Policymaking ‘under the radar’: a case study of pesticide regulation to prevent intentional poisoning in Sri Lanka

Abstract

Background Suicide in Sri Lanka is a major public health problem and in 1995 the country had one of the highest rates of suicide worldwide. Since then reductions in overall suicide rates have been largely attributed to efforts to regulate a range of pesticides. The evolution, context, events and implementation of the key policy decisions around regulation are examined.Methods This study was undertaken as part of a broader analysis of policy in two parts—an explanatory case study and stakeholder analysis. This article describes the explanatory case study that included an historical narrative and in-depth interviews.Results A timeline and chronology of policy actions and influence were derived from interview and document data. Fourteen key informants were interviewed and four distinct policy phases were identified. The early stages of pesticide regulation were dominated by political and economic considerations and strongly influenced by external factors. The second phase was marked by a period of local institution building, the engagement of local stakeholders, and expanded links between health and agriculture. During the third phase the problem of self-poisoning dominated the policy agenda and closer links between stakeholders, evidence and policymaking developed. The fourth and most recent phase was characterized by strong local capacity for policymaking, informed by evidence, developed in collaboration with a powerful network of stakeholders, including international researchers.Conclusions The policy response to extremely high rates of suicide from intentional poisoning with pesticides shows a unique and successful example of policymaking to prevent suicide. It also highlights policy action taking place ‘under the radar’, thus avoiding policy inertia often associated with reforms in lower and middle income countries.

Acute pesticide poisoning amongst adolescent girls and women in northern Tanzania

“…This study reported a relatively high proportion of APP cases (60.2%) with no data on the responsible agents, a proportion much higher than studies amongst women in Sri Lanka [18] and California [60]. This difference could result from the existence of better surveillance systems in Sri Lanka and California compared to Tanzania.…”

Acute Pesticide Poisoning amongst adolescent girls and women in Northern Tanzania

“…For example, the study by Pearson and colleagues, which demonstrated how close collaboration between stakeholders in Sri Lanka made use of surveillance data to implement effective policies to prevent pesticide poisoning, confirms the presence of a robust surveillance system for APP in that country. 61 Absence of information on the poisoning agent was associated with younger age in that adolescent girls were more likely to be involved in an APP where the agent was unknown (PRR Adolescent girls/Adult women = 1.9, 95% CI =0.9 -3.9). This higher proportion of unknown poisoning agents in adolescent girls could be linked to inexperience in pesticides handling in that they are less likely to identify the poisoning agents.…”

Acute Pesticide Poisoning amongst adolescent girls and women in Northern Tanzania

“…For example, the study by Pearson and colleagues, which demonstrated how close collaboration between stakeholders in Sri Lanka made use of surveillance data to implement effective policies to prevent pesticide poisoning, confirms the presence of a robust surveillance system for APP in that country. 59 Absence of information on the poisoning agent was associated with younger age in that adolescent girls were more likely to be involved in an APP where the agent was unknown (PRR Adolescent girls/Adult women = 1.9, 95% CI = 0.9-3.9). This higher proportion of unknown poisoning agents in adolescent girls could be linked to inexperience in pesticides handling in that they are less likely to identify the poisoning agents.…”