Nature and scope of WHO FCTC implementation in africa : A mixed methods approach to understand implementation in Kenya

Background: The WHO Framework Convention on Tobacco Control (FCTC) was adopted in 2003 in response to globalization of tobacco epidemic. As of January 2013, 41 out of 46 African countries had ratified the FCTC; however, there is no evidence of successful implementation. We aim to understand the process and evaluate the current situation and progress of FCTC implementation in Kenya using mixed-methods approach.

Methods: We will triangulate archival documents with interviews of key informants in Kenya, one of the three countries in Africa with a national tobacco policy. Using Nvivo 9 qualitative software, we will thematically code the data using Najam's 5C protocol- content, context, commitment, capacity and clients to determine key factors influencing FCTC implementation. Moreover, using the WHO implementation database, analysis of variance (ANOVA) will be conducted to determine differences in implementation of FCTC provisions using SAS v9.2.

Results: Though Kenya has a national legislation that completely bans smoking in indoor governmental facilities and public transport, we find significant differences in implementation at national and sub-jurisdiction levels. Similarly, we expect to find high variability in implementation of other provisions, especially for tobacco industry regulation. Overall we determine that the FCTC implementation is undermined by the tobacco industry and lack of resources.

Conclusion: The study findings will assist policy makers, public health professionals and researchers to not only determine factors that effectively facilitate FCTC implementation in low-and-middle-income countries but also identify implementation gaps and key venues so that scarce resources can be directed to such areas for improvement.