Promoting Coordination, Cooperation and Collaborative Agreements among Government Agencies in Tobacco Control in Kenya Peter Magati, Jeff Drope & Raphael Lencucha

Tobacco control milestone Kenya Tobacco Control Timeline (Source WHO 2012) Establishment of the national TFI committee Passing the TCA TC Regulations? Ratification of the WHO FCTC Establishment of the TC board Commemorations of the WNTD related TC activities New constitution 2010

Observations of 2012 WHO Joint Assessment of TC status There is no clear mechanism ensuring a smooth and coordinated implementation of the different aspects of tobacco control at different levels of governance Enforcement of the Tobacco Control Act 2007 is not optimal - fragmented enforcement effort Important provisions of Act not implemented e.g. graphic health warnings, strict enforcement of smoking ban and sales and advertising data from industry Policies on viable alternatives for tobacco growers by MOA

Way forward suggested by WHO… A clear mechanism ensuring smooth and coordinated implementation of tobacco control policies at the different levels of governance in MOH; The MOH should engage with the Ministry of Local Government, local governments and other enforcement agencies to actively enforce the provisions of the TCA 2007; The MOH should develop the pending regulations to further facilitate the implementation of the TCA 2007; The MOA and other relevant ministries and agencies should take necessary measures, including sensitization of stakeholders, and develop appropriate policies to meet their obligations under the WHO FCTC

Progress as at 2014… Status in 2014 of tobacco control after joint national capacity assessment o of TC policies – SAME AS 2012!

Objectives Document how government agencies interact in matters tobacco control; Illustrate industry influence in government ministries; Unearth extent of understanding the TCA and WHO FCTC in government Document points of tension/collision and cooperation between health and economic policies

Methodology Key informant Interviews in relevant ministries

Government ministries and agencies involved in Tobacco issues  Ministry of Health  Ministry of Trade  Ministry of Agriculture  Ministry of Finance  Ministry of Devolution and Planning  National Authority for the Campaign against Alcohol and Drug Abuse  Kenya Tobacco Control Board

Government ministries and agencies involved in Tobacco issues  Ministry of East African Affairs, commerce and Tourism  Ministry of Foreign Affairs  Kenya Investment Authority  The Kenya Revenue Authority  Attorney General’s office  County governments!

Challenges of TC in Kenya Tension in the ministry of health NCD division and office of the CPHO. Why? Causing regulations to stall? Tension between TCB and ministry of health staff – stalling of regulations? TCA under the new constitution – Decentralization of the health ministry; National government responsible for policy; implementation/monitoring of some aspects of Act – county governments! Domestication of TC legislation? TI influence in “important government” ministries – stronger arm vs weaker arm analogy! EAC?

Challenges of TC in Kenya There is no genuine inter-ministerial body that implements tobacco control. The TCB is only advisory and also looked at as only serving the Ministry of Public Health; TI workings in the ministry of EAC… strategic? Miles ahead?

Challenges within EAC… TC needs cooperation of many ministries for its successful implementation yet within the EAC, there exists no time where there is an inter-ministerial sectoral council that would approach this from a multisectoral point of view so as to have a common understanding E.g. at no one time will the sectoral council of health sit with that of trade and industry. Tobacco industry is very powerful and can influence workings of government officials at all levels e.g. through bribes and threats! TI firm understanding of trade issues….

Tobacco Control Environment Pro-Tobacco Control agencies/ministries Reserved/Cautious in Tobacco Control Initiatives Undecided/Unknown/Not aware Ministry of HealthMinistry of TradeAttorney general Ministry of Agriculture Ministry of Foreign Affairs Kenya Investment Authority TCB East African Community, commerce and tourism NACADAMinistry of Agriculture KRANACADA County governments

Pro - TC arguments in Kenya Constitution asserts right to health; FCTC is binding and must be implemented; TCA 2007 is in force and must be implemented and enforced; Children Act 2001 provides the protection of children from exposure to anything that would affect their health; What about tax increase=revenue increase? Every Kshs1 earned=Kshs 3 in health care cost. Source of argument unknown…..

Arguments of those at border or against TC in government Kenya has no health problems as far as tobacco is concerned and point out that the consumers of tobacco in Kenya are few Most products are consumed either in Somalia and/or South Sudan and advise that Kenya is least concerned with health problems of other countries Kenya has few farmers planting tobacco with the tobacco used coming from Malawi, Zambia, Tanzania and DRC Congo

Arguments of those at border or against TC in government…. There is no real time Kenyan data on tobacco related diseases, deaths and externalities from major hospitals and are hesitant to rely on data from other countries to convince trade counterparts of the dangers of tobacco consumption and rationale behind tobacco control Tobacco Control Board has a “bad attitude” towards other policy makers. They are accused of lacking a diplomatic face and view their trade counterparts as collaborators of the industry

Arguments of those at border or against TC in government..… Tobacco is not among the prohibited products listed by the Kenya Revenue Authority (KRA) Tobacco products have the Kenya Bureau of Standards (KEBS) mark of quality hence consumers are would be within their rights to consume the products Tobacco is not illegal (it’s not prohibited or restricted) Tobacco firms assist farmers in the production process from provision of inputs, credit facilities and extension services whose expertise the Ministry of Agriculture lacks

Arguments of those at border or against TC in government..… There is tax that is collected by the government from the firms and tobacco sales Tobacco firms are engaged in Corporate Social Responsibilities (CSR) There are both forward and backward linkages as a result of tobacco production in the country e.g. employment and farming

Conclusion Role of the director of public health? Quality of representatives from other government agencies in the TCB – input in decisions? Role of the TCB - focus on advisory role… cohesive vision to encourage others to be part of TC or combative? Role of NACADA? CPHO member of NACADA; secretary to the board… TCB & Min of Health firm understanding of the economic policy arguments/rationale

Conclusion… County governments domestication of tobacco laws- Min of Health devolved; Ministry of Agriculture’s stance that tobacco is a non-scheduled crop. Participation of ministry in art 17 & 18 working group…ownership of progress

Thank You