Plano Estratégico Multissetorial de Combate aos Problemas Ligados ao Álcool, 2016–2020

Objectives

The Multisectoral Strategic Plan to Combat Alcohol-Related Problems for 2016 to 2020 seeks to improve the health and wellbeing of Cabo Verde’s population by reducing harmful alcohol consumption and its health, social and economic consequences.[1][2]It aims to reduce alcohol-related morbidity, mortality and social burden through a balanced public-health response that treats alcohol consumption as a social behaviour shaped by wider cultural, economic and environmental factors, rather than solely as an individual disorder.[3][4]

• Reduce harm associated with non-communicable diseases, injuries, violence, family disruption, disability, workplace absence, road traffic accidents and premature death.[1][5][6]
• Protect women, children, adolescents and people who choose not to drink, including through prevention of early initiation, protection from pressure and advertising, and action on alcohol exposure during pregnancy and breastfeeding.[7][8][9][10]
• Improve access to prevention, screening, treatment, rehabilitation and social reintegration for people and families affected by harmful alcohol use or dependence.[7][11][12]
• Strengthen legislation and enforcement concerning alcohol production, importation, quality, sale, advertising, retail access and consumption in public spaces.[13][14][15]
• Reduce alcohol-impaired driving, road traffic casualties and unsafe road environments through prevention, enforcement and testing.[10][16]
• Prevent, reduce and manage alcohol-related problems in workplaces while protecting workers’ health, safety, employment rights and equal opportunities during treatment.[17][18][19]
• Establish an alcohol information system, improve research and data collection, define outcome indicators, and secure permanent financing for implementation.[2][20]

Implementation

The plan adopts a comprehensive, evidence-based and multisectoral delivery model, with health acting as the catalyst while justice, education, agriculture, finance, municipal authorities, civil society, families and other partners contribute to action.[4]It combines population prevention, communication, regulation, enforcement, clinical care, rehabilitation, reintegration, workplace action, road-safety measures, information systems and financing, with implementation scheduled from 2016 to 2020.[2][21]

• Coordinate implementation centrally through the National Directorate of Health within the Ministry of Health, with technical support from the National Institute of Public Health for information, education and communication and from the Mental Health Programme for treatment and follow-up.[22]
• Operate locally through multidisciplinary municipal commissions coordinated by health representatives and Multidisciplinary Municipal Units bringing together public services, associations, communities and non-governmental organisations involved in alcohol production, control, marketing and consumption.[23][22]
• Provide strategic cross-sectoral coordination through the Interministerial Commission for the Fight against Alcoholism, which is intended to maintain links with municipal structures, guide implementation and meet ordinarily every three months.[22]
• Develop a multidisciplinary trainer group spanning health, education, justice, agriculture, industry and finance to train community-based personnel and sustain skills through periodic meetings and information and communication technologies.[13]
• Deliver accessible information, education and communication through community meetings, schools, printed and digital materials, radio, television, websites, forums and videoconferencing, adapting messages to different audiences.[13][14]
• Strengthen prevention and early identification in health services through systematic use of the Alcohol Use Disorders Identification Test, its abbreviated AUDIT-C version, and the Alcohol, Smoking and Substance Involvement Screening Test.[24][23]
• Expand coordinated care by clarifying referral pathways among hospitals, health centres, therapeutic communities, community services, self-help groups and social-reintegration providers, while improving post-discharge follow-up and labour-market reintegration.[11][25]
• Apply regulatory measures through retailer licensing, controls on domestic and home production, inspection of imported products before customs clearance, municipal inspection teams, customs teams in Praia and Mindelo, and more prompt sanctions for violations.[13][15][26]
• Implement road-safety action through traffic policing, breathalysers, confirmatory testing equipment, traffic operations, driver education, penalty points and sanctions for alcohol-impaired driving.[10][16]
• Establish the National Alcohol Information System using service-level data-collection instruments, periodic reports to the Ministry of Health, research, and a national database covering consumption, harms, economic aspects, policies, prevention, treatment and adolescent alcohol use.[20]
• Finance implementation through a dedicated programme fund and budget line, with contributing institutions, legal arrangements, access criteria and transparent financial-accountability mechanisms to be defined; identified financing sources include the General State Budget, alcohol tax, partners and other funds to be mobilised.[27][28]

Monitoring & Evaluation

The plan establishes monitoring, evaluation and accountability as cross-cutting functions for reducing harmful alcohol use, combining population evidence, service data, enforcement records, research, screening and local implementation reporting. It proposes a National Alcohol Information System and national database to support policy responses, while assigning central coordination to the Ministry of Health and operational delivery to municipal multidisciplinary structures.[2][20][23][22]

• Establish a National Alcohol Information System, conduct research across alcohol-related issues and maintain a national database.[20]
• Collect data through service-level instruments and submit periodic reports to the Ministry of Health on alcohol consumption, trends, harms and policy responses.[20]
• Track seven information categories: consumption levels, consumption patterns, harms and consequences, economic aspects, alcohol-control policies, prevention/research/treatment, and alcohol consumption among adolescents and young people.[20]
• Use outcome indicators to guide intervention policies and assess alcohol-related burden through per-capita consumption and consumption patterns.[4][2]
• Monitor implementation through indicators on trained health services and professionals, training courses, municipalities covered, trainer groups, participants and hospitality workers trained.[21]
• Track awareness and prevention delivery through the number of partners engaged, sessions held, community meetings, textbooks containing alcohol-related content, health facilities using the Alcohol Use Disorders Identification Test and Alcohol, Smoking and Substance Involvement Screening Test, and information, education and communication activities.[14]
• Measure regulatory implementation through revised legislation, municipal inspection teams, customs inspection teams, regular inspections and the prompt application of sanctions.[11][15][26]
• Monitor treatment and reintegration through therapeutic and self-help groups, responsive health facilities and municipalities, ERID cells, and reintegration cases supported by social services and municipalities.[12]
• Track road-safety action through traffic-police personnel and operations, breathalysers, counter-testing equipment and reagents, partnerships, traffic controls and drivers tested on high-risk routes.[16]
• Monitor pregnancy-related prevention through the number of pregnant women screened and sensitised, including use of AUDIT and ASSIST during antenatal recruitment.[29]
• Produce continuous monitoring and evaluation reports on school and leisure-setting alcohol use, alongside quarterly reports on available resources and responses.[18]
• Monitor workplace action through participating workers and services, successful interventions, published indicators, training activity, absenteeism, accident rates and episodes of alcohol consumption.[19]
• Use research indicators covering health delegations and completed studies, publication of results, application of standard data-collection models and establishment of the alcohol-related statistical database.[30]
• Apply ASSIST and AUDIT screening tools to assess substance involvement and hazardous alcohol use, with alcohol scores of 11–26 indicating brief intervention and scores of 27 or above indicating referral for more intensive treatment; an AUDIT score of 8 or more indicates excessive use with high health risk.[31][32]
• Use police and health-facility testing data to document impaired driving, including positive breath tests and confirmatory blood-alcohol testing.[33][34]
• Coordinate monitoring centrally, with the Interministerial Commission for the Fight against Alcoholism following implementation, guiding municipal structures and meeting ordinarily every three months.[23][22]

Baseline evidence includes household expenditure surveys, non-communicable-disease risk-factor surveys, psychoactive-substance surveys, hospital data, police road-traffic data and international estimates. However, data fragmentation, incomplete information on unrecorded production, insufficient labour-market data and limitations in enforcement data constrain comprehensive assessment.[35][5][36][6][37]

The action tables cover 2016 to 2020 and allocate responsibilities to health, police, justice, municipal, education, labour, social-promotion and civil-society bodies. The supplied material does not consistently specify indicator definitions, target values, reporting formats, evaluation methodologies or formal sanctions for non-performance.[21][12][38][27]

Costing & Financing

The financing framework seeks permanent resources for the alcohol action plan through a dedicated fund and budget line, transparent management, local-level oversight and potential earmarking of legally prescribed fees. Although financing is a designated priority area, the extracts provide no quantified Cabo Verde programme budget, fund amount, funding gap or expenditure forecast.[20][39][27]

• Create a dedicated fund for activities addressing alcohol-related problems, with its amount, contributors, legal basis, access criteria and financial-reporting arrangements to be defined.[27]
• Assign the Ministry of Health responsibility for a transparent, criteria-based programme budget line, supported by legal controls to ensure resources reach local interventions.[39]
• Mobilise financing from the General State Budget, alcohol tax revenue, partners and other funds, while establishing an exclusive budget for plan activities.[28]
• Allocate and monitor all programme resources, including their allocation, application and management.[39]
• Link strengthened alcohol-control enforcement to potential tax-revenue gains and social and financial returns that may offset additional investment.[40]
• Address resource requirements for workforce training, community services, treatment and reintegration, inspections, breathalysers, counter-testing equipment, reagents and information systems.[21][12][16]

The economic rationale recognises that alcohol-related social costs may exceed public tax revenues from production and sales. Reported burdens include health-care costs, justice-sector costs, lost productivity, absenteeism, unemployment, early retirement, premature death, pain, suffering and reduced quality of life.[41][42][43]

Comparative international estimates describe substantial alcohol-related costs in the European Union, the United States, the United Kingdom, South Africa and Australia, but these are not Cabo Verde-specific costings. Cabo Verde reportedly allocated approximately 10% of its General State Budget to health, described as close to its financial capacity, while household expenditure on alcoholic drinks represented 2% of budgets in 2001–2002.[42][35][40]