Strengthening prevention of nutrition-related non-communicable diseases through sugar-sweetened beverages tax in Rwanda: a policy landscape analysis

Figures & data

Table 1. Summary of the policy analysis findings using Kingdon’s three streams framework [34]

Stream	Topic	Factors facilitating SSB taxation	Barriers to SSB taxation
Problem	Current understanding of the problem of NR-NCDs	NR-NCDs considered a national problem, resulting in premature death & loss of productivity NR-NCDs impact on individual, family & community because of high cost of lifelong treatment & loss of productivity NR-NCDs recognised as an outcome of increased urbanisation	Primary focus of food policy is undernutrition and food security rather than unhealthy diet related to NR-NCDs Sugar not specified as a target risk factor for NR-NCDs – no explicit target for sugar consumption reduction
Policy	Existing policy environment addressing NCD intervention	Multi-sectoral approach to address NR-NCDs prevention Coherence between central and community-based interventions Excise tax of 39% levied on SSBs and non-SSBs; to increase Government revenue, not designed to support healthy consumption behaviour Beverage consumption considered to be elastic; sensitive to price in the last five years NR-NCDs interventions rely heavily on Government funding, which is considered to be unsustainable	SSB industry is one component of vision for national economic development Public–private partnerships exist to maximise value chain from growing, manufacturing and marketing of sugar-containing products, including SSBs Policy incoherence between Government’s vision for sugar industry and health goals to tackle NR-NCDs Access to quality drinking water, which is still a major challenge for large proportion of population, may encourage consumption of SSBs.
Politics	Stakeholder politics and SSB taxation	Opportunity exists for broad coalition of government and civil society players	Beverage industry is a duopoly, dominated by one large company – a subsidiary of a multi-national beverages concern Local industry positions itself as good corporate citizen by providing jobs, paying taxes, and investing in social development

Table 2. Rwanda policy documents for NCDs

No.	Policy document	Content related to NCDs	Sectoral responsibility
1	National Transformation Strategy, 2017–2024 [35]	Highlights importance of NCDs and how they contribute to individual, family and community poverty because of high costs, including opportunity costs: treatment, lifelong medical care, and lost productivity from premature death in economically productive age groups.	Ministry of Health, with involvement of Education, Local Government, Natural Resources, Gender and Family Promotion, and Agriculture and Animal Resources Ministries
2	National Food and Nutrition Policy, 2014 [36]	Aims to prevent and manage all forms of malnutrition, increase knowledge about NR-NCDs, and develop and strengthen strategies to address NR-NCDs.	Coordinated by Ministry of Agriculture and Animal Resources
3	Rwanda Trade Sector for Quality, 2010 [45]	Ensures that goods and services, especially food emanating from or traded in Rwanda, are designed, manufactured and supplied in a manner that matches society’s needs and expectations, and those of regulatory authorities in local, regional and international markets.	Ministry of Trade and Industry responsible for overall coordination
4	Education Sector Policy, 2014 [41]	Tasks the education sector with developing curricula that address NCDs; emphasizes inter-sectoral cooperation.	Ministry of Education
5	Agriculture Sector Strategic Plan, 2018 − 2024 [38]	Strong focus on nutrition and food security, preventing NR-NCDs. Particular focus on infants and breast‐feeding mothers. Seeks to increase incomes and provide micronutrients to improve and prevent nutritional outcomes, including nutrient deficiencies and stunting in children.	Ministry of Agriculture and Animal Resources
6	Health Sector Policy, 2015 [51]	Promotes dietary diversity to address growing problem of over-nutrition. Recommends that dietary guidelines be developed with specific adaptations for groups and life stages with different nutrient requirements. Includes Government-approved standards for national mandatory fortification of industrially-milled wheat and maize flour, cooking oil, sugar and salt.	Ministry of Health
7	Non-Communicable Disease Policy, 2015 [39]	Makes several recommendations, including creating health- promoting environments; promoting community action to reduce exposure to modifiable NR-NCD risk factors and injuries; strengthening NR-NCDs prevention, diagnosis, care and treatment, and rehabilitation programs within the national health systems; and documenting national trends and determinants of NR-NCDs through monitoring and evaluation systems and research for evidence-based interventions.	Ministry of Health
8	Rwanda Non-Communicable Diseases National Strategic Plan, July 2014 – June 2019 [37]	Aims to reduce NCD-related morbidity and mortality in the Rwandan population. Target is to decrease mortality of under- 40s by 80% by 2020 and save around 8 300 lives per year. Outlines the following actions to achieve these targets: improved access and quality of care; improved general knowledge about prevention of risk factors and early detection; and development of a reliable M&E system, coordination and fund raising.	Ministry of Health
9	Fourth Health Sector Strategic Plan, July 2018 – June 2024 [11]	Outlines national strategic directions to improve health standards of Rwandans. Recommends improving coordination of stakeholders in nutrition program and production of healthy food crops, and increasing knowledge of good nutrition practices. Proposes to increase private sector engagement in nutrition and production of food commodities.	Ministry of Health in collaboration with social cluster Ministries

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