TY - JOUR
T1 - Advancing whole-of-government approaches to tobacco control
T2 - Article 5.3 and the challenge of policy coordination in Bangladesh, Ethiopia, India and Uganda
AU - Barry, Rachel Ann
AU - Abdullah, S. M.
AU - Chugh, Aastha
AU - Hirpa, Selamawit
AU - Kumar, Praveen
AU - Male, Denis
AU - Ralston, Rob
AU - Wagner-Rizvi, Tracey
AU - Collin, Jeff
N1 - Funding Information:
This research was undertaken within the Tobacco Control Capacity Programme, an international consortium funded by the UK Global Challenges Research Fund (GCRF). The wider project sought to develop new studies focused on tobacco control through a process of co-creation of research topics. It was through this process that Article 5.3 was identified by local research teams and via stakeholder events as a key research and policy priority across four countries—Bangladesh, Ethiopia, India and Uganda. Alongside a core focus on national implementation, research conducted by two project teams in India (Delhi and Manipal, Karnataka) allowed for examination of dynamics across multilevel governance (with the Delhi team exploring national and state-level efforts and the Manipal team focused on districts).
Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
PY - 2022
Y1 - 2022
N2 - INTRODUCTION: Despite an extensive evidence base on the diverse economic, environmental and social benefits of tobacco control, difficulties in establishing coordinated national approaches remain a defining challenge for Framework Convention on Tobacco Control (FCTC) implementation. Minimising tobacco industry interference is seen as key to effective coordination, and this paper analyses implementation of Article 5.3 guidelines, exploring implications for whole-of-government approaches to tobacco control in Bangladesh, Ethiopia, India and Uganda. METHODS: Based on 131 semistructured interviews with government officials and other key stakeholders, we explore barriers and facilitators for promoting: (1) horizontal coordination across health and other policy spheres, and (2) vertical coordination across national and subnational governments on Article 5.3 implementation. RESULTS: Our analysis identifies common barriers to coordination across diverse geographical contexts and varying approaches to implementation. They highlight broadly shared experiences of limited understanding and engagement beyond health agencies; restricted responsibility and uncertainty amid conflicting mandates; tensions with wider governance practices and norms; limited capacity and authority of coordination mechanisms; and obstacles to vertical coordination across local, state and national governments. Interview data also indicate important opportunities to advance coordination across sectors and government levels, with Article 5.3 measures capable of informing changes in practices, building support in other sectors, allowing for 'bottom-up' innovation and being shaped by engagement with civil society. CONCLUSION: Supporting effective implementation of Article 5.3 is key to advancing multisectoral approaches to FCTC implementation and tobacco control's contributions to global health and sustainable development.
AB - INTRODUCTION: Despite an extensive evidence base on the diverse economic, environmental and social benefits of tobacco control, difficulties in establishing coordinated national approaches remain a defining challenge for Framework Convention on Tobacco Control (FCTC) implementation. Minimising tobacco industry interference is seen as key to effective coordination, and this paper analyses implementation of Article 5.3 guidelines, exploring implications for whole-of-government approaches to tobacco control in Bangladesh, Ethiopia, India and Uganda. METHODS: Based on 131 semistructured interviews with government officials and other key stakeholders, we explore barriers and facilitators for promoting: (1) horizontal coordination across health and other policy spheres, and (2) vertical coordination across national and subnational governments on Article 5.3 implementation. RESULTS: Our analysis identifies common barriers to coordination across diverse geographical contexts and varying approaches to implementation. They highlight broadly shared experiences of limited understanding and engagement beyond health agencies; restricted responsibility and uncertainty amid conflicting mandates; tensions with wider governance practices and norms; limited capacity and authority of coordination mechanisms; and obstacles to vertical coordination across local, state and national governments. Interview data also indicate important opportunities to advance coordination across sectors and government levels, with Article 5.3 measures capable of informing changes in practices, building support in other sectors, allowing for 'bottom-up' innovation and being shaped by engagement with civil society. CONCLUSION: Supporting effective implementation of Article 5.3 is key to advancing multisectoral approaches to FCTC implementation and tobacco control's contributions to global health and sustainable development.
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U2 - 10.1136/tobaccocontrol-2021-057154
DO - 10.1136/tobaccocontrol-2021-057154
M3 - Article
C2 - 35149600
AN - SCOPUS:85130767960
SN - 0964-4563
VL - 31
SP - s46-s52
JO - Tobacco Control
JF - Tobacco Control
M1 - 057154
ER -
