According to the World Health Organisation (WHO), tobacco-induced cancer and lung diseases kill nearly seven million people around the world every year and accounts for about one in 10 deaths globally.
Uganda’s tobacco smoking prevalence estimates are relatively high by African standards. As such, WHO Global Health Observation data of 2018 shows that Uganda’s adult smoking prevalence for males and females stood at 17 per cent and 3 per cent, respectively in 2016.
According to the report, overall estimates for Africa placed adult male and female smoking prevalence at 17 per cent and 2 per cent respectively, according to WHO 2017 report.
The updated ‘Tobacco Atlas’ of global tobacco control efforts and challenges report presents an even grimmer picture and observes that most countries in sub-Saharan Africa have inadequate monitoring of tobacco use. It further states that globally, the battle to end the scourge of tobacco ailments is still far from ending.
“More than 1.1 billion people are current smokers, while 360 million people use smokeless tobacco. Low and middle income countries represent more than 80 per cent of tobacco users and tobacco-related deaths, placing an increased share of tobacco-related costs on those who can least afford it,” WHO findings state.
The war against use of tobacco in Africa is an even more tedious battle with few countries such as South Africa, Kenya and Uganda pioneering the fight.
In the case of Uganda, since the passing of the Tobacco Control Act, 2015, it is yet to achieve what other laws of its kind have achieved. For example, according to a 2017 YouGov survey, the smoking ban law in the UK, which came into force in 2007 after the ban on tobacco advertising that was enforced in 2005, has seen support for the ban growing up to 83 per cent in recent years from 78 per cent in 2007. This compliance was attributed to more smokers supporting the legislation, which is not the case in Uganda.
Dr Hafsa Sentongo Lukwata, the national tobacco control focal person in Ministry of Health, says: “The law is already being implemented but implementation takes stages. We have sensitised people and are watching to see if they comply. That will inform our next course of action.”
Dr Lukwata says they have arrested several tobacco users and among whom was a South Sudan minister, who was apprehended in an anti-shisha operation. On January 11, the Magistrate’s Court in Makindye sentenced 11 offenders to fines upon their own plea of guilt. Dr Lukwata says this shows that there are efforts being taken by all enforcement parties concerned.
Mr Moses Talibita, the legal officer at Uganda National Health Consumers’ Organisation (UNHCO), augments Dr Lukwata on initiatives made towards fighting tobacco consumption in Uganda.
“Besides enforcement and implementation, we conduct inspections of various public places and we have educated tobacco users to adhere to compliance with the law,” he said.
Inspection being the initial engagement with the tobacco users such as bars, Mr Talibita and his team take the concerned persons such as bar owners through the law.
“Usually, they feign ignorance that it is the first time they are hearing about the law despite us knowing that they have heard of tobacco non-use compliance shisha operations. It is during such engagements that shisha sellers surrender their pots to police and our plans for a public destruction with Police shall happen before the World No Tobacco Day on May 31,” Mr Talibita says.
A few weeks ago, UNHCO, in partnership with Kampala Capital City Authority (KCCA) did an inspection following a tip-off from a whistleblower to verify the information received. Bars such as H2O, Flame, Kyoto, and Tamarai as well those in Centenary Park were visited.
At Tamarai, the inspection team found ash trays displayed at counters and tables, something that violates the law. The management was told to take them off the tables.
A deeper look into the law and their findings
Ms Mable Kukunda Musinguzi, the senior advocacy and networking officer at UNHCO, says: “Ninety one per cent of Kampala schools are less than 50 metres away from shops selling cigarettes while 93 per cent of these shops were displaying tobacco products.”
She says anti-tobacco law is meant to delay or stop children from engaging in tobacco consumption.
“According to WHO, if a child does not use tobacco before 21 years, chances of smoking are low. It is also the first abused substance that always leads to the abuse of drugs such as marijuana,” Ms Kukunda adds.
In Uganda, one is an adult at 18. However, many people, including parliamentarians, argue that in Uganda a person is still a minor at 21 since anyone below 22 years is by law required to present a letter from their guardian before marriage. This implies, they argue, that such a child cannot make independent decisions after all most of them are still in school or dependent on parents at this age.
The law also bans sale of tobacco products in places frequented by children as well as smoking in such places and prohibits comprehensive advertising of these products on billboards, shops etc.
“All these are aimed at helping people quit but also by extension help passive smokers,” Ms Kukunda asserts.
Mr Luke Owoyesigyire, the Kampala Metropolitan deputy police spokesperson, says in their community policing drives, they go to schools to sensitise children about the danger of smoking.
“It is easier to dissuade these youngsters from smoking than changing the adults from the habit,” he says.
Besides, he says, the children take the education to their families and community.
While players such as UNHCO are teaching people about the law, enforcement must be taken on by statutory agencies such as police and KCCA.
Dr Daniel Okello Ayen, the KCCA acting director for Public Health and Environment, says: “In our drive to raise awareness, we focussed on creating a Smoke Free Environment campaign that was launched in August 2018.”
He says the directorate also tackled tobacco advertising since the law comprehensively bans promotion of tobacco products.
Dr Okello cites a Benson & Hedges advert that once graced Ange Noir discotheque but has since been removed after sensitisation.
In enforcing comprehensive ban of adverts, Mr Fred Otunnu, the public relations officer of Uganda Communications Commission, says: “We have an advertising code that governs broadcasters regarding adverts. The banned products cannot be advertised and anyone that does so breaches the law. That attracts the stated penalties.”
However, he adds that social media has brought a new dimension to their regulation regimen.
“It calls for cross jurisdictional manning, more so for content that is from out. Otherwise, for content that is from within, where the origin is traceable, regulation is easy,” he says.
Looking at the law, Dr Okello says Kampala is totally a public place so they have sensitised people on that upon realising that some people had a misconception that the law would make room for smoking zones.
“At the start, many public place owners were willing to comply saying they would create smoking areas,” Dr Okello says, adding that his directorate has also tackled public transport where a lot of smoking happened and adverts for cigarettes were carried by these taxis.
Mr Yasin Ssematimba of Kampala Operational Taxi Stage Association, says: “We are happy because we have learned that passive smoking is more harmful than active smoking.”
Sensitisation has also been taken to owners of public places where fliers on the effects of tobacco smoking were given out as well as erecting billboards advocating a tobacco-free Kampala.
“We are also working with Ministry of Health to develop a guide for enforcement officers such as police and locals on where and how to enforce the law as well as how to plan enforcement drives,” Dr Okello says.
While they have seen compliance, he notes that there are some places where they need to tie up loose ends such as in barracks and prisons where sometimes cigarettes are used as a currency or to ask for favours.
KCCA is also working with Uganda Revenue Authority on ensuring that contraband products such as shisha are not imported into the country.
Public buildings, hospitals and taxis have also presented great success and the directorate will be meeting hotel owners for a discussion on the mater.
Dr Okello says many hotel owners have complained that stopping smoking will affect their revenue as clients, mainly tourists will avoid them.
“However, our argument is that these tourists travel on planes without smoking which clearly shows they can do the same in hotels. Secondly, their countries of origin have similar laws against tobacco use. So they just have to continue abiding as they do in their home countries. More to that, when smoking is entertained, they drive away families that would have otherwise come to their facilities,” he explained.
The fight against tobacco use is undermined by the products being packaged in bright attractive colours which are very appealing to young people.
Another challenge is that tobacco products are cheap and advocates such as UNHCO are calling on government to amend the Excise Duty Act so that these products are made so expensive and make chain smokers reduce the intake while deterring those willing to try.
The Addis Ababa Agenda on Financing for Development endorsed by the UN General Assembly’s Resolution 69/313 of 27 July 2015 recommends that cigarette revenue earmarking can finance development such as universal healthcare.
Bar owners’ take
Mr Tesfalem Gherahtu, the owner of Casablanca and chairman of restaurants and bars in Kololo, Kampala, applauds all parties involved in the no-tobacco sensitisation. “Awareness is very important and I appreciate the meeting that was held in Kololo two weeks ago. It was better than the raids that were done before where people found smoking were slapped by law enforcers,” he says.
He says now that they are aware of the various dangers presented by tobacco smoking, they cannot oppose the law because people’s health is paramount. Mr Gherahtu implores enforcers to spread this awareness to other bar owners in and around the city such as those in Munyonyo. However, he wondered whether tobacco-free shisha, such as is used in United Arab Emirates, is allowed in Uganda.