Facilitators and barriers in the formulation and implementation of tobacco control policies in Kenya: A qualitative study

Abstract

Background: Tobacco use has serious public health implications for both smokers and non-smokers and significant economic implications on health care spending for governments. Tobacco-related deaths are preventable through well-formulated and implemented tobacco control policies. Using tobacco policy as a case study, we aim to describe the tobacco control policy formulation and implementation and the associated facilitators and barriers in Kenya. Method: We used a case-study methodology to integrate two sources of data: a document review of relevant policy documents, published articles and reports between 2004 and 2015 (N = 24 documents) and in-depth interviews (N = 39). Participants were from sectors relevant to tobacco control: research and academia, government, private industry, civil society and non-governmental organizations. Thematic analysis was used to analyze all data. Results: Kenya developed a comprehensive tobacco policy in 2007. The main facilitators to the policy formulation and implementation process were (1) political commitment and strong leadership, (2) the presence of a coordination mechanism, (3) stakeholder passion and commitment, (4) resources and (5) constitutional requirement for inclusion of stakeholders. The main barriers to policy formulation and implementation were (1) industry interference, (2) resources, (3) poor enforcement and (4) lack of clear roles. Conclusion: Although the process for formulating a tobacco control policy in Kenya was protracted, the current policy aligns well with current global efforts. The implementation is still weak and this can be enhanced by provision of necessary resources and continued engagement of all relevant stakeholders. There is a need for continued engagement with political leadership and continuous international information exchange on how policy-makers can address and counter industry interference in tobacco control efforts.