Smokeless Tobacco Control Policies: Analysing the Sri Lankan Ban

Abstract

Background: The smokeless tobacco (SLT) epidemic in Sri Lanka is deeply ingrained in cultural, traditional, socio-economic, and environmental dynamics. The country introduced a comprehensive nationwide ban policy to combat this issue in 2016. This research study aimed to analyse this SLT ban policy to understand its successes and failures in the Sri Lankan context.

Methods: A multi-phased two-stage study (A and B) was conducted. Study A consisted of in-depth interviews and policy document reviews. Nine ban policy actors were interviewed. Twelve published and three unpublished policy documents were analysed. Twelve key stakeholders, including provincial and district health directors and heads of civil organisations, were interviewed in Study B. McConnell's Policy Success-to-Failure framework and the Health Policy Triangle provided the theoretical framework for the study. The data was analysed using NVivo based on two coding frameworks. Fourteen themes were generated.

Results Study A found that a small, homogenous group created the ban without much attention to the systematic factors. Study B revealed that policy implementors were not prepared to execute the plan. Therefore, the ban was not implemented in most places. Additionally, study B showed that the ban could harm the ongoing interventions of the SLT campaign. Key stakeholders, including the frontline workforce, community, religious leaders, and politicians, hesitated to support the implementation of the ban.

Conclusion: The study revealed shortcomings in the SLT ban, highlighting inadequacies in planning, implementation, stakeholder involvement, and cultural awareness. To address these issues, suggestions have been made for a more comprehensive, culturally sensitive approach that engages diverse stakeholders, including community and religious leaders, through a strategic framework.