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

Introduction
While 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.
Methods
Interviews with Uganda government officials within the health sector and beyond, including in ministries of trade, agriculture, and revenue.
Results The 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 demonstrates enthusiasm in some unexpected parts of government for actively engaging with Article 5.3 and for promoting greater inter-sectoral coordination.
Conclusion
This 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.