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Making every school a health-promoting school: global standards and indicators

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Outcome

Supportive and empowering societies through addressing health risk factors

[COUNTRY STORY]

Passage of the Tobacco and Nicotine Control Act to protect the Sierra Leone population from the harmful effects of tobacco and nicotine products

Sierra Leone

Photo: WHO Sierra Leone. A high-level meeting with key committee heads and other senior members of Parliament was held in Freetown, Sierra Leone, in February 2022.

Tobacco control to reduce deaths from smoking

Tobacco consumption is a major public health concern in Sierra Leone, with 18% of men and 3% of women aged between 15 and 49 years estimated to be tobacco users [1]. Despite awareness of the negative health impacts of tobacco, smoking remains prevalent and causes over 3300 deaths in the country annually. To mitigate the harm caused by tobacco use, the Government of Sierra Leone collaborated with the World Health Organization (WHO) and partners to enact the Tobacco and Nicotine Control Act in August 2022. The new legislation seeks to regulate all aspects of tobacco production and usage within the country, with the aim of reducing the health, social, environmental and economic burdens associated with tobacco exposure. According to estimates, investing in the six interventions laid out in the WHO Framework Convention on Tobacco Controll (WHO FCTC) could save almost 20 000 lives and prevent a total economic loss of SLL 1.9 trillion[2]. Once the Act is signed into law by the President, Sierra Leone will be better equipped to protect its citizens from the devastating impacts of tobacco consumption.

Key WHO Contributions

Negotiating the global WHO Framework Convention on Tobacco Control (FCTC) treaty
Developing an investment case for Sierra Leone’s tobacco control efforts
Drafting of Sierra Leone’s 2022 Tobacco and Nicotine Control Act
Holding stakeholder consultation workshops, and orientation and validation meetings for review and finalization of the bill
Mobilizing resources for effective implementation and enforcement of the bill’s provisions
Developing implementation strategies and guidelines, public education initiatives and developing capacities of essential institutions.

How did Sierra Leone, with the support of the WHO Secretariat, achieve this?

WHO FCTC is an international treaty that was negotiated under the auspices of WHO and adopted by the World Health Assembly in 2003, with Sierra Leone becoming a signatory in 2009 [2]. The WHO FCTC 2030 Project was launched in March 2017 with financial support from the United Kingdom, Australia and Norway, with the aim of implementing evidence-based tobacco control measures in low- and middle-income countries, including Sierra Leone.

To this end, in 2018, the WHO FCTC Secretariat and the United Nations Development Programme collaborated with the Ministry of Health and Sanitation (MoHS) and other government agencies and development partners to develop an investment case for Sierra Leone’s tobacco control efforts in the coming years. With funding from FCTC 2030, the WHO provided technical assistance to the MoHS, including access to relevant documents and data sources, data analysis and report writing, and stakeholder consultations to validate the findings.

^{A multistakeholder workshop was held by WHO and the Ministry of Health and Sanitation in 2018 to mobilize public and political support, and accelerate implementation of the Framework Convention on Tobacco Control (FCTC).}Photo credit: WHO Sierra Leone.

The investment case revealed that tobacco-related illnesses cost Sierra Leone an estimated SLL 404 billion, equivalent to 1.5 percent of the 2017 gross domestic product (GDP), with out-of-pocket healthcare expenditures amounting to SLL 45 billion. However, investing in tobacco control could potentially bring economic returns of SLL 23 by 2030 and SLL 26 by 2033 for every SLL 1 invested, underscoring the need to scale up the implementation of WHO FCTC provisions in the country.

With funding from the Bill and Melinda Gates Foundation, WHO provided technical and financial assistance to the MoHS to coordinate the drafting of the Tobacco and Nicotine Control Act 2022 in close collaboration with the Ministry of Justice and international experts in tobacco control law, ensuring compliance with WHO FCTC guidelines. Government law drafters from the Ministry of Justice were trained for three weeks on tobacco control legislation and compliance with the WHO FCTC at the McCabe Centre for Law and Cancer in Australia. They were able to contribute to review and finalization of the law, through stakeholder consultation workshops, orientation and validation meetings.

“This is a remarkable success for public health in Sierra Leone and WHO is proud to have worked very closely with the government, the civil society and the different partners that have supported the process over the years for the development of such comprehensive tobacco control regulation”.

- Dr Steven Velabo Shongwe, WHO Representative in Sierra Leone

Once stakeholders’ inputs were taken into account, WHO advocated for approval of the bill, which was passed in August 2022. To enable its implementation WHO also supported capacity-building training for staff from the MoHS, the Ministry of Finance and the National Revenue Authority at the Knowledge Hub, University of Cape Town, on tobacco dangers, tax modelling and illicit trade elimination.

Adoption of the Tobacco and Nicotine Control Act in Sierra Leone faced significant challenges which threatened its passage into law. Firstly, the tobacco industry actively interfered by lobbying lawmakers to reject the bill. Secondly, resources were inadequate to support civil society involvement in tobacco control advocacy. These challenges emphasize the importance of continued technical and financial support from WHO.

“I want to assure WHO and the Ministry of Health, that we are going to be champions in the well of parliament in ensuring that we pass this bill into law. The beauty about us here is that we are carefully selected, we have all the committee chairmen that are relevant to this bill, and we also have all political parties represented”.

- Hon. Sallieu Osman Sesay, Member of Parliament, Sierra Leone

WHO continues to provide essential support for the development of implementation strategies and guidelines, public education initiatives to increase awareness of the law and ensure compliance, and strategic technical assistance to develop capacities in essential institutions. Moreover, WHO is assisting to mobilize resources for effective implementation and enforcement of the law’s provisions. To maximize impact, the priority FCTC measures defined in the investment case will form the focus of WHO’s efforts. These include improving community awareness about the dangers of tobacco (FCTC Article 12), advocating for an increase in excise tax from the current 30% to a minimum 50% set by the 2017 Economic Community of West African States (ECOWAS) directive on tobacco tax to reduce tobacco demand (FCTC Article 6), a ban on smoking in all public places to reduce smoke exposure (FCTC Article 8), tobacco products bearing health warnings and in plain packaging (FCTC Article 11) and a ban on tobacco advertising, promotion and sponsorship (FCTC Article 13).

References

USAID. The DHS Program: Sierra Leone: Standard DHS [dataset]. Washington, DC: USAID; 2019. https://dhsprogram.com/data/dataset/Sierra-Leone_Standard-DHS_2019.cfm (accessed 24 February 2023).
United Nations Development Programme. Investment case for Tobacco Control in Sierra Leone: Report. New York: UNDP; 2021. https://www.undp.org/sierra-leone/publications/investment-case-tobacco-control-sierra-leone-report (accessed 24 February 2023).