At just 16 years old, Abubakar Salau was receiving treatment for snuff addiction in the
psychiatry ward of Karu General Hospital, according to a publication by the World
Health Organization (WHO).
“I used to mix liquid glue with old tobacco to make my snuff. Whenever I sniffed it, the
feeling was surreal,” he says. “Snuff destroyed my life, though. I lost so much weight,
dropped out of school and hurt members of my family. When I recover fully, I plan to
educate teenagers like myself on the dangers of tobacco,” he claims.
Abubakar’s experience was not an isolated case. The WHO publication reported that at
least five patients visited Karu General Hospital’s psychiatry ward daily for treatment of
complications related to tobacco and drug use.
A study published in PLOS ONE in March 2022 estimated that smoking caused
approximately 29,000 deaths annually in Nigeria. The researchers also estimated that
the economic burden attributable to tobacco in 2019 was ₦634 billion. The calculation
included direct medical costs and indirect costs, such as lost productivity and the costs
borne by informal caregivers.
When someone develops a tobacco-related illness, the financial consequences fall
squarely on the patient. Family members may have to pay for treatment, provide care,
or lose income while supporting a sick relative. Employers and the wider economy can
also bear the cost of lost productivity.
Preventing tobacco-related harm therefore requires more than telling people that
smoking is dangerous. It requires sustained public education, effective laws, monitoring
and enforcement, and reliable information to inform policy.
To sum it all up, it requires deliberate and strategic investment in public health,
especially Tobacco Control.
A fund on paper is not enough
Nigeria's National Tobacco Control Act 2015 established the Tobacco Control Fund
under Section 8. The fund is intended to support tobacco control activities through
sources including government appropriations, fines for violations of tobacco laws, and
contributions from relevant development bodies.
The country subsequently introduced the National Tobacco Control Regulations in
2019, providing a framework for implementing the Act.
The current challenge with the Tobacco Control Fund is operationalising the account.
The account has already been established, and funds have been paid into it. Why, then,
has making the account fully operational proved challenging? This raises concerns
about the reasons for the delay and whether it could be a deliberate attempt to
undermine tobacco control efforts in Nigeria.
Public education campaigns require planning and distribution. Compliance monitoring
requires trained personnel, transport, and reporting systems. Research requires data
collection and analysis. Enforcement requires institutions capable of investigating
violations and taking appropriate action.
The cost of waiting for the next grant
External support has significantly contributed to tobacco control in Nigeria through
capacity building, research, advocacy and technical assistance. International partners
have helped strengthen the capacity of governments and civil society organisations to
develop and implement tobacco control measures.
That contribution matters, particularly when public health programmes compete for
limited government resources.
The problem arises when a continuing public responsibility depends on funding that is
temporary or uncertain.
A grant may support a training programme, a research project or a public awareness
campaign for a defined period. When the grant ends, the knowledge and relationships
developed through the project may remain, but continuing the activities still requires
funding.
If there is no sustainable domestic funding arrangement in place to take over,
authorities especially regulatory agencies may struggle to maintain the same level of
work. This is a risk of donor dependence.
Can tobacco taxation help?
One possible source of additional domestic revenue is tobacco taxation.
Nigerian economists have argued that tobacco taxation can help the government raise
revenue while reducing the consumption of products that cause preventable illness. In
a February 2019 article in BusinessDay, Adedeji Adeniran and Joseph Ishaku of the
Centre for the Study of the Economies of Africa explained that revenue from tobacco
taxation could help finance public education, enforcement and other tobacco control
measures.
Research from across Africa shows that tobacco taxation can reduce smoking and
increase government revenue. According to a case study published by Tobacconomics
and indexed by the WHO Framework Convention on Tobacco Control, South Africa
increased real, inflation-adjusted cigarette excise taxes by an average of 13% per year
between 1994 and 2004. Real retail cigarette prices rose by an average of 8% per year,
while per-capita cigarette consumption fell by more than 5% per year.
Over the same period, adult smoking prevalence fell from 31% to 24%, while real
government revenue from tobacco taxes rose by an average of 9% annually.
The Gambia offers a particularly relevant example for Nigeria's debate about domestic
financing. In an article published on April 12, 2021, the World Health Organization
reported that The Gambia began a plan to increase cigarette prices in 2012, with WHO
support. The government subsequently pursued further tobacco tax increases.
By 2018, revenue from tobacco taxation was nearly three times its 2011 level, while
cigarette imports had declined by more than 60%.
These findings illustrate how tobacco taxation can serve two public purposes: reducing
tobacco affordability and generating revenue for government.
The states cannot be left out
The funding question also matters beyond Abuja. State governments are responsible for
decisions that shape the everyday environments in which Nigerians work, trade, travel
and socialise. State-level public education, monitoring of smoke-free requirements and
coordination with relevant enforcement agencies all require resources and clear
institutional responsibilities.
A national fund alone cannot replace state-level implementation. Nor should states
assume that federal institutions or external partners will finance every activity required
within their jurisdictions.
Federal and state governments should clarify their respective responsibilities, include
realistic tobacco-control provisions in their budgets, and report publicly on
implementation. Where states are developing new initiatives, their proposed activities
should be accompanied by costed plans rather than unfunded promises.
The Way Forward
The immediate priority should be to resolve the operational challenges that are
preventing the Tobacco Control Fund from functioning effectively. If the account has
already been established and funds have been paid into it, the Federal Government
should explain why the fund is not fully operational, identify the administrative, legal or
financial bottlenecks responsible for the delay, and publish a clear timeline for resolving
them.
The Federal Government should shift tobacco control funding from uncertain annual
allocations to a predictable, accountable funding arrangement backed by domestic
resources. Tobacco taxation should be part of this strategy, not merely a means of
raising revenue, but a public health measure that discourages tobacco consumption
while creating fiscal space for prevention.
State governments should also allocate budget lines for tobacco control programmes
within their jurisdictions. A country that has legislated against tobacco-related harm
must also be prepared to finance the implementation of its laws. Donor support should
strengthen these efforts, not determine whether they continue.
By Emmanuel Onwuka, a tobacco-control advocate. Writes from Abuja.
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