Ugandans continue inhaling tobacco smoke in the face of the law

A young boy of about five years wheezes helplessly, scratching his skin. His eyes have turned red. It is 6pm and the taxi park is jammed by passengers heading back home from work.
The child, in company of his mother, is reacting to smoke permeating from the ground through the crowded waiting passengers in down town Kampala.
“Oh God!” the boy’s mothers mutters as she struggles to cover her younger child in a baby sling to avert it from inhaling the tobacco smoke.

The smoke emanates from a cigarette butt finished by one of the passengers even after the fire had long been extinguished. For the next five minutes, the tobacco smell still lingers around the taxi stage.
According to the World Health Organisation (WHO), secondary smokers – another term for passive smokers, which is the inhalation of second-hand smoke by persons other than the primary (active) smoker – exposed to tobacco from the primary smokers, become the non-suspecting smokers and stand a higher risk of several diseases, including at least 14 types of cancer, heart disease and various lung diseases.

Public smoking, however, occur in the face of the Tobacco Control Act (2015) that guarantees the right to a tobacco smoke-free environment, imposes a duty on the smokers not to expose nonsmokers to tobacco smoke.
The law also bans, among others, indoor tobacco smoking at 100 per cent and 50 metres of outdoor within public places, places of work, public means of transport as prescribed under sections 11 and 12 respectively. The 50 metres is approximately half way a football pitch.

Smoking is common in clubs located in the upscale parts of the city, mostly around Centenary Park, along Jinja Road. Many upscale clubs in Kampala are also known for the sale of shisha and shisha pot displays.
The trendy water piped (shisha) flavoured tobacco for middle class and youth has remained popular for its lucrative returns to bar owners among other nicotine products of electronic cigarettes, cigars and snuff.
This tobacco smoking shift from cigarettes to seemingly less demonised trends is purely hinged on the deceptive marketing schemes that paint a picture that these trends expose less harm to the smokers.
According to WHO, there is no safer level of tobacco exposure.

Sometimes referred to as hookah, narghile, water pipe, or bubble smoking, shisha is a way of smoking tobacco, at times mixed with fruit or molasses sugar, through a bowl and hose or tube.
The tube ends in a mouthpiece from which the smoker inhales the smoke from the substances being burnt into their lungs.

Each shisha pot in most clubs costs between Shs8,000 to Shs10, 000, so many youth can afford it.
However, Section 16 of the Tobacco Control Act (2015) provides that “a person shall not import, manufacture, distribute, process, sell, offer for sale or bring into the country tobacco products, including shisha, kuber and other smokeless (flavoured) tobacco products. Other electronic vaporistaion devices and water pipe devices are also banned by the law.
Although the legality of the law is drawn from Article 39 of the Constitution, which provides the right to a clean and healthy environment, the law is flouted in the face of the mandated enforcement institutions, among which are the Uganda Police Force.

Other government agencies instructed under the law to carry out enforcement in Section 26 of the Act include the National Environment Management Authority (Nema), the Kampala Capital City Authority (KCCA), Uganda Revenue Authority (URA), Uganda National Bureau of Standards, health inspectors appointed by the Health ministry and any other officer on whom any written law vests functions to enforce the laws of Uganda.

The 2013 Nationwide Adult Tobacco Study conducted by Ministry of Health and Uganda Bureau of Statistics (Ubos) showed that 9 per cent of Ugandans above 15 years are tobacco users, 6 per cent of whom are direct smokers while the 3 per cent use smokeless tobacco.
The ministry is yet to conduct a youth tobacco country survey.

The annual average medical cost of a current or former smoker suffering from a tobacco-attributed disease is Shs3, 697,255, which is 2.28 times the annual average medical cost of a never smoker, that is Shs1,619,309, according to the 2017 health cost of tobacco use in Uganda study conducted by the Centre for Tobacco Control in Africa (CTCA).

Similarly, the direct cost of treating tobacco attributable illnesses in Uganda is estimated to be Shs108b as per the study, twice the Shs50m annual budget of cancer institute and Shs12b annual budget of the heart institute.
Other tobacco products are also still readily available on the market at the low price affordable by the youth.

In one of the slum areas of Namuwongo, a city suburb in Makindye Division, the business of selling kuber is thriving, with sachet price ranging from Shs500 upwards depending on the flavour and type.
The highly addictive smokeless tobacco disguised as a mouth freshener in sachets, also contains marijuana which may lead to hormonal changes in the body and put one at risk of oral cancer.
At one of the booths disguised as a mobile money business shop, kuber is readily sold to anyone who asks for it regardless of their age as long as they can afford it. The youth make the majority number of the shop customers.

“Which law? All I know is this is where I fetch school fees for my children,” responds the woman at the booth when asked why she is selling the product.
“I am a widow. Let government find us other jobs if they want us to stop selling [kuber],” she added.
Police in collaboration with the Uganda National Health Consumer’s Organisation (UNHCO) have occasionally conducted anti-tobacco operations in different night clubs and bars and impounded shisha pots.
The night clubs and bars, however, resume the sale of similar tobacco products hardly a week after operations due to the absence of the surveillance systems.

Just a stone’s throw from a police post on Jinja Road is Centenary Park, which is considered as hub of shisha smoking. Asked whether he does not fear arrest by police, Emma Sagala, a perpetual shisha smoker at one of the clubs, sneers, saying he was aware of the law but it was none of his business.
“And what business does police have with us? We have always smoked in their presence and some of them are even our friends here,” said Sagala.
Mr Tiare Idwege, the commandant of Environmental Police, says despite the absence of a regulation to guide in the implementation of the law, which makes enforcement difficult, there is also ignorance among police officers.

“Police have to learn, but when there is illiteracy and ignorance it becomes hard. But we have tried our level best to put it into force,” Mr Idwege said.
Asked to account for shisha smoking suspects arrested in the previous operation, Mr Idwege stated that they have been using caution against the law offenders since the law is still new.
None of them has been arraigned and prosecuted in the courts of law.

Punishment
According to the law, one is fined up to Shs200,000 or imprisoned for a period not exceeding five months or both on conviction while the person responsible for the premises shall have his or her licence revoked and the premise locked for not less than six months.
However, Dr Sheila Ndyanabangi, the tobacco control officer at the Ministry of Health, disputes the absence of the regulation as a stumbling block in the effective enforcement of the law, saying the rest of the law is clear except a few areas.

“It’s a question of attitude on the side of the police. As Ministry of Health, we cannot enforce the law. One time we arrested people selling shisha and took them to Kira Road Police Station. The next day when we went back they had released them,” Dr Ndyanabangi said.
The regulation intended to provide more explanation in some areas, including advertising and display of warning stickers against smoking in public places on the side of traders. This is expected to be ready by the end of March, according to Dr Ndyanabangi. It will then be presented to Cabinet for adoption by end of year.

Nevertheless, the Tobacco Control Act (2015), which among others criminalises cigarette smoking in public places, came into force in May 2015. It provides a transition period of one year from the time of commencement before the manufacturers and traders can comply.
As we speak, the entire law is now enforceable considering that the Constitutional Court dismissed the application for any injunction on the Tobacco Control Act, allowing the law enforcers to continue with their work.

Tobacco control advocates are still waiting for the constitutional court petition challenging the legality of the law, but until the court rules otherwise, enforcers have no reason not to apply the law.
However, even with the expiration of the transition period, there is need for clarity on the vague areas in the law, otherwise there is some unguided compliance as citizens search for working mechanisms for eradicating tobacco exposure.

As such, the Environment Police has on several occasions raided bars and night clubs and confiscated shisha pots and smoking pipes, but taken no action against traders who display and promote tobacco products.
Among others, the law under Section 14 restricts the product packaging and labelling where the text and pictures comprising the health warnings and messages shall appear together and shall occupy no less than 65 per cent of each principal display area of the packet as well as the display or make visible a tobacco product at any point of sale.

Except the occasional crackdown on a few shisha smokers, and the disappearance of billboard adverts and sponsorship by cigarette companies; nothing much has changed. The law is hardly enforced--the reason a smoker in a public place such as a taxi park has the audacity to smoke and get away with it.

KCCA officials said they are taking long to enforce the law because it bans smoking in the whole city since it is zoned as a public place, which requires them to come up with a comprehensive plan given the fact that smoking is addictive.
“We have met bar owners and told them that we shall not renew licences of those bars and clubs which still sell shisha but we also found out that most of them are still selling shisha because of ignorance,”
Dr Daniel Okello, the acting director of public health and environment, said in a telephone interview.
He added that they have since received an unspecified amount of money to print stickers showing a public area as a no-smoking area. Dr Daniel Okello, the acting Director Public Health and Environment

“The reason there is a law is because enforcement is continuous but government has not allocated resources for tobacco control. For example, the regulation has not been finalised… to tell how the package should be…that the law talks of 50 metres , it is broad and the regulation has to specify this is what 50 metres look like,” Robinah Kitiritimba, the executive director of UNHCO

Smoke free places: Smoking is prohibited in all indoor public places, indoor workplaces, and public transport. It is also prohibited in the following outdoor places: 1) within 50 metres of any public place, work place, public transport terminal or any other places that provides services primarily to children; 2) within 50 metres of any window, door or air intake mechanism of any public place or workplace or any waiting area or queue; 3) within 50 metres from the place of service or consumption of food or drink; 4) any place designated as a non-smoking area by the person responsible for the premises.
Tobacco advertising, promotion: There is a ban on all tobacco advertising and promotion. All forms of tobacco sponsorship are prohibited.

Tobacco packaging: The Tobacco Control Act of 2015 requires that health warning on cigarette packets must comprise text and pictures and occupy no less than 65 per cent of each principal display area of all tobacco products.

Punishment: Failure to comply with the law could lead to imprisonment exceeding not more than seven years or a fines not less than Shs4.5m or even both.