Plano Estratégico Multisectorial de Combate aos Problemas Ligados ao Álcool 2016-2020

Objectives

Cabo Verde’s 2016–2020 Strategic Multisectoral Plan to Combat Alcohol-Related Problems seeks to improve population health and wellbeing by reducing abusive alcohol use, related morbidity and mortality, and the associated social burden. It frames alcohol harm as a public-health, social, economic and cross-sectoral issue requiring coordinated action across prevention, regulation, treatment, road safety, workplaces, families and communities.[1][2]The plan is guided by public-health priority, equity, evidence, cultural sensitivity, protection of people at heightened risk, shared responsibility and the principle that commercial or other competing interests must not undermine public-health policy.[3][4]

• Reduce harmful consumption, delay initiation of drinking until at least the legal age, protect people who choose not to drink from pressure, and protect vulnerable groups, particularly women, children and adolescents.[4][1][5]
• Strengthen information, awareness, training, communication and education to improve knowledge, prevention capacity and behaviour change among the public, professionals and communities.[1][6]
• Update and enforce legislation governing alcohol production, importation, sale, advertising, licensing, product quality and availability, including controls on homemade and sugar-cane spirits.[6][7][8]
• Expand prevention, detection, referral, treatment, recovery and social, family and occupational reintegration for people and families affected by alcohol-related problems.[9][10][2]
• Reduce alcohol-related road traffic injuries, deaths and other harms through driver controls, lower blood-alcohol limits, education, enforcement and sanctions.[11][12][13]
• Prevent and manage alcohol-related problems in workplaces through occupational safety measures, information programmes, worker assistance, treatment and rehabilitation, while addressing inappropriate conduct within employment rules.[9][14]
• Establish information systems, research and a national database to understand consumption, harms, expenditure, policy effects and population vulnerability.[15][16][17]
• Secure sustained resources through a dedicated fund and budgetary arrangements for programme activities.[18][17][19]

Implementation

The plan adopts a harm-reduction, multisectoral and locally delivered model rather than treating abstinence as its sole objective.[20]Local structures implement interventions, while central institutions coordinate, finance, monitor and evaluate activity.[2]The National Health Directorate coordinates with the Ministry of Health, supported by the National Institute of Public Health for information, education and communication and by the Mental Health Programme for treatment and follow-up.[21]Municipal Multidisciplinary Units, coordinated by Health Delegates, bring together public services and non-governmental organisations involved in alcohol production, control, marketing and consumption.[21]

• Establish active multidisciplinary commissions in every municipality and strengthen the Interministerial Commission to support cross-sectoral participation.[2]
• Engage health, education, justice, agriculture, finance, labour, interior, security, municipal, customs, social-promotion, civil-society, family, community and private-sector actors.[20][22][12]
• Deliver training through multidisciplinary trainer networks and community-level activities, including training health professionals to apply the Alcohol Use Disorders Identification Test and the Alcohol, Smoking and Substance Involvement Screening Test routinely.[22][23][19]
• Strengthen treatment capacity through mental-health teams, therapeutic and self-help groups, Integrated Responses to Dependencies Space cells, referral networks and coordinated social-reintegration support.[10][12]
• Apply inspection and enforcement through municipal multidisciplinary teams, alcohol-retailer and entertainment-venue inspections, imported-product quality controls, and traffic-police roadside testing.[7][10][13]
• Implement workplace prevention through mapping of practice, legal and labour-law measures, codes of conduct, worker-support programmes, risk-awareness activities and training.[24][25][26]
• Operate a National Alcohol Information System using standardised service-level data collection, periodic reports to the Ministry of Health, research studies and a national statistical database.[15][16][17]
• Monitor implementation through indicators covering training, municipal coverage, partner participation, awareness activities, school content, screening-tool use, inspections, treatment and reintegration services, road-safety controls and workplace outcomes.[22][27][23][13][24]
• Review progress through monthly municipal-unit meetings, quarterly reports, twice-yearly national and regional multisectoral evaluation commissions, annual indicator comparison and published evaluation reports.[21][28][29]
• Conduct an internal process evaluation after the first year, annual outcome evaluations from the second year, and impact evaluations in the third and fifth years; classify activities delayed by more than three months as unsuccessful unless conditions permit their reintroduction.[28][29]
• Finance implementation through the General State Budget, alcohol tax revenues, partners and other mobilised funds, with an exclusive budget, a dedicated fund, defined access criteria, analytical accounting and transparent reporting on resource use.[19][30]

Monitoring & Evaluation

The 2016–2020 Strategic Multisectoral Plan provides for a national monitoring, evaluation and accountability system combining routine data collection, implementation indicators, local review and central oversight. Priority areas include information systems and data collection, and the plan calls for outcome indicators to guide alcohol-policy interventions.[1][30]

• Establish a National Alcohol Information System and national statistical database, using standardised collection tools across services and institutions and periodic reporting to the Ministry of Health.[9][15][17]
• Collect data on alcohol-consumption levels and patterns, harms and consequences, economic aspects, alcohol-control policies, prevention, research, treatment, and alcohol use among adolescents and young people.[15]
• Conduct studies on consumption patterns, consumer profiles, alcohol-related expenditure, susceptibility, years of life lost and the impact of measures, with health delegations conducting annual studies from 2016 to 2020 and selected studies scheduled for 2017, 2018, 2019 and 2020.[16][17]
• Monitor implementation through indicators covering trained professionals, trainer networks, municipalities reached, partner engagement, awareness activities, alcohol content in school materials, routine use of the Alcohol Use Disorders Identification Test and Alcohol, Smoking and Substance Involvement Screening Test, and information, education and communication activities.[22][27][23]
• Track enforcement and road-safety activity through indicators such as police operations, breathalyser availability, confirmatory-testing capacity, drivers tested, accidents, injuries, deaths, positive tests and arrests for driving under the influence.[13][31][32]
• Monitor service and reintegration responses through therapeutic and self-help groups established, health structures responding to alcohol-related problems, Integrated Responses to Dependencies Space cells formed, reintegration cases supported, and ongoing individual follow-up to prevent relapse.[12][33]
• Require municipal multidisciplinary units to review implementation monthly and submit quarterly reports, while the Interministerial Commission meets quarterly and national and regional multisectoral evaluation commissions meet twice yearly.[21][28]
• Conduct an internal process evaluation after the first year, annual outcome evaluations from the second year, and impact evaluations in the third and fifth years; publish and disseminate evaluation findings and recommendations.[29]
• Classify activities not completed within three months of their scheduled date as unsuccessful, remove them from the plan unless conditions later permit reintroduction, and reflect such failures in annual programme evaluation.[28]

The extracts identify important data-quality constraints, including fragmented records across sectors, insufficient workplace information, unavailable data on disabling road injuries, and underreporting of alcohol involvement in violence and traffic injuries.[34][35][36][37]Formal indicator definitions, baselines, targets and a consolidated reporting timetable are not fully specified in the supplied material.[1][15][29]

Costing & Financing

The plan identifies financing as one of its eight priority areas and proposes sustained, dedicated and transparently managed resources for alcohol-related interventions.[1][18][22]No Cabo Verde-specific programme budget, costed activity schedule, quantified funding gap or monetary allocation is provided in the supplied extracts.[18][22][30]

• Establish a dedicated fund for activities under the Programme to Combat Alcohol-Related Problems, with its amount, replenishment arrangements, contributors, legal basis, eligibility criteria and financial-reporting model to be defined.[18][17][19]
• Finance implementation through the General State Budget, alcohol tax revenues, partners, other resources to be mobilised, and an exclusive budget for action-plan activities.[30]
• Assign financing, monitoring and evaluation responsibilities to the central level while delivering interventions locally, subject to the availability of required resources.[2][28]
• Apply legal oversight and transparent management arrangements to track budget flows, ensure resources reach local implementation, and monitor all resources allocated to the programme.[22]
• Strengthen regulation and inspection of alcohol production and marketing to support taxation, potentially increase state revenue and contribute to reduced consumption.[18]
• Recognise that harmful alcohol use generates direct costs in health care, justice, property damage, road traffic and imprisonment, as well as indirect costs from absenteeism, unemployment, lost production, early retirement and premature mortality.[38][39]

Health-sector expenditure is estimated internationally to represent 9% to 24% of direct alcohol-related social costs, while justice-related costs are characterised as substantial.[38]Illustrative external estimates include alcohol-attributable costs of 125 billion euros in the European Union in 2003, 233.5 billion dollars in the United States in 2006, 21 billion pounds in the United Kingdom in 2009, and nearly 300 billion rands in South Africa in 2009.[39]These figures are contextual international estimates rather than Cabo Verde programme costs.[39]

The source notes that the Abuja Declaration proposed allocating 15% of public expenditure to health, whereas Cabo Verde was allocating approximately 10% of the State General Budget to health.[18]It also describes public finances as constrained and unpredictable, partly owing to the global economic crisis and pressure to reduce public expenditure.[18]