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KOMPLY

A Project to Support Compliance with the Smoke-free Law in Bars and Restaurants in Kampala, Uganda

 

This project aims to communicate the level of compliance with the indoor 100% smoke-free law in bars and restaurants in Kampala, Uganda to the public, government officials (the Ministry of Health Uganda), and Civil Society Organizations (CSOs) so as to facilitate and enable CSO’s to advocate for stronger compliance of the smoke-free law through the development of resources/skills tools.

The KOMPLY Team

Shannon Gravely BSc, MSc, PhD

Shannon Gravely holds a Ph.D. from York University, Toronto, Canada from the Department of Kinesiology and Health Sciences, Faculty of Health. Additionally, she completed her post-doctoral fellowship at Stony Brook University Health Sciences Center, Stony Brook, NY, USA. Her first decade of post-graduate and professional research was in the domain of cardiovascular behavioural medicine. Shannon joined the International Tobacco Control Evaluation Project (ITC) team in 2013 as a Research Scientist, and in 2015 was appointed to Research Assistant Professor. Her primary role with the ITC team is analysis, interpretation, and writing of scientific publications and presentations of ITC Project data. She is involved in the development and implementation of research studies involving data from several of the ITC Projects including a focus on electronic cigarettes and vapourized nicotine products (VNPs) through cross-sectional and longitudinal analyses, and to measure and track the current psychosocial and behavioral impact (effectiveness) of current policies (or lack of policies) in each of the domains of the WHO Framework Convention on Tobacco Control (FCTC), and, when policies are implemented, to conduct rigorous evaluation of their impact over time. Overall, Shannon is involved with analyzing, interpreting, writing, and disseminating findings from these important global studies on tobacco control and their critical role in policy evaluation and movement for action towards chronic disease prevention. Shannon currently holds a 3-year Canadian Cancer Society Career Development Award in Prevention.

Jean Christophe Rusatira MB, ChB

Jean Christophe, 27 years old male, Medical doctor, founder of Healthy People Rwanda and Finance Officer of the International Youth Alliance for Family Planning from when it was founded in 2013. He was one of the winners of the WHO World No Tobacco day award in 2013 and won the Stars in Global Health by the grand challenges Canada the same year. He has been member of Medical Students’ Association of Rwanda (MEDSAR) from 2008 where he did most of his work in health education focusing on tobacco, non-communicable diseases and sexual health. In 2010, he was elected Director of the Standing Committee on Public health of the MEDSAR. With a team from the George Washington University, he initiated the Maternal Child health care program working in two health centers in Huye District helping 256 mothers with malnourished children. In 2011, he initiated the Rwandan Health Education Project that focused on reproductive health education in youth and people in the villages of southern and Kigali City Provinces reaching over 7640 young people over two years. He was coordinator of the Rwandan Youth Organization Network, organizing the first and second national youth organizations’ exhibitions. In 2013, he founded the medfoster group, and initiated the web-based medical education platform www.medfoster.com and has worked with the Rochester Institute of Technology and the University of Rwanda to further develop user-centered Interactive technology for Medical education.

Kellen Namusisi MSc

Kellen’s key roles at the Centre for Tobacco Control in Africa include providing technical advice on M&E to the 10 target countries in Africa on tobacco control. She has over 10 years’ public health experience focused on project design, management & M&E and organizational development including systems strengthening. Her achievements include; project design and execution, establishing monitoring and evaluation frameworks and systems, developing advocacy and communication strategies, developing strategic plans, capacity building and research. Kellen’s research priorities include health systems strengthening and health policy research.

Kellen holds a Master’s of Science in Population and Reproductive Health from Makerere University Kampala Uganda and a two year Fellowship in HIV/AIDS management by Makerere University and CDC.

Lindsay Robertson BSc, MPH

After an undergraduate degree in psychology, and several years of experience as a mental health promotion advisor, Lindsay decided to complete an MPH and is now in the final stages of her PhD.  Based at the University of Otago in New Zealand (NZ), Lindsay’s PhD is exploring different tobacco retail policies that could be introduced in NZ to change the way tobacco is sold.  At the moment in NZ tobacco is sold almost everywhere, and unlike alcohol, retailers don’t need a licence to sell tobacco.  After investigating tobacco retail policies that have been introduced in overseas countries, Lindsay came to see how valuable research could be in terms of influencing public policy, and equally, how important policy approaches were as a tool to reduce inequity.  Lindsay’s passion for her work stems for a desire to work in a field that emphasises social justice and reducing inequity. Lindsay hopes her work will be used in advocacy efforts, to encourage the government towards adopting policies to better regulate the tobacco retail environment.

Achiri Ndikum BS

Elvis Ndikum Achiri originates from the North West region of Cameroon. He holds a Bachelor degree in Animal and Physiology Biology from the University of Yaounde 1, the mother state University of Cameroon in 2010. He is currently working with the Cameroon Coalition to Counter Tobacco (C3T) as Campaign Officer, advocating for the adoption of a strong tobacco control law in Cameroon. He is also a representative of the African region within the International Union Against Tuberculosis and Lung Diseases , and represented the Cameroon youth civil society during the 16th World Conference on Tobacco or Health (WCTOH 2015). Elvis is the Founder/President of the Association for the Promotion of Youth Leadership, Advocacy and Volunteerism (APYLAV Cameroon), created in 2014 with a vision to promote peace and eradication of poverty among youths. He also launched a petition on CAUSES.COM for “NO MORE TOBACCO IN CAMEROON”. The Global Asthma Network selected him as Principal Investigator to conduct a field research in Yaounde Cameroon on Global Surveillance: Prevalence, Severity, Management and Risk Factors. With aim of having “A World Where no-one suffers from asthma”.

Adeniyi Oginni MB ChB, MPH

Dr. Adeniyi Oginni is a Public Health Physician and Chief Medical Officer at Osun State Hospitals’ Management Board, Osogbo, Nigeria. He trained at Obafemi Awolowo University, Ile-Ife, (Nigeria) for his basic medical degree and University of Ibadan, (Nigeria) for his Master of Public Health degree through a fellowship of the World Health Organisation. He is rounding off his Ph.D programme in Ecology and Environmental Science at the Institute of Ecology and Environmental Studies of the Obafemi Awolowo University, Ile-Ife. His research interest is in risk factors for cardiovascular and respiratory diseases, advocacy and translation of research to implementation. He is currently assessing the effects of metal smelting on selected environment related human health indices in Osun state.

Kelvin Khow MSc, BS

Mr. Kelvin Khow has been working with the World Health Organization (WHO) in various capacities for over 12 years. He is presently Acting Coordinator of the Tobacco Free Initia-tive programme at the Division of Noncommunicable Diseases and Health Through the Life-Course (DNH) at the WHO Regional Office for the Western Pacific based in Manila, Philippines. Previously, he was the Programme Management Officer at the DNH Division. Prior to this, he was working at the WHO Country Office in Iraq on health sector reform and United Nations and donor coordination and before that at the WHO Headquarters office in Geneva, Switzerland on mental health and substance abuse issues and country support. Kelvin’s broad areas of interest include health promotion, leadership capacity building and tobacco control and he is actively involved in assisting countries in the region strengthen their tobacco control policies and measures as well as to advocate for sustainable funding in order to increase investments in prevention of noncommunicable diseases. Kelvin has stud-ied at the London School of Hygiene and Tropical Medicine, University of Michigan, USA and University of Melbourne in Australia.

Andrii Skipalskyi MBA

Andrii Skipalskyi is chairman of the board of the Advocacy Centre LIFE – a non-profit, non-governmental organization that provides advocacy and tobacco control expertise in Ukraine and the eastern European region.

As acknowledgement of his personal and team achievements in May 2015 Andrii received The Judy Wilkenfeld Award for International Tobacco Control Excellence from Campaign for Tobacco Free Kids and on behalf of LIFE team – The Bloomberg Award for Global Tobacco Control in March 2015. Besides Mr Skipalskyi became a Eurasia Foundation Fellow on “Innovations in Advocacy and Public Health in December 2014.

Andrii have been working with LIFE since 2010, providing overall management and advocacy expertise for the Smoke Free Ukraine project, funded by the Campaign for Tobacco Free Kids. Andrii also regularly publish articles in national newspapers focused on tobacco industry interference, tobacco control and public advocacy. As the result of effective tobacco control advocacy, smoking prevalence has fallen drastically by 12% since 2006, dropping Ukraine from the country with the 4th highest rate of smoking (2006) to 24th place according to the WHO report.Prior to this, Andrii worked in international technical assistance projects in the field of social investments, advocacy, anti-corruption and media development, since 2000.

Advocacy Center “LIFE” serves as the secretariat and resource center for the Coalition for a Tobacco Free Ukraine, a coalition of over 100 organizations, and manages a tobacco control press center with ties to over 200 national and regional media.

Socrates Kakoulides MD

Socrates is a physician and documentary filmmaker, whose focus is on producing social impact media. He is the Senior Producer at United Nations on their virtual reality experiences, and recently produced “Clouds Over Sidra” about life in a Syrian refugee camp and “Waves of Grace,” the story of an Ebola survivor in Liberia. His work has screened in film festivals such as Sundance, Tribeca, IDFA and received the 2015 Interactive Award at the Sheffield Doc/Fest. Socrates is a cardiology fellow in New York and a published researcher on public health in underserved communities.  This work has includes studying the impact of media on health behaviours.

Specific Aims

To ensure 100% compliance with the new 100% smoke-free law in bars and restaurants in Kampala, Uganda. To communicate the level of compliance with the indoor 100% smoke-free law in bars and restaurants in Kampala, Uganda to the public, government officials (the Ministry of Health Uganda), and Civil Society Organizations (CSOs) so as to facilitate and enable CSO’s to advocate for stronger compliance of the smoke-free law though the development of resources/ skills tools. This project will also involve the training of the team members from three other countries in Africa (Cameroon, Nigeria, and Rwanda) so that objectives measures of proxy indicators and PM2.5 measurements can be taken there to support future initiatives.

  1. To assess the level of compliance with the 100% indoor smoke-free law in bars and restaurants in Kampala Uganda by measurement of (1) indoor-air quality PM2.5 levels and (2) documentation of the presence or absence of signage and other proxy indicators of smoking in selected bars and restaurants, immediately after the smoke-free law is implemented in May 2016, and then again after enforcement is applied by law in November 2016.
  2. To examine the factors contributing to the level of compliance with the 100% indoor smoke-free law (e.g. awareness, attitudes, and compliance) among bar and restaurant owners, managers and employees.
  3. To train the three KOMPLY team members from other African countries (Cameroon, Nigeria, and Rwanda) to measure both proxy indicators of smoking and non-compliance and indoor-air quality PM2.5.

Background

Article 8 of the WHO FCTC requires Parties to adopt and implement legislative and other measures providing for protection from exposure to tobacco smoke in indoor public places, workplaces, public transport, and, as appropriate, other public places.8 As part of the gold-standard of smoke-free laws, designated smoking rooms or ventilation schemes are not permitted, as complete prohibition of smoking in all indoor environments is the only intervention that effectively protects people from the harm of SHS.

Prior to the adoption of the FCTC, there was little or no progress in the implementation of smoke-free policies. The 2002 Tobacco Atlas reported that in 2000, not a single nation had implemented a comprehensive smoke-free law. Rather, those nations with any kind of smoke-free law had only partial and/or voluntary restrictions on smoking in some public places or workplaces. The adoption of the FCTC was a strong catalyst for advancement because it put in place the necessary framework to encourage nations to proceed with enacting tobacco control policies. With this, Ireland became the first country to go smoke-free in all public places and workplaces, including restaurants and pubs, on March 29, 2004. Thereafter, many FCTC nations followed suit as ratification took place in great numbers, and scientific evidence became available. Between 2005 and 2014, nearly 50 countries (representing 18% of the world’s population) have enacted or implemented strong smoke-free legislation across the globe.

The magnitude of reductions in smoke in public places is related to the strength and comprehensiveness of Article 8 policies. While 49 countries have implemented smoke-free legislation to the highest level possible (and in-line with article 8 guidelines), and many other countries have partial public locations covered, many countries fall short when it comes to enforcement of, and compliance to, their smoke-free laws. In particular the African region lags behind much of the world in both the implementation and compliance with smoke-free laws. In particular, there are certain venues where exposure is extremely high, such as bars and restaurants. For example, a study in Kenya, Zambia and Mauritius (which included a representative sample of 4,251 smokers) reported that the prevalence of smoking in bars was 83%, 70% and 45% respectively, despite there being smoke-free legislation that includes these establishments. In Uganda, exposure to SHS in bars and restaurants has been estimated to be 62%. Given that in low and middle income countries (LMICs) such as Uganda, tobacco control legislation is susceptible to poor implementation and public sector corruption, and low compliance, civil society and academia have potentially an important role to play in monitoring the adherence to smoke-free legislation, including monitoring compliance and air contamination levels.

Currently, smoking prevalence in Uganda is 10.3% of men, 1.8% of women, and 5.8% overall (0.9 million adults).Although low in relation to other countries, the tobacco industry has turned its’ attention to Africa and WHO predicts that if nothing is done to stop this effort, then smoking prevalence in the African region will only grow.16, 16 The Ugandan government recognized the urgency to move forward with strong tobacco control measures and passed new legislation in 2015 under the Tobacco Control Act 2015. Uganda’s 2015 tobacco control law is a comprehensive set of regulations which include a 100% ban on smoking in indoor public places, workplaces and public transport; prohibition on smoking within 50 meters of all public places; pictorial health warnings, covering 65% of the pack to inform the public of the dangers of tobacco; a ban on the sale of cigarettes to and by persons less than 21 years; a ban on tobacco advertising, promotion and sponsorship (TAPS); requirements that cigarette packs should not be prominently displayed at point-of-sale. The law is supposed to be enforced by officers appointed by the government and will include specific public health officers under the Public Health Act, environmental inspectors from the National Environmental Management Authority (NEMA), standards inspectors from the National Bureau of Standards, customs officers under the Uganda Revenue Authority, and other persons whose duty is to maintain law and order. While the law was adopted in September 2015, it will be implemented in May 2016, yet a period of six months is allowed after implementation until enforcement of the law becomes mandatory (i.e. this will occur in November 2016).

In this project, we aim to gather information on the level of compliance with the smoke-free law at high-risk hospitality venues and on the reasons why a venue does or does not comply with the law.  Ultimately, our project intends to monitor and support compliance with the smoke-free law in Uganda, and to share lessons learned with other African colleagues on how to advocate for enforcing smoke-free laws.

Methodology

Objective and subjective data about compliance with the smoke-free law will be collected, collated and used to engage with a range of stakeholders, such as the government, the public, and civil society organizations (CSOs). This information will be used to guide key parties about how they can act to improve compliance in hospitality environments.  Specifically, the results should be used to educate venue owners, policymakers, employees, and/or the general public about the existence of the smoke-free law, the status of compliance, and what they can do to increase compliance.

Moreover, this project will involve training our own team members from other African countries how to measure air quality and other objective proxy indicators of non-compliance so that each member will be able to take measurements in indoor public places. This could be used as evidence to advocate for smoke-free laws where they do not yet exist, and to monitor compliance as smoke-free laws are implemented (or to strengthen laws that are in place but where there is poor compliance).

We intend to engage and collaborate with tobacco control CSOs in Uganda to determine their needs in relation to supporting the implementation of the smoke-free law, and co-design advocacy tools that help improve compliance.  We will focus the campaigns around key messages from the study, and will direct the campaign at groups that we identify as important to the success of the smoke-free law.  The advocacy tools will take the form of media best suited for our target audience.  Potential examples of such a tool include a social media campaign directed at young smokers and their peers, a “Thank You for Not Smoking” poster campaign around bars and restaurants, a public awareness campaign using “100% Smoke-Free” graffiti murals in city centers, stylized “Smoke Free” logos for successfully complying bars and restaurants, and video training sessions for law-enforcement officers outlining key messages of the law.

Identification of CSOs will be undertaken in the stakeholder mapping exercise, however, likely CSOs include: Uganda Health Communication Alliance, Uganda National Consumers Organization, Text to Change, Parliamentary Forum on NCDs, Uganda National Tobacco Control Alliance. The CSOs can use the project findings to design advocacy messages in order to reach the public, restaurant and bar owners, as well as policy makers. The messages will be communicated through platforms such as social media, media press briefings, TV, radio and during meetings.

Dissemination and Publication Plan

Deliverables

  1. Map key stakeholders and identify potential champions for enhancing enforcement and advocacy.
  2. Establish a working group of representatives from key CSOs, hold meetings with CSOs in order to develop advocacy tools based on their input (and interview data) in order to help them communicate the state of compliance of the 2016 Smoke-Free law in hospitality environments, and how to help in facilitating communication for better compliance with the law, and design media advocacy tools in partnership with CSOs.

Dissemination and Publication Plan

We will work with key stakeholders and champions on a dissemination and communications plan to include activities such as

  1. Conduct a press conference with government and CSOs with a focus on health and tobacco control, and tobacco control officials (specifically enforcement agencies).
  2. Prepare and submit a journal article to a relevant public health journal for publication.
  3. Disseminate a press release on national media targeted at the general public, included bar and restaurant venue owners/managers/employees.
  4. Prepare and submit a scientific report and send it directly to the government tobacco control and health branch and relevant CSO partners
  5. Design and prepare a factsheet for all participating sites that highlights the project’s findings about compliance to the smoke-free law among the participating hospitality sites. The fact sheet will be creatively designed to catch the attention of these venue owners. It will also include suggestions about how they can help to increase compliance with the smoke-free law within their respective establishment.

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