Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Globalization and Health
Published in: Globalization and Health 1/2018

Open Access 01-12-2018 | Research

The institutional context of tobacco production in Zambia

Authors: Ronald Labonté, Raphael Lencucha, Jeffrey Drope, Corinne Packer, Fastone M. Goma, Richard Zulu

Published in: Globalization and Health | Issue 1/2018

Login to get access

Abstract

Background

Tobacco production is said to be an important contributor to Zambia’s economy in terms of labour and revenue generation. In light of Zambia’s obligations under the WHO Framework Convention of Tobacco Control (FCTC) we examined the institutional actors in Zambia’s tobacco sector to better understand their roles and determine the institutional context that supports tobacco production in Zambia.

Methods

Findings from 26 qualitative, semi-structured individual or small-group interviews with key informants from governmental, intergovernmental and non-governmental organisations were analysed, along with data and information from published literature.

Results

Although Zambia is obligated under the FCTC to take steps to reduce tobacco production, the country’s weak economy and strong tobacco interests make it difficult to achieve this goal. Respondents uniformly acknowledged that growing the country’s economy and ensuring employment for its citizens are the government’s top priorities. Lacklustre coordination and collaboration between the institutional actors, both within and outside government, contributes to an environment that helps sustain tobacco production in the country. A Tobacco Products Control Bill has been under review for a number of years, but with no supply measures included, and with no indication of when or whether it will be passed.

Conclusions

As with other low-income countries involved in tobacco production, there is inconsistency between Zambia’s economic policy to strengthen the country’s economy and its FCTC commitment to regulate and control tobacco production. The absence of a whole-of-government approach towards tobacco control has created an institutional context of duelling objectives, with some government ministries working at cross-purposes and tobacco interests left unchecked. With no ultimate coordinating authority, this industry risks being run according to the desire and demands of multinational tobacco companies, with few, if any, checks against them.
Footnotes
1
Trade value in US$.
 
2
Tobacco leaf accounted for only 1.67% of the total of Zambia’s exports in 2012.
 
3
In a revealing aside, the same report comments with respect to trade that when Zambia liberalized in 1993 as a conditionality of a structural adjustment loan, “The immediate impact…was a further deterioration in manufacturing sector performance” (¶ 4.1.10). One rebounding exception in the later 1990s was growth in the tobacco sector.
 
4
This estimate uses the old ZMK currency, and not the post 2013 re-valued ZMW.
 
5
This is a questionable assertion. Over the period that tobacco production increased in Zambia (since the late 1990s), the World Bank extreme poverty rate (<$1.90/day in consumption) increased from 41% (1996) to 64% of the population (2010), the latest year for which data are available (data adjusted to 2011 prices). There was also a parallel decline in the share of income held by the lowest 20% since the early 2000s. World Bank Indicators, http://​data.​worldbank.​org/​country/​zambia, Accessed January 10, 2017.
 
6
We explore how regional trade agreements shape tobacco production and consumption patterns in a separate paper presently under review.
 
7
The individual also seemed to be under the mistaken impression that Zambia was still negotiating ratification of the FCTC when in fact it had ratified the convention 5 years earlier.
 
8
This support program for small-scale farmers in 2015 was expanded to include nine crops (maize, rice, sorghum, groundnuts, orange maize, soya, cotton, beans and sunflower) but continues to exclude tobacco (http://​www.​parliament.​gov.​zm/​sites/​default/​files/​images/​publication_​docs/​Ministerial%20​Statement%20​-%20​Hon.​%20​Minister%20​of%20​Agric%20​and%20​Livestock%20​01.​10.​15.​pdf) Accessed 10 January 2017.
 
9
Such dialogue is actually discouraged by the FCTC’s Article 5.3, which requires that “in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.”
 
10
Neither the Ministry of health NGO informant offered any substantiation for their perceptions. In 2015 Zambia committed 9.6% of its expenditures to health, four times what it provided in the Farmer Input Support Program. In US$ terms, total health spending (US$628 million) was around 7 times more than annual revenues earned from tobacco, although what portion of health spending went to tobacco-related diseases is not known. See: http://​www.​parliament.​gov.​zm/​sites/​default/​files/​images/​publication_​docs/​2015%20​Budget%20​Speech_​0.​pdf Accessed 10 January 2017.
 
11
This requirement is stated as one of the principles of Article 5.3 of the Convention (http://​www.​who.​int/​fctc/​guidelines/​article_​5_​3.​pdf Accessed 9 January 2017).
 
12
Recent media accounts suggest there may be more than one, with a new one opening as recently as December 2016 in Zambia’s Northern Province (https://​www.​lusakatimes.​com/​2016/​12/​07/​kasama-another-agro-processing-plant/​ Accessed 8 January 2017).
 
Literature
1.
2.
WHO. Tobacco agriculture and trade. Geneva: WHO; 2016.
3.
Tembo S, Sitko N. Technical compendium: descriptive agricultural statistics and analysis for Zambia. Indaba Agricultural Statistics for Zambia: Lusaka, Zambia; 2013.
4.
5.
6.
Butler S. Obstacles to the implementation of an integrated National Alcohol Policy in Ireland: nannies, neo-liberals and joined-up government. J Soc Policy. 2009;38(2):343–59.CrossRef
7.
Axelsson R, Bihari-Axelsson S. Intersectoral problems in the Russian organisation of public health. Health Policy. 2005;73(3):285–93.CrossRefPubMed
8.
Kavanagh D, Richards D. Departmentalism and joined-up government. Parliam Aff. 2001;54(1):1–18.CrossRef
9.
Christensen T, Lægreid P. The whole-of-government approach to public sector reform. Public Adm Rev. 2007;67(6):1059–66.CrossRef
10.
Christensen T, Lægreid P. The challenge of coordination in central government organizations: the Norwegian case. Public Organ Rev. 2008;8(2):97–116.CrossRef
11.
12.
Lencucha R, Drope J, Chavez JJ. Whole-of-government approaches to NCDs: the case of the Philippines interagency committee—tobacco. Health Policy Plan. 2015;30(7):844–52.CrossRefPubMed
13.
Drope J, Lencucha R. Tobacco control and trade policy: proactive strategies for integrating policy norms. J Public Health Policy. 2013;34(1):153–64.CrossRefPubMed
14.
Ostrom E. An agenda for the study of institutions. Public Choice. 1986;48(1):3–25.CrossRef
15.
Ostrom E. Background on the institutional analysis and development framework. Policy Stud J. 2011;39(1):7–27.CrossRef
16.
Ostrom E. Understanding institutional diversity. Princeton, New Jersey: Princeton University Press; 2005.
17.
18.
Drope J, Lencucha R, Magati P, Small R. Tobacco control governance in sub-Saharan Africa: implementing article 5.2(a) of the World Health Organization framework convention on tobacco control. UNDP and WHO FCTC Convention Secretariat: New York, NY; 2016.
19.
Brusca I, Montesinos V. International experiences in whole of government financial reporting: lesson-drawing for Spain. Public Money Manag. 2009;29(4):243–50.CrossRef
20.
Lencucha R, Drope J, Labonte R, Zulu R, Goma F. Investment incentives and the implementation of the framework convention on tobacco control: evidence from Zambia. Tob Control. 2016;25:483–7.CrossRefPubMed
21.
Greer SL, Lillvis DF. Beyond leadership: political strategies for coordination in health policies. Health Policy. 2014;116(1):12–7.CrossRefPubMed
22.
Duit A, Galaz V. Governance and complexity—emerging issues for governance theory. Governance. 2008;21(3):311–35.CrossRef
23.
Vangen S, Huxham C. Enacting leadership for collaborative advantage: dilemmas of ideology and pragmatism in the activities of partnership managers. Br J Manag. 2003;14:S61–76.CrossRef
24.
Wilkins P. Accountability and joined-up government. Aust J Public Adm. 2002;61(1):114–9.CrossRef
25.
Brinkerhoff DW. Coordination issues in policy implementation networks: an illustration from Madagascar’s environmental action plan. World Dev. 1996;24(9):1497–510.CrossRef
26.
Schmidt VA. Discursive institutionalism: the explanatory power of ideas and discourse. Annu Rev Polit Sci. 2008;11(1):303–26.CrossRef
27.
Schmidt VA. Taking ideas and discourse seriously: explaining change through discursive institutionalism as the fourth “new institutionalism.”. Eur Polit Sci Rev. 2010;2(1):1–25.CrossRef
28.
Stoker G. Governance as theory: five propositions. Int Soc Sci J. 1998;50(155):17–28.CrossRef
29.
Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. London: SAGE; 1994. p 358.
30.
Noy C. Sampling knowledge: the hermeneutics of snowball sampling in qualitative research. Int J Soc Res Methodol. 2008;11(4):327–44.CrossRef
31.
32.
Goma F, Drope J, Zulu R, Li Q, Chelwa G, Labonte R, et al. The economics of tobacco farming in Zambia. Lusaka, Zambia and Atlanta, USA: University of Zambia; American Cancer Society; 2016.
33.
Vision 2030: A prosperous middle-income country nation by 2030. Lusaka, Zambia: Republic of Zambia; 2006.
34.
35.
36.
37.
38.
Ministry of Health. National Health Strategic Plan 2011–2015. Lusaka, Zambia: Ministry of Health; 2010.
39.
40.
41.
Jha P, Chaloupka FJ. Curbing the Epidemic: Governments and the Economics of Tobacco Control. Washington: World Bank Publications; 1999. p 140.
42.
Lencucha R, Drope J, Labonte R. Rhetoric and the law, or the law of rhetoric: how countries oppose novel tobacco control measures at the World Trade Organization. Soc Sci Med. 2016;164:100–7.CrossRefPubMedPubMedCentral
43.
The National Agriculture Policy 2012-2030. Zambia: Minstiry of agriculture and co-operatives. p. 2011.
44.
Lee K, Chagas LC, Novotny TE. Brazil and the framework convention on tobacco control: Global Health diplomacy as soft power. PLoS Med. 2010;7(4):e1000232.CrossRefPubMedPubMedCentral
45.
46.
Bialous S, da Costa E Silva V, Drope J, Lencucha R, McGrady B, Richter AP. The Political Economy of Tobacco Control in Brazil: Protecting Public Health in a Complex Policy Environment. Rio de Janeiro, Brazil: Centro de Estudos sobre Tabaco e Saúde, Escola Nacional de Saúde Pública/FIOCRU; 2014.
47.
Harvey D. The new imperialism. New York, USA: Oxford University Press; 2003.
48.
Labonté R, Stuckler D. The rise of neoliberalism: how bad economics imperils health and what to do about it. J Epidemiol Community Health. 2016;70(3):312–8.CrossRefPubMed
49.
Schrecker T, Bambra C. How Politics Makes Us Sick: Neoliberal Epidemics. London: Springer;2015. p 179.
50.
Kalamwina C. Managing the transition from the millenium development goals to the sustainable development goals: what will it take (report to the United Nations). New York, USA: Permanent Mission of the Republic of Zambia to the United Nations; 2015.
51.
Makoka D, Drope J, Appau A, Labonté R, Li Q, Goma F, et al. Costs, revenues and profits: an economic analysis of smallholder tobacco farmer livelihoods in Malawi. Tob Control. 2017;26:634–40.CrossRefPubMed
Metadata
Title
The institutional context of tobacco production in Zambia
Authors
Ronald Labonté
Raphael Lencucha
Jeffrey Drope
Corinne Packer
Fastone M. Goma
Richard Zulu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2018
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-018-0328-y

Other articles of this Issue 1/2018

Globalization and Health 1/2018 Go to the issue

Research

Does quality influence utilization of primary health care? Evidence from Haiti

Research

Regional organisations supporting health sector responses to climate change in Southeast Asia

Research

Results-based aid with lasting effects: sustainability in the Salud Mesoamérica Initiative

Research

Saving Lives at Birth; development of a retrospective theory of change, impact framework and prioritised metrics

Research

Defining the global health system and systematically mapping its network of actors

Research

Health service utilization, unmet healthcare needs, and the potential of telemedicine services among Korean expatriates