Published on 29/07/2024
At 15 years old, Albert Elwa, a Ugandan started drinking alcohol, and it wasn’t long before his life spiralled
out of control, condemning him to 15 painful years of rehabilitation and treatment for
alcoholism.
“For 15 years, I have been in prevention and treatment, so when we talk about the effects of
alcohol, I had my education messed up, I couldn’t work, I was saved by rehabilitation,” said
Elwa while appealing to Parliamentarians in December 2023, to enact the Alcoholic Drinks
Control Bill 2022, saying it would help fight alcoholism in Uganda.
Elwa’s relief from alcoholism was short-lived as, five years after rehabilitation, he was
diagnosed with oesophageal cancer at 30 years. This discovery, he says, shocked the medical
team in India, where he had flown to receive specialized treatment.
“The doctors in India couldn’t figure out how a person at my age could contract oesophageal
cancer, so they went into my medical history, and they concluded that my previous lifestyle of
alcohol abuse had set the foundation for cancer. As I speak, I have no oesophagus. And now in
treatment, I continue to see the devastating effects of alcohol,” explained Elwa.
Alfred Jatho, a Medical Specialist at Uganda Cancer Institute, explained that the risk of alcohol-
associated cancers in Uganda remains high and continues to rise as alcohol intake increases. He
noted that when people drink alcohol, it is turned into a chemical acetaldehyde that can damage
the DNA/genetic information within a cell.
“Acetaldehyde is a genotoxic that can damage a cell’s DNA/genetic information. Therefore,
acetaldehyde can cause cancer by damaging DNA and stopping our cells from repairing this
damage. The carcinogenicity (ability to cause cancer) of alcoholic beverages does not seem to
vary with the type of beverage; the effect appears to be caused by ethanol itself,” said Jethro.
He, however, cautioned that stopping alcohol consumption is not associated with immediate
reductions in cancer risk. Still, the risks eventually decline, although it may take years for the
risks of cancer to return.
He noted, “One study estimated that it would take more than 35 years for the higher risks of
laryngeal and pharyngeal cancers associated with alcohol consumption to decrease to the level of
never-drinkers.”
Uganda’s Alcohol Plight
The World Health Organisation (WHO) Statistics 2023 Report ranks Uganda among the leading
alcohol consumers. Ugandans consume 12.2 litres of alcohol per person annually, which is
double the African region average of 6.3 litres and the global average of 6.18 litres per person
per year.
At the regional level, Uganda is the largest alcohol consumer in East Africa, with an alcohol per
capita consumption of 9.5 litres of alcohol per year, compared to Kenya-3.4 litres, Tanzania-9.4
litres, Rwanda- 9 litres, and Burundi- 7.5 litres, according to the WHO report.
The November 2022 Uganda Alcohol Report estimates that there are about 5-12 million alcohol
drinkers in Uganda, consuming an estimated 110.6 million litres annually. Uganda’s alcohol
industry is valued at around UGX2Trn (US$537,858,000). The report further reveals that over
65% of the alcohol consumed in Uganda is illicit alcohol that isn’t regulated, thus costing the
government UGX616Bn (US$165,660,264) in revenue.
Margaret Muhanga, Minister of State for Primary Health Care, revealed that Uganda spends over
UGX2.654Trn (US$713,737,566) annually to treat alcohol-related diseases and called for raising
the legal age for alcohol consumption from the current 18 to 21.
“The legal drinking age is a public health measure aimed at protecting young individuals from
the potential harms associated with alcohol use during the critical period of development. The
brain continues to develop throughout adolescence and into the early twenties. Exposure to
alcohol drinking during this critical period can have lasting effects on cognitive function,
memory, and decision-making,” said Minister Muhanga.
Glance into the New Alcoholic Drinks Control Bill
To fight alcoholism, Uganda is now introducing a new, harsh alcoholic drinks control law.
Experiences from Lithuania, Scotland, the Russian Federation, and neighbouring Kenya show
such a law is effective if a country chooses to implement it.
In August 2023, Sarah Opendi (Tororo DWR) tabled before Parliament the Alcoholic Drinks
Control Bill 2023 and defended the enactment of the law, arguing that the high consumption of
alcoholic drinks has affected productivity in the communities, thus creating the need to protect
children from easy alcohol accessibility and regulate time for sale of alcoholic beverages.
Opendi explained, “Uganda’s statistics on alcohol consumption are particularly worrying because
the harmful use of alcohol causes a high burden of disease and has significant social and
economic consequences. Alcohol consumption is associated with increased risk of overall
mortality and several chronic non-communicable diseases, including coronary artery disease,
congestive heart failure, and stroke.”
She proposed in clause 14 that all licensed businesses selling alcoholic drinks should operate
between 17:00 and 22:00 hours on working days and noon to midnight on public holidays and
weekends. She also proposed a jail term of 10 years for anyone found selling alcohol past legal
time or paying a fine of Shs20M (US$5,378.58).
Further, clause 5(5) of the Bill seeks to impose a pre-requisite for granting a license to business
premises within 400 meters of a school, a health facility, a residential area, or a place of worship.
What Uganda Can Learn from Other Nations
In proposing the new law, Uganda can borrow from other countries, such as South Africa, Peru,
and Finland, which enacted similar laws and made some progress in reducing alcoholism,
according to the World Health Organization.
According to the South African government, three million individuals die annually due to
alcohol, which accounts for five percent of deaths, figures the Government describes as
worrisome.
In 2010, South Africa adopted a multi-ministry rather than an individual-ministry responsibility
approach to reduce the harmful use of alcohol by setting up an inter-ministerial committee
comprising 11 ministries (Health; Correctional Services; Basic and Higher Education; Science
and Technology; Economic Development; Finance; Transport; Sports and Recreation; Trade and
Industry; Justice and Constitutional Development; and the South African Police Service).
The approach was intended to create synergies rather than assign individual responsibility to a
single ministry to combat alcoholism. This has significantly improved coordination and
implementation efforts in reducing alcohol-related harm.
Uganda’s current response follows a similar pattern, though not entirely. The alcohol control Bill
is being jointly handled by the Committees of Health and Trade to strike a balance between the
alcohol industry’s business interests and public health concerns about alcoholism.
Peru Alcohol Sale Ban
Peru instituted a local ban on the sale of alcohol in La Victoria in Lima in 2007 and a similar ban
in Lima in 2011. The ban restricted the sale of alcohol up to midnight from Sunday to
Wednesday.
According to the Pan American Health Organization, the WHO regional office for the Americas,
the ban resulted in a decrease in the number of homicides, alcohol-related road accidents, and
violent deaths due to the phased geographical restrictions on the days and hours of sale of
alcohol.
Finland Advertisement Ban
To reduce young people’s exposure to alcohol advertisements, Finland progressively restricted
alcohol advertising on both broadcast and social media. In 2008, Finland limited the time and
placement of alcohol advertisements by banning advertising on television from 07:00 to 19:00
and in cinemas. In 2015, Finland became one of the first countries to ban alcohol advertisements
on social media.
However, the most crucial thing is implementing the law, as the Kenyan experience shows.
Skeptics of Uganda’s Alcoholic Drinks Control Bill 2023 cite Kenya, which enacted a similar
law in 2010. A study published in the African Journal of Alcohol & Drug Abuse: Challenges
Facing The Implementation Of Kenya’s Alcoholic Drinks Control Act 2010 says alcoholism
reduced for a few years, then worsened due to poor implementation of the law and corruption.
Does Uganda Need More Laws to Regulate Alcohol Consumption?
The proposed law will not be the first to try and fight alcoholism in Uganda. This has further
contributed to scepticism about the proposed law.
The Uganda Youth Development Link, in its September 2009 Review of the Alcohol Laws in
Uganda, noted that Uganda isn’t short on laws to regulate the alcohol industry, but the
effectiveness and efficacy of the laws on alcohol are greatly hampered by poor enforcement.
Complex investigative procedures and evidential requirements also exist, and attempts to enforce
these laws are further hampered by excessively low and inadequate penalties for contravention.
“Most of the laws in place would, to a reasonable extent, combat alcohol abuse in their current
form if implemented. However, poor or non-enforcement of these laws leave the offenders with
much room for continued abuse and violation of the laws, which results into increased levels of
alcoholism and many other health and social problems, especially to the youth,” the report reads
in part.
Uganda currently has eight laws regulating the alcohol sector. These include the Enguli
(Manufacture and Licencing Act) 1966, which prohibits the consumption and export of Bengali,
and the Liquor Act 1960, which provides for premises and hours for the manufacture and sale of
liquor and also restricts the consumption of liquor by children.
The Transport and Road Safety Act 2020 prohibits driving while under the influence of alcohol
and provides three years of jail time or a fine of UGX6M (US$1,613) for contravening this
provision. The same law also stipulates a 10-year jail term for causing death while driving under
the influence of alcohol, while drunken drivers who cause bodily harm are required to
compensate their victims on top of the UGX2M fine or jail term of 3 years.
The Uganda National Bureau of Standards Act 2013 establishes the Standards body mandated to
determine, formulate, and enforce standards for commodities sold in Uganda, including alcohol,
to protect the public. Meanwhile, the Food and Drugs Act Cap 278 creates offenses for
preparing, labelling, possessing, and selling dangerous and adulterated food for human
consumption.
Although Section 12 of the Penal Code Act 1950 provides that intoxication shall not constitute a
defence to any criminal charge, the same law in Section 12 (2) stipulates that intoxication shall
be a defence to any criminal charge if, because of the intoxication, the person charged at the time
of the act complained of, did not know that the act was wrong or did not know what he or she
was doing and 2(a) the state of intoxication was caused without his or her consent by the
malicious or negligent act of another person.
Activists argue that this colonial provision only favours the suspects but falls short of addressing
the plight of the deceased or victim and their loved ones, thus the need to protect society by
requiring courts to sentence offenders to compulsory alcohol abuse treatment and counselling for
their rehabilitation.
The Shop Hours Act 1963 regulates shop hours, while the Potable Spirits Act 1965 prohibits
compounding any spirits for profit or sale without a license.
Brian Sserunjogi, in his November 2018 Brief, Alcohol Consumption Among Youth in Uganda:
Why Policy Intervention Is Necessary, argues that despite the large health, social, and economic
burden associated with harmful alcohol use, regulation of harmful alcohol consumption has
remained a relatively low priority in Uganda’s public policy.
“The regulatory environment and enforcement measures that control alcohol consumption in
Uganda are outdated, weak, and uncoordinated. These laws specify penalties that are too light to
prevent harmful alcohol consumption currently. For instance, the English Act Cap. 86 imposes a
fine of up to USh.2,000 for any manufacturer of jaggery without a license and authorization from
the minister. In addition, the Liquor Act Cap. 93 imposes a fine of up to 200 for making alcohol
sales to anyone below 18 years,” noted Sserunjogi.
He added that the Enguli Act (1966), the Liquor Act (1960), and the Potable Spirits Act (1965)
enacted during colonial times are not able to provide the necessary safeguards to protect the
population against the harmful use of alcohol in the current context.
“Enforcement of the existing laws is weak as government departments tasked with enforcement
lack sufficient human and financial resources to investigate alcohol-related crimes. Therefore,
the existing laws must be reviewed to reflect the changing social and economic patterns. Finally,
these three laws need to be consolidated into a single Act for ease of reference,” added
Sserunjogi.
How Uganda Is Responding to the Alcoholism Challenge
There are also other policy measures to fight alcoholism, and they have largely been ineffective.
For instance, the country currently relies on taxation as a quick fix to alcoholism. Hafsa
Lukwata, Head of Mental Health Division, Ministry of Health, defends taxation, saying this
makes alcohol less available in Uganda.
“One of our biggest problems is the availability of alcohol. It is everywhere and all the time and
to everyone. We need to increase the taxes so that the prices go up and not everyone can afford
to buy these products; let us leave them for those that are already addicted and those that are
rich,” said Lukwata.
In the April 2024 report on the 2024/25 Ministerial Policy Statement by Parliament’s Health
Committee, MPs proposed a 20% increase in taxes on harmful products like alcohol and tobacco
to increase revenue from US$95.3Mn (UGX350,434,301,000) in FY 2022/23 to US$726.49
(UGX2,671,427,233,300) in FY 2026/27.
However, Parliament’s Finance Committee on Excise Duty (Amendment) Bill 2024 report
recommended imposing a rate of 60% or UGX1500 per litre on un-denatured spirits of an
alcoholic strength by volume of 80% or more made from locally produced raw materials, as
opposed to the Government’s proposed rate of UGX5000 per litre, whichever is higher. The
report argued that the Government’s rate is too high compared to the final product of UGX1700
per litre.
Uganda also enacted stricter penalties for motorists driving under the influence of alcohol
following the amendment of the Traffic and Road Safety Act in 2020. However, the Ministry of
Works and Transport has yet to enact Regulations to operationalize the Act.
Mwebaze Isharaza, the co-founder of the Addiction Prevention and Rehabilitation Association of
Uganda (APRAU) APRAU, proposes that the Government expand treatment and rehabilitation
centres, taking them closer to the people. He said there is a high prevalence of underage
drinking, though the response to Alcohol Use Disorders (AUDs) is still inadequate.
APRAU is an umbrella body for private institutions currently involved in the prevention,
treatment, and care of addiction and mental illnesses in Uganda.
“Uganda is estimated to have about 4 million cases of AUDs. The current combined response by
the Government and private sector does not meet even 10% of the treatment needs. The private
sector has a bed capacity of 500 beds for in-patient treatment and care for individuals struggling
with addiction to alcohol, drugs, and other mental illnesses and disorders. The government has
one specialized public institution for the treatment, with a capacity of 80 beds,” explained
Mwebaze.
Richard Baguma, consultant at Uganda Alcoholic Policy Alliance, said the treatment for
alcoholism costs around UGX2 Million (US$537.858) monthly and about UGX24M
(US$6,454.3) annually in private clinics. He said this cost is too high for average Ugandan
families.
“About 20 Alcohol rehabilitation centres in Kampala, Wakiso, and Mpigi are all full, and those
are children of the well-off. We estimate that it costs about UGX2M per month in a rehabilitation
centre. How many people have UGX24M per year because it takes 8-12 months to treat?”
Baguma posed.
SOURCE: NEWS AGENCIES
