Beyond flowery rhetoric and grand promises, the will of a government to act on a policy is first reflected in its financial plan. Activities for the implementation of such policies are provided with a budget line followed by a full disbursement of the budgeted sum to empower execution.
Tobacco control in Nigeria has made commendable progress despite the observed funding crunch. The enactment of the National Tobacco Control Act, 2015; the slow but eventual approval of its Regulations in 2019, and 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 this progress and a seeming pro-tobacco-control posturing of the Federal Government, the establishment of a dedicated Tobacco Control Unit within the Federal Ministry of Health (the primary executor of the National Tobacco Control Act 2015) has been a glimmer of light. Unfortunately, like a financial orphan, tobacco control is left out when it comes to adequately implementing budget.
The 2022 Tobacco Atlas indicates that nearly $2 trillion is spent annually in health care costs worldwide, causing production loss from premature death and sickness as a result of tobacco.
Nigeria has a smoking population of over 7 million people and an estimated 246 deaths weekly because of tobacco consumption. This grave public health problem continues to fester, and ordinarily should cause policy makers to lose sleep until it is wholly addressed through adequate and sustained funding of tobacco control to nip the problem.
Also, an estimated N526.4 billion is spent annually on treatment of tobacco related illnesses. All these worrisome figures present a strong case for special budgetary provisions for tobacco control.
Within the Federal Ministry of Health, it is unclear what priority is given to tobacco control. It is however perceivable to the extent that there is a lukewarm attitude towards the inclusion of tobacco control as a line item in the yearly budget proposal – causing a critical funding gap for the important work. While it is expedient to allot funds for issues such as cancer, it also makes simple sense to adequately apportion funds for tobacco control, with evidence that tobacco is one of the leading causes of several kinds of cancer.
The tobacco market in Nigeria is estimated to be worth $74.90 million and is projected to reach $228.36 million by 2025, easily making it a multi-billion-naira market. A market that has left sickness and death in its wake.
A major share of tobacco control funding is sourced externally through foreign aid. According to the strength of these foreign donors the aid provided are generous, yet they are a trickle in relation to the sheer size of the country and are easily spread thin when a national implementation drive of the National Tobacco Control Act is attempted.
Note also that the government cannot and should not abdicate its responsibility of funding tobacco control or other developmental issues to foreign aid. The yawning funding gap makes the ill-intentioned dollars of the tobacco industry alluring.
Institutionalisation of tobacco control funding will make agencies of government saddled with tobacco control full proof and inoculated from possible inducement and industry interference, thus strengthening tobacco control.
The full operationalisation of the Tobacco Control Fund is a quick first step towards sustainable funding. However, to control the products and activities of the humongous tobacco industry in Nigeria, the Tobacco Control Fund alone will fall short. It is imperative that progressively increasing tobacco taxes are earmarked for tobacco control efforts, while also making special budgetary provisions for the same.
The most probable effects of adequate and sustained state funding of tobacco control will be a significant decrease in the smoking population, a consequent decrease in tobacco related illnesses and a drop in tobacco induced health costs.
The Federal Government must demonstrate good faith in tobacco control through its inclusion of a robust line item in the annual Appropriation Act. It is also pertinent to remark that the implementation of the National Tobacco Control Act, 2015, which is modelled on the recommendations of the WHO Framework Convention on Tobacco Control (WHO-FCTC) requires national application to be truly effective.
Finally, the National Assembly must prioritise allotment of adequate resources for tobacco control and duly extend its oversight to ensure that funds assigned and disbursed are judiciously used.
By Paul Ashibel, Nigeria Tobacco Control Alliance
