Search

Background: A number of countries have adopted sugar-sweetened beverage taxes to prevent non-communicable diseases but there is variance in the structures and rates of the taxes. As interventions, sugar-sweetened beverage taxes could be cost-effective but must be compliant with existing legal and taxation systems. Objectives: To assess the legal feasibility of introducing or strengthening taxation laws related to sugar-sweetened beverages, for prevention of non-communicable diseases in seven countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda and Zambia. Methods: We assessed the legal feasibility of adopting four types of sugar-sweetened beverage tax formulations in each of the seven countries, using the novel FELIP framework. We conducted a desk-based review of the legal system related to sugar-sweetened beverage taxation and assessed the barriers to, and facilitators and legal feasibility of, introducing each of the selected formulations by considering the existing laws, laws related to impacted sectors, legal infrastructure, and processes involved in adopting laws. Results: Six countries had legal mandates to prevent non-communicable diseases and protect the health of citizens. As of 2019, all countries had excise tax legislation. Five countries levied excise taxes on all soft drinks, but most did not exclusively target sugar-sweetened beverages, and taxation rates were well below the World Health Organization's recommended 20%. In Uganda and Kenya, agricultural or HIV-related levies offered alternative mechanisms to disincentivise consumption of sugar-sweetened beverages without the introduction of new taxes. Nutrition-labelling laws in all countries made it feasible to adopt taxes linked to the sugar content of beverages, but there were lacunas in existing infrastructure for more sophisticated taxation structures. Conclusion: Sugar-sweetened beverage taxes are legally feasible in all seven countries Existing laws provide a means to implement taxes as a public health intervention. [ABSTRACT FROM AUTHOR]

Background and context: Routine collection of quality oncology data remains underprioritized in resource limited settings. For breast cancer (BC) care at Princess Marina Hospital (PMH) in Botswana, this hampers its use for oncology program evaluation and clinical research. The Peo Data Acquisition Core (DAC), part of a consortium for planning of a noncommunicable diseases center for research excellence in Southern Africa, engaged relevant stakeholders and departments at PMH to establish health care worker driven processes that support sustained improvements in the quality of routinely collected breast cancer data. Aim: Assess PMH BC care needs to support the improvement of routinely collected data. Strategy/Tactics: Conventional routine data quality assessments guide iterative identification of data quality gaps for improvement, but tend to consume additional human resources to implement and prioritize data quality over existing provider concerns. We undertook a holistic approach to identifying needs challenging the improvement of data routinely collected about PMH BC patients. Program/Policy process: A need assessment began with mapping of patient care process, capturing process steps, including subprocesses, actors, and an inventory of related data capture systems. The assessment also gathered care providers' perceptions of challenges to providing care as well as perceptions of the up-time of an existing electronic health record (EHR). Outcomes: BC patient management involves multiple care providers who attend to patients in different locations within the hospital. Except for EHR captured laboratory data, nearly all other documentation of patient care occurred through paper-based registers, diaries and general clinical forms. Providers indicated the overbooking of patient appointments and use of different formats to manage patient data as key challenges for them. EHR appointment scheduling components appear underutilized by providers, and a brief monitoring of provider perceptions of the EHR's speed and reliability suggests it is poorest in the mornings - at a time when providers are the busiest attending to patients. What was learned: Needs assessment findings suggest several opportunities to respond to provider recognized challenges through greater adoption of EHR usage. Establishment of a Quality Improvement (QI) group that champions improvements in routine BC data quality should integrate standardization of patient data formats and EHR centralized appointment booking. QI group composition should include both care providers and an EHR IT technician. [ABSTRACT FROM AUTHOR]