Upstream policymaking in Africa: a case study analysis of the district to national alcohol sachet bans policy transfer in Uganda

Background High rates of heavy episodic drinking in Uganda have been linked to alcohol sachets due to their affordability and widespread availability. The Gulu district enacted a local sachet ban in 2016 which transferred to a national ban in 2019 to protect population health. This paper examines this transfer.Methods Seventeen semi-structured interviews were conducted with government representatives, NGOs, and civil society members at district and national levels, alongside a review of eleven key policy documents. Data were thematically analyzed. We applied Jensen et al’s framework.Results For both bans, the rationale was to reduce alcohol availability and harms. The local ban inspired the national ban which was enacted following further parliamentary discussions, and the resolution of ministerial disagreements. Implementation involved a multi-sectoral taskforce, and goods seizures in both cases. Those bans successfully withdrew sachets from the market but have not been evaluated.Conclusion In a context of limited progress on national alcohol policy implementation across the continent, this study of a local to national alcohol policy transfer in Africa offers valuable learning. It shows how local governments in decentralized systems can advocate for strong alcohol regulation and should be recognized as partners in upstream policymaking. Future evaluation is needed to assess the long-term effectiveness and public health impact of the policy.