the policy is an assurance about the Uganda’s government commitment to address the growing social, economic challenges relating to alcohol use in Uganda.”
Prior to the policy approval, the government instituted a multi-sectoral committee to oversee the implementation of the ban on sachet alcohol.
These are brave steps for which the government of Uganda should be applauded and supported with regards to implementation.
UAPA commends all our valiant members and partners for their unwavering support. Special appreciation goes to the IOGT-NTO Movement in Sweden for the logistical and technical support towards our persistent advocacy efforts and to the MoH for their co-operation and commitment to this cause. To be applauded also is the MoTIC for the strong steps taken towards elimination of sachet alcohol from Uganda.
A lot has been achieved in the past ten years of advocacy but still a lot has to be done to consolidate the achievements.
Next steps for Uganda’s alcohol regulation
The journey to address alcohol harm in Uganda has made tremendous strides but is far from over. Realization of alcohol policy is simply an anticlimax of the struggle for the alcohol policy that shall be considered successful on promulgation of the Alcohol Law.
Though policies and laws can be interrelated, they definitely serve different purposes. Policies outline government intentions for the society as a whole, while laws are standards, principles, and procedures that must be followed. An alcohol law is thus needed to ensure implementation of the NACP.
In the past, several attempts have been made by different legislators to advance the new alcohol law for Uganda. The latest was in 2016 when Hon. Betty B. Nambooze tabled a motion to be allowed to present a private members bill to repeal the Enguli Act and consolidate the different alcohol laws in the country. I was privileged to witness the presentation of this bill and observed raised emotions and sharp divisions in the parliament right at its mention. After heated debates, it was decided that the Alcohol Bill is presented by the government as it had far reaching social and economic implications.
Since 2018, UAPA through the already established TWG facilitated several meetings to draft the Alcohol Control Bill. Inspired by the progress of alcohol regulation in Kenya, Uganda’s Alcohol Bill is currently being drafted by the TWG.
It provides for the regulation of alcohol manufacture, packaging, licensing, sale, and consumption; and the restriction of alcohol advertising, promotions and sponsorships; as well as the protection of alcohol control policies from commercial and other vested interests of the alcohol industry.
On the other hand, parallel efforts are underway as MoTIC has prepared the Principles of Alcoholic Drinks Control Bill. As expected the proposed principles of the bill from the MoTIC prioritize the promotion of formal trade ahead of protection of the youth in particular, human health and life in general. The struggle for leadership in alcohol regulation between health and commercial interests in Uganda is open again and probably shall be tougher than before as Uganda enters election period and a tough stance on alcohol may be seen as source of unpopularity to the policy makers.
It is a time for the public health champions to show face again, to see a proper law if the gains made in the policy shall be consolidated.
For further reading:
News: alcohol policy developments in Uganda
Follow IOGT International’s coverage of the alcohol issue in Uganda
Uganda And The New Alcohol Control Bill 2016
by Rogers Kasirye