Policy Processes in Multisectoral Tobacco Control in India: The Role of Institutional Architecture, Political Engagement and Legal Interventions

Document Type : Original Article

Authors

1 Department of Family Medicine, McGill University, Montreal, QC, Canada

2 Department of Public Health, Health Policy Unit, Institute of Tropical Medicine, Antwerp, Belgium

3 Institute of Public Health, Bengaluru, Karnataka, India

4 Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada

5 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

6 Department of Political Science, Faculty of Arts, McGill University, Montreal, QC, Canada

Abstract

Background 
The development and implementation of health policy have become more overt in the era of Sustainable Development Goals, with expectations for greater inclusivity and comprehensiveness in addressing health holistically. Such challenges are more marked in low- and middle-income countries (LMICs), where policy contexts, actor interests and participation mechanisms are not always well-researched. In this analysis of a multisectoral policy, the Tobacco Control Program in India, our objective was to understand the processes involved in policy formulation and adoption, describing context, enablers, and key drivers, as well as highlight the challenges of policy.
 
Methods 
We used a qualitative case study methodology, drawing on the health policy triangle, and a deliberative policy analysis approach. We conducted document review and in-depth interviews with diverse stakeholders (n = 17) and anlayzed the data thematically.
 
Results 
The policy context was framed by national law in India, the signing of a global treaty, and the adoption of a dedicated national program. Key actors included the national Ministry of Health and Family Welfare (MoHFW), State Health Departments, technical support organizations, research organizations, non-governmental bodies, citizenry and media, engaged in collaborative and, at times, overlapping roles. Lobbying groups, in particular the tobacco industry, were strong opponents with negative implications for policy adoption. The state-level implementation relied on creating an enabling politico-administrative framework and providing institutional structure and resources to take concrete action.
 
Conclusion 
Key drivers in this collaborative governance process were institutional mechanisms for collaboration, multi-level and effective cross-sectoral leadership, as well as political prioritization and social mobilization. A stronger legal framework, continued engagement, and action to address policy incoherence issues can lead to better uptake of multisectoral policies. As the impetus for multisectoral policy grows, research needs to map, understand stakeholders’ incentives and interests to engage with policy, and inform systems design for joint action.

Keywords


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Articles in Press, Corrected Proof
Available Online from 14 July 2021
  • Receive Date: 19 October 2020
  • Revise Date: 19 May 2021
  • Accept Date: 07 June 2021