Competing coalitions in alcohol policymaking in Malawi: a retrospective case study analysis of the alcohol sachet ban

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-09-03 DOI:10.1016/j.drugpo.2025.104979

Isabelle Uny , Denview Magalasi , Marsha Orgill , Cissie Namanda , Gemma Mitchell , Nazarius Mbona Tumwesigye , Linda Bauld , Charles Parry , Niamh Fitzgerald , Benjamin Kaneka

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Abstract

Background

Harmful alcohol consumption has significant public health implications across Africa and disproportionately affects vulnerable populations. In Malawi, the emergence of alcohol sachets - small, affordable plastic packets containing high-strength spirits – and their consumption, has raised substantial public health concerns. In particular, the resulting access and consumption amongst young people, led to a ban on those products by the Malawi Government in 2017. This study focuses on the policy process of the sachets ban, from agenda setting, to formulation and covers the modalities for implementation.

Methods

Retrospective policy case study involving a documentary analysis of all key regulatory documents and in-depth interviews with thirteen policy stakeholders and key informants. The Advocacy Coalition Framework was used to guide the analysis.

Results

The findings reveal a long and contested process involving two primary coalitions. The pro-ban coalition (NGOs, civil society organizations, religious leaders, and government representatives), which used empirical and local evidence on sachet alcohol-related harms, particularly among young people, to emphasize the need to regulate. The opposing coalition (spearheaded by alcohol and plastics manufacturers) mounted multiple legal challenges, stalling the policy formulation of the ban. Ultimately, a strong enduring public health coalition, a high court ruling and a decisive government decision facilitated a final and complete ban in 2017.

Conclusion

This analysis demonstrates how public health advocates successfully countered industry interference through evidence-based advocacy, community engagement, and strategic coalition-building. The Malawi case offers valuable lessons for other African countries considering similar alcohol control measures, highlighting the role of coalitions, the importance of framing alcohol regulations as public health protections, and of developing robust implementation mechanisms.

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马拉维酒精政策制定中的竞争联盟：酒精小袋禁令的回顾性案例研究分析

有害酒精消费在整个非洲具有重大的公共卫生影响，对弱势群体的影响尤为严重。在马拉维，酒精小袋的出现及其消费引起了严重的公共卫生关切。酒精小袋是一种可负担得起的装有高强度烈酒的塑料小包。特别是，由此导致的年轻人获取和消费，导致马拉维政府于2017年禁止这些产品。本研究侧重于小袋禁令的政策进程，从议程设定到制定，并涵盖执行方式。方法回顾性政策案例研究，包括对所有关键监管文件的文献分析和对13名政策利益相关者和关键举报人的深度访谈。倡导联盟框架被用来指导分析。调查结果揭示了一个涉及两个主要联盟的漫长而有争议的过程。支持禁令的联盟（非政府组织、民间社会组织、宗教领袖和政府代表）利用有关小袋酒精危害的经验和当地证据，特别是在年轻人中，强调有必要进行管制。反对联盟（以酒精和塑料制造商为首）提出了多项法律挑战，拖延了禁令的政策制定。最终，一个强大而持久的公共卫生联盟、一项高等法院裁决和一项果断的政府决定促成了2017年最终和彻底的禁令。本分析展示了公共卫生倡导者如何通过循证倡导、社区参与和战略联盟建设成功地对抗行业干预。马拉维的案例为考虑采取类似酒精控制措施的其他非洲国家提供了宝贵的经验教训，突出了联盟的作用、将酒精管制作为公共卫生保护的重要性，以及建立强有力的执行机制的重要性。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.