Evaluating the progress of alcohol policies in Burundi against the WHO 'Best Buys' interventions: Implications for public health

Introduction: Alcohol use is a major global health risk, with Global South countries experiencing greater harm per litre of alcohol consumed than those in the Global North. In Burundi, a country with a low-income economy, 16.6% of people aged 15 and above engage in heavy episodic drinking, and over 30% of women drink during pregnancy. This paper examines current alcohol policies in Burundi, how well they match the World Health Organization (WHO) 'Best Buys' policy options, and stakeholder views on their implementation. Methods: We identified policy documents via online searches, visits to government offices, and snowball sampling from contact with key stakeholders. Semi-structured interviews were conducted with 10 stakeholders. The WHO European Action Plan to Reduce the Harmful Use of Alcohol (EAPA) tool was used to analyse the extent to which Burundi has adopted recommended policy standards. Interviews were thematically analysed using NVivo software. Results: Only nine of the 34 WHO EAPA indicators are addressed; seven out of 34 indicators are mentioned with no clear actions; and 18 are not addressed in the eight policy documents that met our inclusion criteria. The large proportion of indicators absent from Burundi policy relate to availability, pricing and taxation, drink-driving, and marketing. An absence of legislation to support existing policies, industry interference, corruption, and cultural norms around alcohol were identified as key barriers to implementation. Conclusions: Burundi should enact laws to support existing policies and design regulations targeting taxation, marketing, and availability. Government and civil society coalitions should report and address any influence of the alcohol industry on policymaking and implementation.