‘That is a Ministry of Health thing’: Article 5.3 implementation in Uganda and the challenge of whole-of-government accountability

Abstract

IntroductionWhile Uganda has made legislative progress towards implementing Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC), ongoing challenges in minimising tobacco industry interference have not been adequately explored. This analysis focuses on understanding difficulties in managing industry engagement across government ministries and in developing effective whole-of-government accountability for tobacco control.MethodsInterviews with Uganda government officials within the health sector and beyond, including in Ministries of Trade, Agriculture and Revenue.ResultsThe findings indicate substantial variations in awareness of Article 5.3, its norm and practices across government sectors. The data suggest ambiguity and uncertainty about accountability for Article 5.3 implementation, with policy makers in departments beyond health often uncertain about obligations under the FCTC. Second, we highlight how responsibility for Article 5.3 implementation and the obligations incurred are widely seen as restricted to the Ministry of Health. Third, competing mandates and perceived difficulties in reconciling health goals with economic growth are shown to impact on accountability for tobacco control. Yet, importantly, the data also demonstrate enthusiasm in some unexpected parts of government for actively engaging with Article 5.3 and for promoting greater intersectoral coordination.ConclusionThis paper demonstrates the intrinsic challenges of developing whole-of-government approaches, highlighting considerable uncertainty and ambiguity among decision makers in Uganda about tobacco control governance. The analysis points to the potential for Uganda’s national coordinating mechanism to help reconcile competing expectations and demonstrate the importance of Article 5.3 beyond health actors.

Advancing whole-of-government approaches to tobacco control: Article 5.3 and the challenge of policy coordination in Bangladesh, Ethiopia, India and Uganda

“…In Uganda28 and Ethiopia,29 legislation broadly addresses most of the eight key recommendations of Article 5.3, while notably omitting reference to raising awareness of industry interference and treatment of state-owned elements of the tobacco industry. Ethiopia’s legislation also excludes reference to avoiding preferential treatment for the industry 24 25…”

“…This paper builds upon linked case studies examining contextspecific challenges of tobacco control governance in Bangladesh, 23 Ethiopia, 24 Uganda, 25 the Indian state of Karnataka, 26 and the dynamics of implementation across India's states and union territories. 27 Our case selection covers diverse tobacco control experiences and trajectories via which to understand coordination challenges and opportunities associated with Article 5.3 implementation.…”

Norms, rules and policy tools: understanding Article 5.3 as an instrument of tobacco control governance

“…This research formed part of the Tobacco Control Capacity Programme (TCCP), an international consortium funded by the UK Global Challenges Research Fund to strengthen research capacity for tobacco control in low-and middle-income country (LMIC) contexts. It was guided by priorities identified by LMIC partner institutions and stakeholders, led by four project teams in Addis Ababa, Kampala, Delhi and Manipal, and Karnataka, and builds on case studies examining Article 5.3 implementation in these contexts 26–29. Preliminary findings were reviewed and key themes discussed at TCCP consortium meetings in London and Edinburgh, Addis Ababa, and New Delhi.…”

“…Ethiopia’s 2019 tobacco control legislation codified several Article 5.3 guidelines in the context of the government’s negotiations with Japan Tobacco International over the privatisation of its state-owned tobacco monopoly 26. The adoption of Article 5.3 guideline recommendations in Uganda,27 an important leaf grower and exporter,30 is recognised as an example of good legislative practice 31. India’s federal system, in which central and state governments share constitutional responsibility for public health,32 33 has led to Article 5.3 ‘notifications’ being issued at the subnational level 28.…”

Firm foundation or neglected cornerstone? The paradox of Article 5.3 implementation and the challenge of strengthening tobacco control governance

“…The papers in this supplement begin to address empirical and conceptual gaps within public health research, highlighting persistent challenges in implementing Article 5.3 across disparate social, political and economic contexts. In their analysis of Article 5.3 and whole-of-government accountability in Uganda, Male et al 29 highlight substantial variations in awareness and engagement across government sectors. While Uganda's 2015 Tobacco Control Act is regarded as a success story in advancing key Article 5.3 recommendations, this paper demonstrates how responsibility for minimising industry interference was widely seen as restricted to the Ministry of Health, with difficulties exacerbated by competing mandates across government agencies and perceived tensions with economic growth.…”