The role of principled engagement in public health policymaking: the case of Zambia's prolonged efforts to develop a comprehensive tobacco control policy.

Autor: Silumbwe A; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden., San Sebastian M; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden., Zulu JM; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia., Michelo C; Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.; Strategic Centre for Health Systems Metrics (SCHEME), Global Health Institute, Nkwazi Research University, Lusaka, Zambia., Johansson K; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Jazyk: angličtina
Zdroj: Global health action [Glob Health Action] 2023 Dec 31; Vol. 16 (1), pp. 2212959.
DOI: 10.1080/16549716.2023.2212959
Abstrakt: Background: The Framework Convention on Tobacco Control (FCTC) requires countries to develop and implement multi-sectoral tobacco control strategies, including policies and legislation. Zambia, potentially faced by a rising problem of tobacco smoking, signed the FCTC in 2008 but has been unable to enact a tobacco policy for over a decade.
Objective: This study explores the role of 'principled engagement', a key element of the theoretical framework for collaborative governance, in Zambia's delayed success to develop a comprehensive tobacco control policy.
Methods: This was a qualitative case study of key stakeholders in the collaborative process of trying to develop a tobacco policy in Zambia. Participan-ts were sampled from across various sectors, including government departments and civil society, comprising anti-tobacco activists and researchers. A total of 27 key informant interviews were undertaken. We supplemented the interview data with a document review of relevant policies and legislation. Data were analysed using thematic analysis.
Results: Several factors hindered efforts to attain principled engagement, including the adverse legal and socioeconomic environment in which the collaborative regime evolves; poor planning of meetings and frequent changes in tobacco focal point persons; lack of active and meaningful participation; and communication challenges among the key stakeholders. These collaborative dynamics, coupled with the opposition to tobacco control efforts from within some government departments, revealed the inadequacy of the current collaborative governance regime to facilitate enactment of a comprehensive tobacco control policy in Zambia.
Conclusion: Efforts to develop a comprehensive tobacco control policy in Zambia will require addressing challenges such as disagreements, communication, and leadership at engagement level across interested sectors. We further argue that principled engagement has a greater role to play in unlocking these efforts and should therefore be embraced by those entrusted to lead the process to develop tobacco policy in Zambia.
Databáze: MEDLINE
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