Identifying Key Barriers and Facilitators to Implementing WHO Framework Convention on Tobacco Control Regulations in...

To document the development and implementation of a World Health Organization Framework Convention on Tobacco Control (FCTC)-guided law in Ethiopia.

We analyzed 15 publicly available documents, including news articles and government documents. We triangulated findings by interviewing three tobacco control advocates, two academic researchers, and four government officials. We used a thematic framework analysis to analyze the data and documented this through a retrospective policy analysis.

Local and international health advocacy groups supported regulation development through capacity-building workshops. The National Tobacco Enterprise/Japan Tobacco International used standard industry arguments to weaken draft regulations, but government officials, supported by health advocacy messages promoting Ethiopia's World Health Organization FCTC obligations, rejected these arguments. Key barriers to implementation included industry interference, lack of funding and resources, monitoring and evaluation system issues, government system coordination issues, and a lack of organizational knowledge. Key facilitators included financial mechanisms and health advocacy support, and government and inter-governmental support, which contributed to increased monitoring, education efforts, and technical support.

The tobacco industry remains the biggest barrier to FCTC implementation, continuing to advertise at the point-of-sale, fuel illicit tobacco trade, and push the sale of single-cigarette sticks near schools. Other barriers include a shortage of funding/resources, a lack of strict enforcement, and an absence of local regulations. Financial and technical support and leveraging the FCTC as a legal instrument can help uphold strong regulations. More efforts are needed to educate government authorities and establish local regulations to protect policy implementation.

Previous studies have analyzed the adoption of World Health Organization Framework Convention on Tobacco Control (FCTC)-guided policies, but less is known about implementing these policies, especially in World Health Organization African Region. This study analyzed the key barriers and facilitators to developing and implementing FCTC-guided regulations in Ethiopia. Barriers include tobacco industry interference (youth advertising and fueling illicit tobacco), a shortage of funding/resources, and a lack of strict enforcement and local regulations. Financial and technical support and leveraging the FCTC as a legal instrument can help uphold strong regulations. Efforts are needed to educate government authorities and establish local regulations to protect policy implementation.