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Framework Convention on Tobacco Control (FCTC) is the first public health treaty negotiated under the auspices of WHO q Adopted by the WHA in 2003, entered into force in 2005 q To date, 180 countries ratified WHO FCTC globally; 43/47 countries in the African region ratified (38) or acceded (5) The WHO FCTC is an international regime to strengthen and harmonize tobacco control across member states, often enmeshed in complex web of international norms that may have a baring on ‘how’ governments approach the FCTC implementation in respective countries Currently, limited understanding of ‘how’ non-health sectors view the FCTC and to what extent they perceive conflict/s between the FCTC vs. other international (economic) commitments Situating FCTC adoption and implementation in the web of norms, this study explores the proposition: norm divergence at the international level perpetuates policy divergence within governments in the three African countries, and addresses two research questions 1. How do the study participants in different sectors understand or interpret the meaning of the FCTC? 2. How do the study participants perceive the relationship between the FCTC and non-health norms ? Theoretical framework q The study uses ‘norm’ lens to examine the relationship between FCTC and other international norms, primarily economic agreements Data collection q Purposive and snowball sampling technique to recruit participants from different government sectors, non-governmental organizations, inter- governmental organizations, and tobacco industry q Key Informant Interview : Kenya (17); Malawi (15) and Zambia (23) Analytic strategy q Deductive analysis of transcripts and notes to identify reference to international norms (commitments, agreements and institutions) q Inductive analysis interpreting the ‘meaning’ ascribed to these norms by the participants Ethics approval q Institutional Review Board (IRB) approval from McGill University, Morehouse University (American Cancer Society) A. Awareness of FCTC and its regulatory provisions q Familiarity with FCTC among study participants from health sector outmatched most non-health sector participants in Kenya and Zambia B. Perceptions of FCTC implementation q Amidst competing priorities and implementation challenges, optimism for FCTC full compliance was evident [Kenyan supreme court’s verdict upholding tobacco control regulations compliant to FCTC, was a response against British American Tobacco (BAT) Kenya Limited] C. Perceptions of ‘conflicts’ between FCTC & International Commitments D. Perceptions of ‘convergence’ between FCTC & International Commitments Tobacco control norms are enmeshed in a web of multilateral commitments at both international (WTO) and regional (EAC, COMESA, SADC) levels The ‘perceived’ conflict/s between the FCTC and international economic commitments is a key obstacle to FCTC adoption and implementation and the reasons include, Ø A genuine misunderstanding of the relationship between international commitments Ø The power of economic interests to shape policy discourse Ø A structural divide between sectors in the form of ‘bureaucratic silos’ 1. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003 2. Finnemore M, Sikkink K. International Norm Dynamics and Political Change. Int Organ. 1998 Oct 1;52(4):887–917 This analysis is derived from research supported by the National Institute on Drug Abuse, the Fogarty International Center, and the National Cancer Institute of the National Institutes of Health (Award Number R01DA035158). We thank all the study participants for their participation in the research Ratified in 2004 Ratified in 2008 Not Ratified INTRODUCTION METHODOLOGY CONCLUSION REFERENCES ACKNOWLEDGEMENTS Contact: K Srikanth Reddy, PhD Faculty of Medicine, McGill University [email protected] “Many of the government institutions, when you start mentioning the FCTC they [non-health sector] think it’s dropped from the moon” - WHO official in Kenya “The ratification of FCTC is still being discussed” - Zambian Foreign Trade respondent q Contrastingly, non-health sectors and civil society in Malawi were widely aware of FCTC, citing the economic significance of tobacco Without tobacco revenues, “FOREX shortages would be more acute….and you need the FOREX to buy malaria drugs and other life savings drugs such as HIV drugs etc.” - Malawi Investment and Trade Centre respondent q FCTC served to strengthen country’s domestic tobacco control efforts by providing support for Tobacco Control Act (TCA) - 2007 q Non-health sector participants in Zambia perceived FCTC implementation largely conflicts with country’s economic commitments “The health sector must have signed those protocols on behalf of the country without wider consultation with other sectors such as agriculture ..we (are) just victims of the decision (laughter) and then we are expected to abide by laws” - Agribusiness Zambia respondent q Malawi government has done little domestically in tobacco control q Unlike Kenya and Zambia, Ministry of Agriculture and Tobacco Control Commission in Malawi has the mandate for tobacco control leadership and implementation “No clear understanding of hierarchy between international agreements, i.e. FCTC and economic commitments (WTO, EAC)” - Kenya Revenue Authority respondent q All 3 countries are members of multilateral (WTO) as well as regional trade and economic cooperation organizations q Norms of regional organizations (targeting economic growth in the region) conflicts with FCTC q Rift between domestic public health and economic interests were evident in all countries “ We [health] want to protect people’s health, we want plain packaging but the ministry of industry and trade says no…..,because it will affect our sales” - Ministry of Health respondent, Malawi “At no one time will the sectoral council of health sit with that of trade and industry. Since there is no interaction at drafting policies, this causes a point of divergence - Kenyan representative to the EAC q To accomplish regional harmonization, an inter-ministerial and inter-sectoral co-operation council across partner countries at the EAC level suggested However, ‘policy silos’ within EAC was evident q Increasing optimism for inter- sectoral collaboration and co- ordination between health, economic and development sectors in Zambia q Malawi has been vocal opponent of FCTC in several regional forums q Malawi uses farmers’ livelihood & economic stability as rationale to resist tobacco control measures within country, and to challenge novel tobacco control measures (eg. plain packaging) “I think, that relation (health, economic and development sectors) has really been brought close and its really been boosted by the MDGs” - Zambian Diplomat ANALYSIS ANALYSIS… 1 McGill University, 2 American Cancer Society, 3 University of Ottawa, 4 University of Nairobi, 5 University of Zambia, 6 CARD, Malawi K Srikanth Reddy 1 , Raphael Lencucha 1 , Jeffrey Drope 2 , Ronald Labonte 3 , Peter Magati 4 , Fastone Goma 5, Richard Zulu 5 , Donald Makoka 6 A conflict of commitments? International economic commitments and WHO FCTC implementation in Kenya, Malawi and Zambia “... [FCTC]...was [seen as] a threat to tobacco producing countries who were members of SADC...there was fear that regulations might affect revenue of these countries” - Ministry of Foreign Affairs Zambia respondent (as SADC representative)
