Inertia or unanticipated bottlenecks? Exploring stakeholder perspectives on the implementation determinants of the national alcohol policy five years post-enactment in Zambia.

Background: Alcohol use accounts for a huge proportion of the global burden of disease, and many countries grapple with its severe negative social and health consequences. In 2018, Zambia adopted a national alcohol policy with the aim to reduce the prevalence and impact of harmful alcohol use. However, five years post-adoption, the policy implementation has been slow. This study sought to explore the implementation determinants of the national alcohol policy five years post-enactment in Zambia. Implementation determinants, a concept from Bullocks theoretical framework, refer to the enabling and inhibiting factors that shape the alcohol policy and related implementation outcomes among implementing agents and teams.

Methods: We employed a qualitative case study design using data collected from 25 semi-structured interviews targeting government ministries, civil society, and agencies responsible for enforcing the alcohol policy. We applied both inductive and deductive manifest thematic analysis using Bullock's analytical framework for understanding the determinants of implementing evidence-based policies.

Results: The alcohol policy was generally viewed by key stakeholders as comprehensive framework for action, yet its policy directives remained unclear. A restructured policy coordination committee enhanced the organisational capacity to implement joint action for this policy. However, weak collaboration between the council and state police hampered the enforcement of alcohol laws. Implementing agencies faced obstacles such as lack of financial and human resources, absence of rehabilitation services, and misapplication of alcohol selling licences. Further, community inaction and resistance to alcohol control laws affected the policy implementation. The socio-political environment contributed to implementation challenges through framing alcohol as an economic development issue and culturally tolerating harmful alcohol use. Additionally, changes in government affected policy ownership while unregulated illicit alcohol production and the sale of traditional and imported spirits further hampered the implementation of the policy.

Conclusion: Overcoming implementation hurdles to the alcohol policy demands comprehensive strategies such as engaging communities, challenging cultural norms, strategically assigning funding, and fostering collaboration among implementing agencies. This may entail leveraging enablers such as stakeholder recognition of the policy framework and the restructured committee for the coordination of the alcohol policy implementation. Key actions should include empowering local government to enforce measures to reduce unregulated alcohol availability and ensure adequate resource allocation for alcohol control activities among implementation agents, including those providing treatment and rehabilitation services.