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

Rachel Ann Barry*, S M Abdullah, Aastha Chugh, Selamawit Hirpa, Praveen Kumar, Denis Male, Rob Ralston, Tracey Wagner-Rizvi, Jeff Collin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)s46-s52
JournalTobacco Control
Volume31
Issue numberSuppl 1
Early online date11 Feb 2022
DOIs
Publication statusPublished - Jun 2022

Keywords

  • tobacco control
  • Article 5.3
  • WHO Framework Convention on Tobacco Control
  • multilevel government
  • comparative analysis
  • multisectoral coordination

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