Assessing capacity of enforcers and level of enforcement of the tobacco control act 2015 in kampala.

Abstract

Background Tobacco use is the leading cause of preventable death worldwide killing non-users who are affected by the second hand smoke. Uganda enacted a comprehensive Tobacco Control Act 2015 (TCA) to domesticate the WHO FCTC which is now in its second year into force but it is not known whether the enforcers have the required capacity to enforce this law in Kampala. The objectives of this study were to determine the knowledge and attitudes of the enforcers and the level of enforcement of the TCA, as well as to explore the predictors of capacity to enforce and key barriers to the TCA enforcement in Kampala. Methods: A cross sectional study using both quantitative and qualitative methods was employed to assess capacity of enforcers from institutions located in Kampala mandated to implement the TCA 2015. A Semi Structured questionnaire was used for data collection using kobo-collect software for the quantitative survey and a WHO adapted capacity assessment guide was used for key informant interviews. Capacity to enforce was assessed using elements that checked the enforcer‟s knowledge and attitudes about the law, their motivation to enforce and the self-efficacy towards enforcing the law. Results: A total of 162 interviews from 5 institutions (KCCA, URA, NEMA, UNBS and Police) and six key informant interviews were conducted between March and May 2018. This study showed that only 23% (37/162) of the enforcers had capacity to enforce. Predictors of capacity to enforce were found to be male gender [AOR = 0.16, 95% CI (0.05 - 0.55), p<0.01)], having knowledge when the law was passed [AOR = 0.19, 95% CI (0.07-0.52, p < 0.01)], having plans to enforce [AOR = 0.22, 95% CI (0.05-0.93, p = 0.04)] and age range 21-30 years [AOR = 0.27, 95% CI (0.09 - 0.81), p<0.02)]. The level of enforcement of TCA was mainly low to moderate for most of the institutions mandated to enforce the TCA. Lack of knowledge about the law amongst the enforcers and the general public and lack of adequate funds were reported as major barriers to enforcement. Conclusion: The capacity to enforce the TCA in Kampala was low but there is potential to develop this capacity through dissemination of tobacco control law as well as sensitization of enforcers, institutional managers and the general public about the harmful effects of tobacco use and tobacco control generally.