Challenges

Various challenges to NCD prevention policy formulation and implementation emerged across the countries. One of the cross cutting challenge was limited resources; Financial resources to facilitate policy development meetings as well as policy implementation was inadequate in all countries and there seem to have been an over-reliance on NGOs. In many policy development meetings, NGOs/CSOs and other stakeholders had to participate at their own expense which privileged industry and others with more resources. For tobacco and alcohol policies, most of the countries report lack of reinforcement due to inadequate capacity and funding. Even though countries have seen improvement in political will for NCD prevention, political commitment for comprehensive action is still inadequate as evidenced by the government’s minimal financial commitment to NCD prevention.

Another challenge was conflicts of interest, particularly by the political leaders and particularly in the development of tobacco and alcohol control policies. In some instances, certain decision-makers failed to endorse some NCD-prevention policies because of their personal interests in the industries or economic interests for the country. In some situations, there was disagreement between departments within the federal government. For example, in South Africa, different government departments took opposing positions in terms of alcohol control: the departments of Social Development and Health supported the Control of Marketing Alcohol Beverages Bill, while the Department of Trade and Industry and the National Treasury focused on the potential economic impacts of the intervention and did not support the Bill, seeking to introduce modifications.

The other challenge was industry influence, especially the tobacco and alcohol industries, substantially delayed policy development and implementation in most of the countries. In Malawi, the alcohol industry was the primary reason for the delay in endorsement of the alcohol policy. In Kenya, the tobacco industry has led legal challenges to tobacco control policies for the last 10 years. They have filed court cases against implementation of sections of the bill and amendments to the bill through parliament with concerns mainly around taxation methods (differential taxation) and size of warning labelling on packets among others. In South Africa, Industry opposition emerged during the formulation of the tobacco control, alcohol advertising and salt reduction policies. In tobacco control opposition to the policy was sustained until the final approval by the president. In terms of alcohol advertising, opposition was so strong that the proposed policy was leaked to the media before it could be approved by cabinet for public comment. So serious was the opposition from industry that the alcohol advertising control bill was withdrawn. Business also opposed the salt reduction policy but the opposition fizzled when the private sector realized the opposition was not strong enough and the strategy changed to focusing on the lack of control in the informal sector.