Objective: The adoption of the WHO Framework Convention on Tobacco Control (FCTC) has accelerated adopting FCTC-guided policies globally. However, low and middle-income countries suffer to implement these policies due to limited resources, weak political institutions, and limited state capacity. This is especially concerning in Africa, which is expected to have the largest growth in tobacco use of any region. This study aims to document the development and implementation of a WHO Framework Convention on Tobacco Control (FCTC)-guided law in Ethiopia.

Methods: We analyzed publicly available documents including news articles, advocacy reports, and government documents. We triangulated findings by interviewing nine key stakeholders. Data were thematically analyzed through a retrospective policy analysis.

Results: Health advocacy groups provided technical support through capacity building workshops to help develop the law’s regulations. The National Tobacco Enterprise/Japan Tobacco International used standard industry arguments to weaken draft regulations but government officials, supported by health advocacy messages promoting Ethiopia’s WHO FCTC obligations, rejected these arguments. Implementation included training law enforcement of smoke-free requirements, using radio and television programming to raise public awareness about tobacco use and placing ‘No Smoking’ stickers throughout the country. Compliance with smoke-free requirements was mixed but moderate to good air quality (76.4%) was recorded in Addis Ababa. Compliance with pictorial health warnings varied with high compliance in Addis Ababa (89.1%), and low compliance in Dire Dawa (9.3%). Compliance with the tobacco advertising ban in indoor and outdoor point-of-sale locations was 60.3% and 96.5% respectively. Single stick sales were reported at most point-of-sale locations.

Conclusion: Continued health advocacy engagement and adherence to WHO FCTC guidelines can help establish strong implementing regulations without delays. The Ethiopian case serves as a guide for advocates attempting to implement public health laws amidst challenges related to limited government capacity and resources, political unrest, and continued industry interference.