National Plans of Action for Tobacco Control and the WHO Framework Convention on Tobacco Control (WHO FCTC) Anne-Marie Perucic TFI, WHO

1- National Plans of Action: How to develop them

RITC Workshop | Ottawa, 7-11 May |3 | National Plan of Action Definition: " a roadmap outlining how a country intends to deal with the tobacco epidemic and setting a timeline and target date for completion" Source: Building Blocks for Tobacco Control: a Handbook, WHO Important tool for tobacco control, creates a momentum for tobacco control and a catalyst for development of needed activities such as drafting legislation. Importance of Article 5 of the WHO FCTC (Guiding Principles) as a legal/policy basis for development of national plans of action

RITC Workshop | Ottawa, 7-11 May |4 | National Plan of Action It is a document that describes : the goals and objectives of a country in relation to its health priorities, the strategies and activities that are needed to achieve these goals and objectives the resources that the government is willing to commit the parties responsible for each activity the mechanism for tracking progress

RITC Workshop | Ottawa, 7-11 May |5 | Steps for developing a National Plan of Action for Tobacco Control 1.Finding the architects of the plan by: –Designating a national focal point for tobacco control – within the Government, specifically within a unit of the Ministry of Health. –Creating a national steering committee for tobacco control: must be multisectoral and should include: Government ministries: Health, Finance, Customs, Trade and Commerce, Agriculture, Labour, Law and Justice, Education, Culture, Environment etc. Private sector: Media, NGOs, Health professionals, Lawyers, Economists, Business, industry and labour unions, farmer groups, religious groups, consumer organization etc. Note: Do NOT engage the tobacco industry when designing, implementing and evaluating plans of actions for tobacco control

RITC Workshop | Ottawa, 7-11 May |6 | Steps for developing a National Plan of Action for Tobacco Control 2.Determining needs and resources: conduct a situation analysis (to the extent data is available): –Mapping political environment in relation to tobacco control (existing tobacco control measures, role of tobacco industry in country, role of tobacco control advocates in country, current attitude of key institutions such as media and business community) –Health and economic impact of tobacco use and economic importance of tobacco –Public knowledge about impact of tobacco and public support for tobacco control (through surveys) –Monitoring of tobacco industry's activities

RITC Workshop | Ottawa, 7-11 May |7 | Steps for developing a National Plan of Action for Tobacco Control 3.Setting the strategic direction which includes the vision, the mission, the goal and objectives of the programme. 4.Drafting the National Plan: 1.Usual timeframe: 5 years 2.Use the WHO FCTC as a base – the various elements that should be considered for inclusion are outlined in the Convention. 3.Should be adapted to the country's unique socio-cultural and political-economic situation. 4.Should identify the general and specific objectives and corresponding strategies and activities required to achieve the objectives. 5.Expected outputs should be listed for each objective and responsible people/agencies assigned to each activity. 6.Determine resources needed for activities selected to achieve each objective (pinpoint potential sources of funding).

RITC Workshop | Ottawa, 7-11 May |8 | Steps for developing a National Plan of Action for Tobacco Control 5.Ensuring legitimacy of the National Plan by: oUndertaking a broad consultation to establish ownership of the plan among the implementing and enforcing parties,  This will be made easier if the national steering committee includes are the parties needed for the implementation of the National Plan. oEnsure formal recognition/adoption of the National Plan by the Government granting it official status. 6.Launching the National Plan of Action oPublicise the creation and adoption of the National Plan – through press conferences and other media events (could be made to coincide with the celebration of Wold No Tobacco Day).

RITC Workshop | Ottawa, 7-11 May |9 | Elements of a National Action Plan Vision: communicate what the plan believes is the ideal condition for the country Mission statement: describing what the plan is trying to accomplish Background summarizing key findings of situation analysis and outlining the rationale for taking action Goal and objectives –For each objective select strategies and expected results Define specific activities within each strategy –For each activity list: - who is responsible - target date for completion of activity - resources needed to complete the activity Progress indicator to measure effectiveness of implementation

RITC Workshop | Ottawa, 7-11 May | National Plans of Action: Pitfalls Not feasible: include too many activities to undertake in a rather short period of time Cost assessment: sometimes too large (and with no funding ground) to be fully endorsed by the Government Too general: does not include concrete activities

2- The WHO FCTC: Overview

RITC Workshop | Ottawa, 7-11 May | The WHO Framework Convention on Tobacco Control GLOBAL RESPONSE “ We need an international response to an international problem. I believe that the response will be well encapsulated in the development of an International Framework Convention”. »Dr Gro Harlem Brundtland »Seminar on Tobacco Industry Disclosure »Geneva, 20 October 1998 The Convention is a set of legally binding rules that will govern the global rise and spread of tobacco and tobacco products in the next century. The underlying objective of this Convention will be to reduce the morbidity and mortality attributable to tobacco.

RITC Workshop | Ottawa, 7-11 May | STATUS OF THE WHO FCTC The WHO FCTC entered into force on 27 February 2005 As of 06 May 2007, the WHO Framework Convention on Tobacco Control had 147 Parties, representing about 80% of the world population. 8 out of the 11 Mega Countries are Parties to the WHO FCTC –They include: Brazil, Bangladesh, China, India, Japan, Mexico, Nigeria and Pakistan –They represent: 3.2 billion people and 51% of the world population

RITC Workshop | Ottawa, 7-11 May | Uniqueness of the WHO FCTC Addresses tobacco control from both the supply-side and demand-side perspectives. Reflects measures that have proven effective in reducing tobacco consumption. Includes provisions related to questions of the liability of Contracting Parties. Includes provisions relating to the potential saboteurs of its implementation, the tobacco companies.

RITC Workshop | Ottawa, 7-11 May | WHO FCTC Article 5: General Obligations 1.Each Party shall develop, implement, periodically update and review comprehensive multisectoral national tobacco control strategies, plans and programmes in accordance with this Convention and the protocols to which it is a Party. 2.Towards this end, each Party shall, in accordance with its capabilities: a)establish or reinforce and finance a national coordinating mechanism or focal points for tobacco control; and b) adopt and implement effective legislative, executive, administrative and/or other measures and cooperate, as appropriate, with other Parties in developing appropriate policies for preventing and reducing tobacco consumption, nicotine addiction and exposure to tobacco smoke.…

RITC Workshop | Ottawa, 7-11 May | An Evidence-based Strategy packaging and labelling supply reduction demand reduction prices and taxes advertising, promotion, sponsorship illicit trade alternative activities treatment of dependence liability sale to and by minors exposure to tobacco smoke regulation of tobacco products Reduces DEMAND Part III, Articles 6 – 14 Reduces SUPPLY Part IV, Articles 15 – 17 PROTECTS the environment Part V, Article 18

RITC Workshop | Ottawa, 7-11 May | WHO FCTC Demand reduction clauses: –Article 6: Price and tax measures to reduce the demand for tobacco –Article 8: Protection from exposure to tobacco smoke –Articles 9 & 10: Regulation of the contents of tobacco products and Regulation of tobacco product disclosures –Article 11: Packaging and labelling of tobacco products –Article 12: Education, communication, training and public awareness –Article 13: Tobacco advertising, promotion and sponsorship –Article 14: Demand reduction measures concerning tobacco dependence and cessation

RITC Workshop | Ottawa, 7-11 May | WHO FCTC Supply reduction clauses: –Article 15: Illicit trade in tobacco products –Article 16: Sales to and by minors –Article 17: Provision of support for economically viable alternative activities

3- Example of a National Plan of Action

RITC Workshop | Ottawa, 7-11 May | Mauritius draft National Plan of Action Situation analysis: including information on the state of affairs for consumption, prevalence, tobacco production, existing regulations, surveillance and existing sources of data at the national level. Time frame: 3 years Goal and objectives: –Goal: "To reduce mortality and morbidity due to the use of tobacco products". –Main objectives: To prevent the use of tobacco among young people and adults. To protect from exposure to environmental tobacco smoke (ETS). To promote cessation among smokers.

RITC Workshop | Ottawa, 7-11 May | Mauritius draft National Plan of Action Specific objectives derive from each of the main objectives defined above (specific objectives and corresponding activities cover all provisions of the WHO FCTC). A section follows to justify with numbers and evidence the reason why the specific objective was selected. Institutional Framework: setting up a National Committee on Tobacco Control (NCTC) –Chaired by the Principal Medical Officer/Chief Medical Officer of the MoH and assisted by the Tobacco Control Focal Person in charge of the tobacco programme in the Ministry. –Other Members include: Ministries of Health and Quality of Life, Education and Scientific Research, Finance, Youth and Sports, Women's Rights and Family Welfare, Mauritius Institute of Education, Mauritius College of the Air, Mauritius Research Council, National Agency for the Treatment and Rehabilitation for Substance Abusers and VISa (NGO).

RITC Workshop | Ottawa, 7-11 May | Mauritius draft National Plan of Action Example of a strategic plan for a specific objective to attain Main Objective: To prevent the use of tobacco among young people and adults. –Specific Objective 1:To increase public awareness on the consequences of tobacco use.

RITC Workshop | Ottawa, 7-11 May | Specific Objective 1: To increase public awareness on the consequences of tobacco use - Activities StrategiesActivitiesOutputsCollaborating bodies 1- Provide information and education to the public and targeted groups Hold awareness sessions in the community Different target groups sensitizedMOH, other Ministries, VISa and other NGOs, religious bodies, Community Leaders, MCA, advertising agencies, the press. Produce and distribute health education materials Materials printed and distributed Carry out media campaignsMedia materials produced and used. Advertisement on user-friendly magazines and newspaper carried out. Organize World No-Tobacco DayThematic activities held. Print rotating messages and pictures on cigarette packets. Text messages and pictures prescribed by the Ministry of Health. Messages and pictures printed. 2- Carry out advocacy with the media and other influential groups and people Hold advocacy workshops/meetings with the media and other influential groups and people, e.g trade unions, managers. One workshop held annually. Local media and others receive information on the effects of tobacco use. MOH, other Ministries, VISa and other NGOs, the press, Community Leaders/groups, trade unions. Train community leaders as advocates 100 Community leaders trained annually and accept a no-smoking leadership role.

RITC Workshop | Ottawa, 7-11 May | Specific Objective 1: To increase public awareness on the consequences of tobacco use - Funding ACTIVITIES Cost (Rs) TotalCost (Rs) Total Cost (US$) Funding Agencies Implementing Bodies Hold awareness sessions in the community Produce and distribute health education materials. 400, ,000 Carry out media campaigns675,0001,000,000 Organize World No-Tobacco Day125,000150,000 Print rotating messages and pictures on cigarette packets. Hold advocacy workshops/meetings with the media and other influential groups and people, e.g trade unions, managers. 27,50032,50037,500 Circulate regular updates and research papers from authoritative sources to the press and opinion leaders. Train community leaders as advocates15,000 20,000

RITC Workshop | Ottawa, 7-11 May | Specific Objective 1: To increase public awareness on the consequences of tobacco use – Indicators to measure effectiveness of implementation S/NSpecific ObjectivesINDICATORSMeans of Verification 1.To increase public awareness on the consequences of tobacco use. Percentage of school youth aged years reporting that tobacco use is harmful to health. Percentage of adults reporting that tobacco is harmful to health-causes cancer. GYTS NCD Surveys

RITC Workshop | Ottawa, 7-11 May | Thank You! Useful resource: Building Blocks for Tobacco Control: A handbook WHO, 2004 URL: ol_handbook/en/index.html ol_handbook/en/index.html