NATIONAL ALCOHOL POLICY
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INTRODUCTION
Malawi has a population of 13.2 million1 growing at a rate
of 2.8 percent per annum. Eighty-three per cent of the
population is rural. The economy has an annual national
budget approximately $1.8 billion2, a current average
annual growth rate of 7 percent, and per capita gross
domestic product GDP at $1603 and mainly agricultural (35
percent of GDP).
According to STEPS4 survey, one in five males and one in
fifty women drink alcohol excessively. Overall, 7.8 percent
of all people who take alcohol drink harmfully. Currently,
80 percent of the population abstains and 20 percent of
the youths who drink heavily5.
The harmful alcohol use causes significant public health
problems such as risks of disease and disability currently
ranking third6 leading risk factor globally, after childhood
underweight and unsafe sex.
In case of minors, 9 out 10 boys who drink had their first
drink of alcohol before the age of 14 and 80 percent of
them were involved in premature sexual relationships7. It
was evident that young people were more vulnerable to the
adoption of risky behaviors due to indulgence in alcohol
use.
1
Census 2008
2009/10 Budget
3
Human Development Index 2001
4
A national survey conducted by WHO [Malawi, 2009] to determine risk factors on NCDs
5
Global Status Report on Alcohol and Health (2004)
6
Global Status Report on Alcohol and Health, 2011
77
GSHS, WHO (Malawi 2009)
2
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The Policy prioritizes behavior change through prevention
programmes for the abstention target group through
elaborate education programmes.
1.2
Rationale
The Government of Malawi has since 1979 enacted several
legislations8 targeting various alcohol-related offences
towards reducing the impact of alcohol-related harms.
Nevertheless, most of the provisions are either outdated,
disjointed, not effectively enforced and/or fall short of
international standards.
The Policy shall provide comprehensive strategies for
developing, implementing, coordinating, monitoring and
evaluating health-related interventions from alcohol related
harm.
The rationale is founded on the belief that a comprehensive
national alcohol policy shall:
1.2.1
Identify the effects of alcohol-related harm across
public health, social, economic terms;
1.2.2
Identify the key target groups affected by
alcohol-related harm in terms of alcohol consumption
patterns;
1.2.3
Identify key stakeholders for developing,
implementing, coordinating, monitoring and evaluating
8
Liquor, Road Traffic, Taxation, and Consumer Protection Acts
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health-related intervention deriving from alcohol
related harm;
1.2.4
Contribute to national development through
reducing the pressure exerted on resources by social
and health problems;
1.2.5
Provide the framework for addressing harmful
use of alcohol;
1.2.6
Clearly define programming parameters such as
scope of strategies, interventions, targeting in respect
of the overall goal of the policy;
1.2.7
Develop tailor-made target-specific responses
and interventions for reducing alcohol-related harm;
1.2.8
Define the relationship between alcohol and
poverty, HIV and AIDS, and Non Communicable
Diseases;
1.2.9
Outline the alcohol-related impacts at individual,
family, community, national levels;
1.2.10 Draw out the legal framework for control of
alcohol-related harms;
1.2.11 Provide a framework for the promotion,
protection and fulfillment of human rights in view of
alcohol-related harm;
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1.2.12 Provide support for developing adequate
treatment and rehabilitation9 services for those
affected by alcohol-related harm such as disease,
injury, disability, social problems;
1.2.13 Provide mechanisms for capturing data for
recorded and unrecorded alcohol production and
consumption.
1.2.1
Problem Statement
The objects of the existing laws10 do not reflect the purpose
of promoting public health outcomes.
The major problem is the significance of public health and
socio-economic harms.
The intent of this Policy, therefore, is to promote the public
health goals.
1.2.2
Purpose
The Policy shall support public health and socio-economic
strategies in reducing harmful use of alcohol.
In particular, the Policy aims at providing and setting
guidance within the specific public health and socioeconomic priority areas for action at community and
national levels.
9
Treatment, therapy, remedy, cure, etc
Road Traffic, Consumer Protection, Liquor Licensing and Taxation Acts
10
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1.3 Linkages with Other Relevant Policies
In particular, the Policy links with the Public Health Act, which
embraces prevention and control of communicable and noncommunicable diseases, injuries and mental health.
1.4 Key Challenges
The Policy
challenges:
1.4.1
envisages
the
following
implementation
Institutional
In respect of roles, functions and powers, the Policy
anticipates challenges in coordination, management,
implementation and monitoring of alcohol programmes.
The Policy shall provide legal authority for formally
empowering relevant institutions to subject accountability
and liabilities against harmful use of alcohol.
The Policy, therefore, recognizes the institutional
multisectoral roles and responsibilities spreading across the
different ministries.
1.4.2
Political Will and Public Support
The Policy shall recognize that implementation hinges on the
political commitment as well as the support of the general
public.
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The Policy, therefore, shall call for the institutionalization of
alcohol programmes for ensuring sustainable Government
and public support.
1.4.3
Human Resource and Management
The Policy recognizes that there are limited personnel for
prevention, management and control of alcohol-related
cases.
The Policy, therefore, shall promote capacity building and
partner cooperation with the existing players at national
including primary healthcare, regional and international
level for lessons, experiences, best practices, models and
information resources.
1.4.4
Financing
The delivery of alcohol programmes shall require the
commitment of financial and technical resources for
achieving the intended goals of the Policy.
The Policy, therefore, recognizes that Malawi Government,
through Parliament, shall identify with the consequences of
alcohol-related burdens such as public health, social and
economic costs.
The Policy also recognizes the support from the
development partners to assist in the provision of resources.
1.4.5
Behavioral
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The Policy recognizes the differences in drinking patterns
according to age, sex, culture, type of alcohol and income
distributions.
The Policy desires positive change in behavior patterns
through health promotion interventions.
1.4.6
Influence from the Alcohol Industry
The Policy recognizes exertion of influence on policy
decisions through their corporate responsibility of tax
remittances.
The Policy shall urge restraint through collective
responsibility in interacting with the Alcohol Industry.
1.5 Alcohol and the existing Laws
The Policy recognizes the existing laws contained in the
Liquor Licensing, Taxation, Road Traffic and Consumer
Protection Acts.
The Policy shall set out a comprehensive implementation
mechanism for ensuring efficient and effective enforcement,
prevention, advocacy campaigns, treatment, monitoring
mechanisms for the achievement of the objects of reducing
alcohol-related harms.
1.6 Impact of Alcohol Supply and Use
1.6.1
Positive Impact
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The Policy duly recognizes the important role that alcohol
production, distribution and sales play in securing public
revenues through taxes and personal incomes as well as
employment.
1.6.2
Negative Consequences
The Policy also considers the public health
development11 burdens from harmful use of alcohol.
1.6.2.1
and
Alcohol and Public Health Costs
1.6.2.1.1 Communicable Diseases
The Policy primarily identifies HIV and AIDS as a
communicable disease whose casual relationship with
harmful alcohol use poses greater risks worth intervening. In
particular, studies show key patterns of interaction between
alcohol use and sexual behavior, therefore, poses greater
risks of STIs and/or HIV infection12.
In many respects, alcohol use is linked to increased
incidences of sexual behavior.
Similarly, harmful alcohol use is also associated with the
increased weakening of the immune system leading to
further defenselessness to and development of HIV and
AIDS respectively.
11
12
Socio-economic
Alcohol Use and Sexual Behavior: A Cross-Cultural Study in Eight Countries (WHO, 2009)
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For the infected persons, harmful alcohol use on the one
hand and AIDS and TB conditions on the other undermine
efforts to addressing medical complications such as
inconsistent adherence and delayed treatment.
1.6.2.1.2 Non-Communicable Diseases (NCDs)
The Policy recognizes the burden of disease exerted by
harmful alcohol use particularly on non-communicable
diseases such as cancer, diabetes, liver and heart disorders,
chronic respiratory diseases, violence, trauma and injuries
and mental illnesses.
The Policy recognizes three major alcohol-related public
health conditions namely toxicity, intoxication and
dependence that lead to burdens of disease, injury and
deaths.
In particular, intoxication makes individual drinkers
vulnerable to a range of risk-taking behaviors such as
indulgence in unsafe sex, violence, suicides and injuries.
The dependence-producing properties of alcohol
consumption manifest as either stimulants or depressants,
resulting in excitation, withdraw and anxiety behaviors,
which is a cause for concern in public health perspectives.
Similarly, alcohol is a toxic substance that exerts different
body organs disorders and disability as well as injuries and
death tolls.
1.6.2.1
Alcohol and Development Costs
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Harmful use of alcohol is considered both a cause and
consequence of social and economic harms at individual,
family, community and national levels.
In essence, harmful alcohol use not only takes away the
required human resource through the associated alcoholrelated harms but also exerts disproportionate costs on
prevention, enforcement, treatment services that would
otherwise be avoided.
The main social harms include gender-based violence,
family disruptions, and diminished incomes through
diversions, commission of crimes, youth delinquencies,
addictions, child neglect, abuse and exploitation.
Similarly, significant economic harms comprise work-related
problems due to absenteeism and underperformance
leading to unemployment, homelessness and reduced
workplace productivity.
The Policy shall recognize that costs borne out of public
health and socio-economic burdens collectively translate into
enormous development expenses.
2.
BROAD POLICY DIRECTIONS
The Policy strategic direction shall be reducing harmful use
of alcohol.
2.1 Vision
To create a society free of alcohol-related harms.
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2.2 Mission
To promote public health and socio-economic conditions by
reducing harmful use of alcohol for the improved well-being
of Malawians.
2.3 Overall Objective of Policy
The overall policy objective is reducing harmful use of
alcohol.
2.4 Principles
The Policy shall be guided by the following principles:
2.4.1
Needs and Evidence-Based The Policy shall
address the needs of the target groups based on the
evidence and analysis of data and information
products through monitoring and evaluation;
2.4.2
Non-participation of economic stakeholder The
collaboration13 with economic stakeholders shall be
during implementation and NOT the development and
review of policy.
2.4.3
Prevention and Protection The Policy shall
prioritize prevention and protection interventions other
than those that require treatment responses;
13
Recommendation by WHO
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2.4.4
Partnership & Cooperation The Policy recognizes
the multi-sectoral approach towards addressing
harmful use of alcohol.
2.4.5
Rights-Based The Policy shall promote and
protect the interests of the vulnerable groups from
alcohol-related harm.
2.4.6
Governance The Policy shall promote a clear
management framework at community and national
levels.
2.5 Objective(s) of the Policy
The specific objective(s) of the Policy is reducing alcohol
consumption.
3.
POLICY THEMES
In general, the dynamics of alcohol is basically the supply
and demand function; therefore, the response system
towards reducing alcohol-related problems must seek to
address such parameters.
The Policy, therefore, prioritizes regulation (availability and
accessibility)
and
prevention
(acceptability
and
affordability) responses towards reducing alcohol-related
harm.
Policy Area 1: Supply of alcohol products
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The supply function of alcohol refers to the availability
(production) and accessibility (distribution and sale) of such
alcohol-related products.
In particular, availability means the production system
through formal14 and informal 15mechanisms and the
accessibility of alcohol products refers to the distribution
and sales systems.
The alcohol products are made available through
production, whether communally-produced or consumerbranded produced.
The alcohol products, therefore, can be identified as
follows:
homecraft,
local-industrial,
local-industrial
production of cosmopolitan alcohol beverages and
globalized-industrial production of cosmopolitan alcoholic
beverages like brandy, whisky and vodka.
The Policy realizes that there are homecraft production and
shall recognize them after being tested and certified safe
by regulatory bodies.
The Policy, therefore, shall set the scope for national and
community action in guiding the homecraft production
through organization, mobilization, monitoring and control
measures.
Objective To ensure reduced harmful use of alcohol
14
15
Legally sanctioned by tax and illegally availed through border smuggle
Locally untaxed brews
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Priority Area 1 To provide for availability and accessibility
systems through limitations
Strategies
(i)
(ii)
Provide producer-license for alcohol products;
Local authorities shall regulate the number of retail
outlets per locality;
(iii) Enforce minimum purchase and consumption age;
(iv) Limit by time and hours for opening and closing of
outlets;
(v) Limit areas by density and location of outlets;
(vi) Limit public drinking;
(vii) Ban on liquor sachets
(viii) Classify retail outlets as bottlestores, night clubs, bars
and shops for license and time administration;
(ix) Restrict community-based and urban-based selling
premises;
(x) Restrict community-based brewing to a reasonable
number of premises in the traditional authority as
decided by local councils;
(xi) Empower community policing forums to monitor supply
of alcohol products from the designated premises;
(xii) Register
communal
brewers
through
associations/cooperatives at traditional authority level;
(xiii) Empower local councils through traditional authorities
to levy community brews;
(xiv) Assure and monitor minimum standards of communal
brews to screen off harmful ingredients16 from the
designated points;
(xv) Promote business alternatives for local brewers;
16
Drugs such as chamba, ARVs, fertilizers
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Priority Area 2 Develop capacity for alcohol law
enforcement agencies such as the Police, Road Traffic
Directorate, Courts, Local Authorities, Malawi Bureau of
Standards, Malawi Revenue Authority
(i)
(ii)
Strengthen institutional capacities of the existing law
enforcement, implementation and monitoring agencies;
and
Administer the existing and new regulations on
production, distribution and sales of alcohol products;
Policy Area 2: Demand for alcohol products
Objective To reduce the demand for alcohol products
through behavior change interventions
Priority Area 1 To promote formal education and training
Strategies
(i)
Provide for school-based curriculum interventions such
as life skills education;
(ii) Develop workplace alcohol policy for employees;
(iii) Provide for formal work-place education sessions for
employees;
Priority Area 2 To promote informal education (civic
education/community action campaigns)
Strategies
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(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
NAP
Encourage public awareness campaigns on health,
social and economic problems caused by harmful use
of alcohol;
Develop information, knowledge and skills products on
the magnitude of alcohol-related harm for effective
interventions;
Mobilize community groups for promoting greater
leadership for increased coordination of and
partnership in alcohol-related programmes;
Engage advocacy on alcohol-related harms by civil
society;
Strengthen the capacity of existing research institutions
for designing and implementing measures that target
problems that arise over time on alcohol-related
harm;
Develop capacity of facilitators of alcohol-related
harm reduction programmes;
Develop and disseminate public education messages
on the Policy and legislation provisions to community
groups through print and electronic media;
Promote decentralization of harmful alcohol use
prevention through local authorities;
Enforce alcohol no-drink rule by workers during
working hours;
Provide for the National Day of No Harmful Use of
Alcohol;
Priority Area 3 To regulate marketing of alcohol products
by the alcohol industry
Strategies
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(i)
Limit alcohol advertising by content of messages and
volume per a given period through product placement
on radio, TV and internet through e-mails and mobile
phones particularly targeting young ones;
(ii) Limit sponsorships for cultural or sports events as well
as promotional competitions of alcohol products;
(iii) Set deterrence systems for infringements on marketing
restrictions;
(iv) All alcoholic beverages must carry health warning
labels;
Priority Area 4 To promote research on trends in
consumption patterns and their impact on public health
outcomes
Strategies
(i)
(ii)
Ensure evidence-based research on the impact of
alcohol responses;
Ensure surveillance on consumption, consequences and
responses;
Priority Area 5 To set higher minimum prices for alcohol
products
Strategies
(i)
Increase taxes by percentage volume of alcohol;
Priority Area 6 To reduce drink-driving cases of injury and
deaths
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Strategies
(i)
Reduce and enforce a legal blood alcohol
concentration BAC limit from 0.8g/L to 0.5g/L for
driving through random breath tests;
(ii) Establish sobriety checkpoints for regular breath testing
of drivers;
(iii) Provide for on-the-spot fines with incremented severity
per subsequent offence annually such as driving license
seizures, suspensions, revokes;
(iv) Develop a record system that catch repeat drink-drive
offenders;
(v) Enforce mandatory fines for funding/sponsorship for
anti-public health alcohol programmes;
Priority Area 7 To promote the public health services’
response through prevention and treatment
Policy Strategies
(i)
Develop capacity of primary health care system17 for
delivery of prevention and treatment for alcoholattributable conditions;
(ii) Provide rehabilitation services such as counseling to
sufferers of alcohol harm;
(iii) Establish and maintain a registration and monitoring
system of alcohol-attributable burdens such as disease,
injury and deaths for effective reporting;
(iv) Provide specialist training for treatment of alcohol
disorders;
17
WHO_ASSIST and WHO_PEN
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4.
NAP
IMPLEMENTATION ARRANGEMENTS
4.1 Institutional Arrangements
4.1.1
NCDs)
Inter-Ministerial Committee on NCDs (IMC-
1.
There shall be the Inter-Ministerial Committee on NonCommunicable Diseases with overall oversight
leadership, coordination and follow-up of the Policy
strategies and activities led by the Ministry of Health;
2.
The membership of the Committee shall be as follows:
Secretary for Health (Chairperson);
Secretary for Home Affairs and National Defence;
Secretary for Education;
Secretary for Local Government;
Secretary for Youth;
Secretary for Trade;
Secretary for Information;
Roles, Functions and Powers of IMC-NCDs
1.
IMC-NCDs shall provide policy direction and oversight
for the implementation of the Policy;
2.
IMC-NCDs shall
responsibility;
4.1.2
provide
overall
Non-Communicable
Diseases
illnesses---Ministry of Health
coordination
&
Mental
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1.
There shall be the Sub-Technical Working Group
(TWG) on alcohol harm reduction responsible for the
technical direction and programme implementation;
2.
The membership of the TWG shall be as follows:
Director for Clinical Services (Health) (Chairperson);
Director for Preventive Health Services (Health);
Director for Non-Communicable Diseases (Health);
Director for Home Affairs and National Defence;
Director for Education;
Director for Nutrition, HIV and AIDS;
Director for Local Government;
Director for Youth;
Director for Trade;
Director for Information;
Center for Social Research;
WHO Representative;
NGO Alcohol Network (Drug Fight Malawi);
National AIDS Commission (NAC);
Roles, Functions and Powers of TWG
1.
Develop a comprehensive
implementing the Policy;
plan
of
action
for
2.
Coordinate alcohol-related programmes including the
implementation of the plan of action in line with the
Malawi Growth Development Strategy;
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3.
Serve as a hub for local, regional and international
cooperation on matters of alcohol programming;
4.
Liaise with relevant authorities like Road Traffic Act;
Pharmacy, Medicines and Poisons Act on the proceeds
of crime compensations resulting from harmful alcohol
use;
5.
Link up with the law enforcement agencies like the
judiciary, Police, Malawi Bureau of Standards for
specific alcohol programmes such as treatment,
rehabilitation, counseling;
6.
Publish reports on the national alcohol response;
7.
Submit Annual Reports
Committee on Alcohol;
4.1.3
to
the
Inter-Ministerial
NCD Focal Point
1.
There shall be focal persons, from the Ministry of
Health, at the Local Authorities level;
2.
The focal persons shall coordinate the partners, line
ministries, government departments, agencies, civil
society organizations
during implementation of
respective roles and responsibilities;
4.1.4
Institutional Roles
The Policy recognizes the roles played by different
government agencies, civil society organizations and
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international partners in the implementation of alcohol
programmes.
Lead Ministries for policy areas
1.
Ministry of Health shall primarily lead the Policy as
well as implement the prevention pillar of alcoholrelated programmes;
2.
Ministry of Home Affairs and National Defence shall
ensure the implementation of the enforcement strategy
of the Policy;
3.
Ministry Education shall ensure that public education
programmes for alcohol consumption reduction are
implemented in accordance with the objects of
achieving national development;
4.
Ministry of Local Government shall coordinate the
implementation of alcohol-related harm reduction
activities at the district level in partnership with other
stakeholders;
5.
Ministry of Trade and Industry shall assure
compliance of quality standards of alcohol products;
6.
Ministry of Youth and Sports Development shall
coordinate the implementation of alcohol-related harm
reduction activities through the youth groups;
7.
Ministry of Information shall promote the civic
education component of the alcohol response;
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Private Sector18
The Policy recognizes the private sector participation
through public-private partnerships in community
programmes that intend to reduce alcohol-related harms.
Civil Society Organizations
1.
The Civil Society Organizations (CSOs) shall collect,
process, analyze, and disseminate relevant data and
information to all stakeholders on alcohol-related
harm;
2.
The NGOs shall promote advocacy campaigns on the
alcohol harm reduction responses;
3.
The NGOs shall facilitate review of the Policy to
ascertain the effectiveness of the measures as well as
implement the alcohol-related programmes;
Statutory Institutions
1.
Malawi Bureau of Standards MBS shall liaise with the
alcohol industry in setting minimum standards of alcohol
products;
2.
Local universities and research institutes shall
promote research and undertake capacity building on
alcohol-related harm.
18
See 2.3.3
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International Partnership
The Policy recognizes the role of global partners in
strengthening desired national responses through support of
technical and practical issues.
4.2
Implementation Plan
1.
The Policy recognizes that effective implementation of
the alcohol programmes shall require the guidance of
supporting plans such as the National Alcohol Response
Master Plan:
2.
IMC-NCDs shall disseminate the Alcohol Policy to
different stakeholders prior to the set up of the
National Commission on Alcohol;
3.
IMC-NCDs shall hold a donors fundraising conference
for alcohol programmes;
4.
IMC-NCDs shall submit the Policy and a proposed Bill
on Alcohol Act to Government for Cabinet
consideration.
4.3 Resource Mobilization Arrangements
4.3.1
Policy recognizes the need for mobilizing technical
and financial resources for the effective administration
of alcohol programmes;
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4.3.2
The Policy identifies sources of resources and uses
thereof as the key elements of the mobilization
strategy;
4.3.3
In particular, the Policy recognizes alcohol taxes,
levy, fines and donors as sources whereas
administration and program delivery as uses of such
resources;
4.4 Implementation Risks
The Policy anticipates the following risk(s):
4.4.1
Limited progressive political commitment;
5. MONITORING & EVALUATION
The Policy recognizes the need for establishing efficient and
effective national monitoring and evaluation frameworks for
guiding the national alcohol response.
In particular, the M & E frameworks shall prioritize output,
outcome and impact indicators across alcohol consumption,
consequences and response focus areas.
The Lead Ministry shall lead, coordinate, monitor, and
ensure timely reporting and dissemination of alcohol-related
performance and outcomes.
The Government shall follow-up with relevant actions upon
the recommendations following the annual reports.
5.1
Means of Monitoring
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(Methods and frequency) (See Annex-Appendices 1, 2)
5.2 Review
The Policy shall be reviewed after every five years after
the initial implementation.
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