Alcohol Policy Development. Experience of Alcohol Industry organized Alcohol policy process in Uganda. Malawi 12-14th November 2008 Presented by Rogers Kasirye Uganda Youth Development Link (UYDEL)

Uganda  Located in East Africa, Land locked, Traversed by the equator,  Population- 28 million, predominantly rural-75% with Multiple Ethnicity.  Income per capita USD 300 and 31% live below the poverty line( below 1$ per day).  Adult literacy -75%.

HIV/AID Statistics  Adult HIV Prevalence was estimated at 6.4% in 2005 from 30 %.  One million people are estimated to HIV Positive  An estimated 2 million orphans  A multi-sectoral Approach emphasizing the ABC+.

General Alcohol problem in Uganda  Local illegal alcohol share of market is 70% mostly un recorded.  million crates of beer are produced annually and contribute enormous income revenue (30% of market share.  In 2003, 54% of Ugandan adult population completely abstained from Alcohol.  2007 UN world report ranked Uganda as 13 th in world seizure of cannabis.  About 20% of the admissions at the national referral mental hospital are due to alcohol or other drugs with alcohol contributing over 40%.

Alcohol statistics  Alcohol ranks 10 th in generating government revenue.  Catholics largest consumers followed by protestants.  Increasing numbers of young people taking on to drinking more in binge style.  Male drink outdoors, female at homes  Alcohol is number five among causes of poverty

Alcohol and Students  Numbers of students expelled is high.  Prevalence is estimated at 70% in secondary.  More male problem; girls are also catching up.  Taught as a subject, given low attention in schools.  Peer influence and selling of alcohol by students and non teaching staff reported.

Security agencies  Police among the security agency worst hit followed by night guards as worst users of alcohol.  350police officers implicated in the vice.  177 cops admitted for treatment.  Most cops started drinking at age 15-19years  The situation in army not yet known.  Adult prisons affected inmates and guards.

Why Alcohol problem increase in Uganda  Lack of effective laws,  a range of cultural, social and economic factors has created fertile environment for alcohol misuse.  Advertisement over $200 mll, in 2006 spent on media to promote alcohol,  Lack on effective alcohol policy, and poor enforcement of outdated laws.

Research on Alcohol in Uganda.  Mainly thematic, sporadic and uncoordinated, remains a virgin area Examples and areas  Gender and alcohol study.  poverty  HIV/AIDS  Schools and Police  Local brewing.

Gender alcohol study 2005  With support of WHO and GENACIS group, interviewed 1479 respondents (49% males and 51%females in 4 districts.  Level of alcohol consumption was high in Uganda. Often consumed during parties.  Men consume more heavily and frequently than women.  Women take alcohol at home, men drink from bars and most people drink evenings and weekend.  Ugandan’s drink more as they grow older.

Poverty research and Alcohol  Research by National Statistics bureau and poverty research centre  Number 5, major cause in the country.  Brewing is a source of revenue and employment.  People spend a lot of time drinking.  People drink because they are poor and because they are poor they drink. Cause and consequences.

Alcohol perpetuating factors  Pleasure and recreation, culture,  Peer pressure transactional sex, unemployment,  Lack of livelihood opportunities and male role.  Breakdown of tradition social controls.  Insecurity in daily life.

Problems of alcohol abuse in Uganda  Associated medical problems (HIV/AIDS).  Associated mental health problems.  Associated psycho-social (child neglect, Violence, personal security and safety.  Associated high risk behaviours and social economic problems.

Support us to ban alcohol sachets in Uganda

Alcohol industry  Dominated by 3 major breweries  Nile breweries Ltd (a subsidiary of SAB Miller plc- South Africa), EABL & Parambot ltd.  Share of the Alcohol market is only 30% of all alcohol consumed in the country  The home brew is uncoordinated and varies in types of brews, amount and locations.

Experience with alcohol industry  Breweries created an organisation that oversees self-regulation (UAIA).  Aggressive policy to increase clientele through massive advertisement on FM radios, TV, websites, bill boards  Massive sponsorship of sports activities, performing arts, music.  Brewery at collision with Informal sector due to market share

Experience with alcohol industry  Free alcohol promotions, at discounted prices.  Changed bottle designs  Under-declared amounts of alcohol content  Introduced new small cheaper packaging.  and sachets (tot packs of spirits) which are becoming smaller daily, easy for young people to access & carry in pockets/bags.

Experience with alcohol industry  Desire to increase sales have encouraged sale of alcohol at sales counters accessed by minors, young people in super markets, groceries, shops & bars.  Total disregard of the law on availability of alcohol, time of selling alcohol  Alcohol retailers have no local marketing code of conduct that prevents minors from buying alcohol.

Alcohol Policy development.  After release of WHO report (2005), by media parliament requested the prime minister to give a report on the same.  MOH caught off guard, established a committee including public and civil society.  A draft alcohol report was written, a concept paper developed.  MOH took on the task of developing the alcohol policy.  The alcohol industry smelt a rat and jumped on board to support the policy development.

Alcohol policy development  Late 2006 picked on over 7 key individuals sponsored a trip through ICAP to Cape town S.A.  Discussed AP and agreed to their support to promote self –regulation see Cape town declaration  Brewery and stakeholders agreed to fund a consultant (Keith Evans) to work with MOH to develop a policy.  Then entire process high jacked, financially supported.  CSOs and FBOs left out.

Alcohol Policy development  Drafting committee (2 MOH, 1economist, 1social scientist and 2 from brewery).-UNBS, URA, CSOs, Local Gvt, Police, consumer bodies deliberately left out.  Later sponsored in a validation meeting in Sheraton with accompanying meals and fat per diem to pass it.  Some members objected and walked out in protest.  The news item in this regard were shelved by the news editors.

Drafting challenges as alleged by drafting committee  ‘Purity’ members, no trust in alcohol Industry and wanted a ban.  Some centers wanted a one-sided policy no mention of alcohol benefits.  Stakeholders not comfortable about contribution of alcohol industry.( no mention of the reason.

Enabling factors as observed by drafting committee  Support from ICAP (intn’l exposure to drafting team (conferences, tours/holidays)-compromised the process.  Involvement of MoH DDHS and Minister.-other ministries & CSOs disregarded  WHO advocacy role  Committed drafting team  Existence of public-private partnerships policy at MoH  Knowledgeable & flexible facilitators-ICAP facilitators supported by breweries (  Evidence based info to inform process.-mainly from ICAP.

Weakness of the draft policy observed by drafting committee  No representation of the informal sector.  Failure to involve the civil society  Need for statutory body to implement the policy.  Judgmental approach-branding puritans  No clarity about the home of the policy. Implication: The drafting committee does not believe in its ability to accomplish this task; pushed by alcohol industry to pass defective policy that ignores best practice and real life situation in Uganda

Senior mgt MoH comments  MOH has sent the policy back to the drawing table  Drafting committee to give more data in situation analysis.  Alcohol industry has tendency to discard available data.  Questions about self regulation by alcohol industry  Gvt may find that allowing self-regulation by industry results in loss of policy control of the marketing of a product that seriously affects public health social and economic well being of communities.

Senior mgt MOH comments  Wanted issues affecting the informal sector to be clearly explained. Informal sector produces 70% of alcohol but ignored by policy.  Entrepreneurship policy should encourage adding value to produce safer and refined products by informal alcohol producers. –control measure for UNBS than MoH; later not part of committee.  Economic impacts should clearly reflect the positive and negative economic impacts of alcohol. Argument for –ve benefits far outweigh the +ve.

Senior mgt MOH comments  Explicitly explain justification for high level statutory body in view of the challenges of implementing the policy when many politicians and leaders have vested interests in alcohol industry in addition to the mult- sectoral nature of the policy.  Policy process not thought thru and not backed up by empirical evidence.  Process significantly lies outside MoH mandate & capacity. Thus body must be outside MoH; possibly local govt  Requested to inclusion of the community awareness of emergence, mgt of intoxication.

Other Issues with draft alcohol policy  Advocate selling to minors (18yrs)  Age need to raise to 21 years  Emphasis on freedom of drinking.  Creates a situation that laws do not exist. (i.e. Enguli Act is un enforceable  Distorts research and findings. (see UYDEL report 2008 on state of alcohol in Ug).

Issues of alcohol influence experience  Buying off actors MoH officials (thru workshops and tours).  Excludes key actors and undertakes an exclusive process due to hidden agenda.  Funds health experts of distort alcohol messages in their avert.  Alcohol adverts not well balances, appealing to young people & distort facts.

Other Issues with draft alcohol policy  Alcohol poisoning has occurred due toxic substances 100 people in 2006 alone.  drunken driving problem and accidents.  burning of schools  Domestic violence high in IDP camps.  Research link high levels of perceived risk to HIV/AIDS to alcohol consumption.

Other Issues with draft alcohol policy  It is a copy cat (Malawi, Swaziland) and does not truly reflected national situation, needs and aspirations.  Ignores best practice and WHO good practices.  Policy observe that adults need to be encouraged to drink in moderation.  Alcohol is not only an individual problem but family, community and national problem.  Compromises public health principles.

+ve aspects in alcohol policy dev’t.  Focus on unrecorded alcohol, harm reduction and bring this sector under regulatory mechanisms.  Emphasize awareness, treatment and rehab services which are limited and concentrated in major towns.

Uganda need to……..  Reactivate alcohol licensing boards  Update and review the law.  Re-draft policy with a reconstituted committee involving all stake holders  Massive sensitization of the current legal regime- Enguli Act 1964  Regulate the industry and the media  Enforce underage drinking & ban sachet packaging  Invest in research on alcohol.

UYDEL’s alcohol advocacy work

Thank you and support us to ban alcohol sachets in Uganda