Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Uganda: a policy landscape analysis

ABSTRACT

Background

Uganda is experiencing an increase in nutrition-related non-communicable diseases. Risk factors include overconsumption of sugar-sweetened beverages. Fiscal and taxation policies aim to make the consumption of healthier foods easier. However, the adoption and implementation of fiscal policies by countries are constrained by political and economic challenges.

Objective

We investigated the policy and political landscape related to the prevention of nutrition-related non-communicable diseases in Uganda to identify barriers to and facilitators of the adoption of sugar-sweetened beverage taxation in Uganda.

Methods

A desk-based policy analysis of policies related to nutrition-related non-communicable diseases and sugar-sweetened beverage taxation was conducted. Four key informant consultations (n = 4) were conducted to verify the policy review and to gain further insight into the policy and stakeholder contexts. Analysis was framed by Kingdon’s theory of agenda setting and policy change.

Results

Nutrition-related non-communicable diseases were recognised as an emerging problem in Uganda. The Government has adopted a comprehensive approach to improve diets, but implementation is slow. There is limited recognition of the consumption of sugar and sugar-sweetened beverages as a contributor to the nutrition-related non-communicable disease burden in policy documents. Existing taxes on soft drinks are lower than the World Health Organization’s recommended rate of 20% and do not target sugar content. The soft drink industry has been influential in framing the taxation debate, and the Ministry of Finance previously reduced taxation of sugar-sweetened beverages. Maintaining competitiveness in a regional market is an important business strategy. However, the Ministry of Health and other public health actors in civil society have been successful (albeit marginally) in countering reductions in taxation, which are supported by industry.

Conclusions

An established platform for sugar-sweetened beverage taxation advocacy exists in Uganda. Compelling local research that explicitly links soft drink taxes to health goals is essential to advance sugar-sweetened beverage taxation.

KEYWORDS:

• Fiscal policies
• non-communicable diseases
• sugar-sweetened beverage tax
• policy analysis

Responsible Editor

Jennifer Stewart Williams

Responsible Editor

Jennifer Stewart Williams

Ethics and consent

This study utilised publicly available data and did not have ethical implications.

Acknowledgments

We thank the stakeholders that participated in the consultations for this study. We would also like to thank Nancy Coulson and Gill Nelson for their contributions to this manuscript. We would like to acknowledge and thank the guest editors of the supplement, Boyd Swinburn and Zodwa Ndlovu.

Disclosure statement

The authors report no conflicts of interest.

Author contributions

KH and AE conceptualised the study. All authors designed the study protocol. GA collected and analysed data, and drafted the manuscript; SAK, AMT, AE, and KH reviewed the manuscript; All authors approved the manuscript for submission.

Paper context

Uganda is experiencing an increase in nutrition-related non-communicable diseases and taxation of sugary beverages can prevent this. Private actors have influenced taxation policies related to sugary beverages. Although the policy environment is supportive of the tax, the lack of information related to both risk factors and private actors presents a barrier to its adoption. Local research is needed to support the adoption of a sugary beverage tax.

Additional information

Funding

This work was carried out with support from the International Development Research Centre, Ottawa Canada under grant number 108648-001. The views expressed herein do not necessarily represent those of IDRC or its Board of Governors. The research reported in this publication was also partly supported by the South African Medical Research Council;International Development Research Centre [108648-001];South African Medical Research Council