Beyond flowery speeches and grand promises, a government’s desire to act on a policy is first reflected in its financial plan. Activities to implement these policies have a budget line followed by a full disbursement of the budgeted sum to enable execution.
Tobacco control in Nigeria has made commendable progress despite the shortage of funding observed. The enactment of the National Tobacco Control Act, 2015; the slow but eventual approval of its regulations in 2019 and the few pockets of implementation of the Graphic Health Warning (GHW) policy are testament to the thorny path of tobacco control efforts in the country.
However, with these advances and an apparently pro-tobacco control attitude from the federal government, the creation of a dedicated tobacco control unit within the Federal Ministry of Health (the primary enforcer of the National Tobacco Control Act of 2015) was a beacon of hope. light. Unfortunately, like a financial orphan, tobacco control gets left behind when it comes to getting the budget right.
The 2022 Tobacco Atlas indicates that nearly $2 trillion is spent on health care costs worldwide each year, resulting in lost production due to premature death and tobacco-related disease.
Nigeria has a smoking population of over 7 million people and about 246 weekly deaths due to tobacco use. This serious public health problem continues to escalate and would normally cause policy makers to lose sleep until it is fully addressed with adequate and sustained tobacco control funding to quell the problem.
In addition, around N526.4 billion is spent annually on the treatment of tobacco-related diseases. All these worrying figures argue in favor of special budget provisions for tobacco control.
Within the Federal Ministry of Health, the priority accorded to tobacco control is unclear. It is, however, noticeable in that there is a lukewarm attitude towards the inclusion of tobacco control as a line item in the annual budget proposal – causing a critical funding shortfall for the important work. While it is appropriate to allocate funds for issues such as cancer, it also makes sense to allocate funds appropriately for tobacco control, with evidence that tobacco is a leading cause of several types of cancer.
The tobacco market in Nigeria is estimated at $74.90 million and is expected to grow to $228.36 million by 2025, easily making it a multi-billion naira market. A market that has left disease and death in its wake.
A significant portion of tobacco control funding comes from outside through foreign aid. Depending on the strength of these foreign donors, the aid provided is generous, but it is minimal compared to the sheer size of the country and is easily dispersed when a national campaign to implement the national tobacco control law is tempted.
Note also that the government cannot and should not relinquish its responsibility to fund tobacco control or other development issues to foreign aid. The gaping funding gap makes the tobacco industry’s ill-intentioned dollars alluring.
Institutionalizing tobacco control funding will make government agencies struggling with tobacco control immune to industry incentives and interference, thereby strengthening tobacco control.
The full operationalization of the Tobacco Control Fund is a quick first step towards sustainable funding. However, to control the products and activities of the huge tobacco industry in Nigeria, the Tobacco Control Fund alone will not be enough. It is imperative that the progressive increase in tobacco taxes be earmarked for tobacco control efforts, while making special budgetary provisions for this purpose.
The most likely effects of adequate and sustained public funding for tobacco control will be a significant reduction in the smoking population, a consequent reduction in tobacco-related diseases, and a reduction in tobacco-induced health costs.
The federal government must demonstrate good faith in tobacco control by including a robust line item in the annual appropriation act. It is also relevant to note that the implementation of the National Tobacco Control Act 2015, which draws on the recommendations of the WHO Framework Convention on Tobacco Control (WHO-FCTC), requires national to be truly effective.
Finally, the National Assembly should prioritize the allocation of adequate resources for tobacco control and duly extend its oversight to ensure that funds allocated and disbursed are used wisely.
By Paul Ashibel, Nigerian Alliance for Tobacco Control