Capacity building and initiatives
Some countries can't tackle the tobacco epidemic alone. WHO is there to help.
Implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) requires strengthening of national capacity for tobacco control. To support countries in implementing some of the WHO FCTC provisions on the ground, WHO launched “MPOWER” in 2008. MPOWER is a set of six proven policy measures that are known to reduce tobacco use effectively. Jointly with its national and international partners, WHO works with countries to strengthen national capacity to put the MPOWER measures in place.
Article 5 of the WHO Framework Convention on Tobacco Control mandates Parties to develop, implement, periodically update and review comprehensive multisectoral national tobacco control strategies, plans and programmes; to establish or reinforce and finance a national coordinating mechanism or focal points for tobacco control; and to adopt and implement effective legislative, executive, administrative and/or other measures. Building national capacity to carry out effective and sustainable national tobacco control programmes is an urgent priority and one of the most important measures required to combat the tobacco epidemic.
Capacity building has typically been defined as the development and strengthening of human and institutional resources. It is acknowledged that the process needs to go beyond the public sector, as it is also influenced by entities in the private sector including commercial enterprises and nongovernmental organisations. The United Nations Development Programme defines capacity as "the ability to perform functions, solve problems, and achieve objectives" at three levels: individual, institutional and societal. The expected outcome of building national capacity is a comprehensive and sustainable national strategy for multi-sectoral tobacco control programmes and policies.
Inadequate resources
Most national tobacco programmes are inadequately understaffed and under-resourced. Governments collect USD 133 billion in tobacco excise tax revenues, but spend less than USD 1 billion on tobacco control, with this gap being most evident in low- and middle-income countries (LMICs). In middle-income countries, per capita excise tax revenues are more than 1,000 times larger than public spending on tobacco control, while in low-income countries they are more than 4,000 times larger.
Strategically-designed national capacity building measures will have a great impact in reversing the tobacco epidemic, particularly in LMICs. The development of a national plan of action is the foundation for successful tobacco control at the country level.
Other important elements include:
- establishing an effective infrastructure for a national tobacco control programme, training and education;
- raising public awareness through effective communications and media advocacy;
- programming specific tobacco control activities, legislative measures for tobacco control; and
- exploring economic interventions and funding initiatives.
Building blocks for tobacco control: a handbook
WHO's Tobacco Free Initiative (TFI) has published a handbook to address the practical elements of various tobacco control measures. This is the first document to comprehensively address how to build tobacco control capacity at the national level. Conceived as a “How to” manual, the approach is intentionally pragmatic. It addresses "real world" issues and provides practical advice for setting up viable national tobacco control programmes.
Key strategies
The following link provides a summary of key strategies to strengthen national capacity for tobacco control:
- Analyse the national tobacco control situation (impact of tobacco use, political willingness, public awareness, etc.).
- Develop consensus and political commitment for tobacco control in the country.
- Outline national tobacco control strategies based on priorities that consider the characteristics of the national tobacco epidemic and the socio-political environment.
- Establish a national co-ordination: after the nomination of a focal point or person responsible for tobacco control a committee for tobacco control involving different government sectors needs to be created. This tobacco control Committee will develop policies and programmes for tobacco control.
- Build a comprehensive national plan of action reflecting national priorities and realities.
- Establish through national regulation/legislation sustained funding mechanisms for tobacco control programmes.
- Incorporate national tobacco control efforts into existing national, state and district level health structures to ensure sustainability.
- Develop strategies for monitoring and counteraction of tobacco industry activities in the country.
- Establish a system of monitoring and evaluation of tobacco control policies development and implementation.
Capacity building activities
WHO plays a key role in strengthening national capacity for tobacco control, mainly through the following activities:
- co-ordinating global expertise
- facilitating assistance to comprehensive tobacco control efforts at the national level
- assisting the implementation of effective national tobacco control strategies
- promoting partnerships with governments and civil society
Capacity assessments
WHO has engaged in a series of Tobacco Control Capacity Assessments, which are joint exercises between national governments and WHO to identify country capacity (including strengths, opportunities, barriers and obstacles) for the implementation of effective tobacco control measures. The assessment includes an analysis of the commitment and the organizational structure available to implement the WHO FCTC demand reduction measures, as well as any other specific tobacco control measures according to national circumstances and priorities and in the context of their obligations under the WHO FCTC. The result of this capacity assessment is a set of recommendations to guide government and other stakeholders in developing and implementing tobacco control programmes.
African tobacco control
Overview of tobacco control in Africa
Africa is poised to experience a tobacco epidemic
Africa is poised to experience a tobacco epidemic. The existence of an attractive, under-tapped market and the targeted tactics of the tobacco industry have created "perfect storm" conditions for tobacco use to take root, especially among young people. Seventeen per cent of 13–15-year-olds in the region are already using tobacco products, a statistic that matches the global average (WHO, 2008). Tobacco use is, and will continue to be, a significant driver in the epidemiological transition from communicable to noncommunicable diseases in Africa. WHO projects that in the coming years, deaths in Africa from infectious diseases, maternal and perinatal conditions and nutritional deficiencies combined will increase, but deaths from noncommunicable diseases will increase at a higher rate.
If strong tobacco control measures are not implemented, the number of smokers in sub-Saharan Africa is projected to increase 148% by 2030, to 208 million smokers (Jha & Chaloupka, 2000). We have an opportunity to prevent a foreseeable catastrophe. Indeed, we have the opportunity to create an enabling environment in which 84 million current tobacco users reduce their tobacco consumption or quit altogether and 331 million youths under the age of 15 never take up tobacco use at all.
The WHO Framework Convention on Tobacco Control (WHO FCTC) and its guidelines provide the foundation for countries to implement and manage tobacco control. WHO introduced MPOWER to assist in the country-level implementation of effective measures to reduce the demand for tobacco, contained in the WHO FCTC. At the moment, the key demand reduction measures identified in the package are being implemented to great effect in many regions.
African tobacco control leaders have articulated their needs
Most African countries still have not fully developed the capacity to implement and enforce important policies outlined in the WHO FCTC and the implementation guidelines adopted by the Conference of the Parties.
- Technical capacity for strengthening tobacco control. Technical capacity gaps remain, for example, in the areas of tobacco taxation and surveillance. In theory, tobacco taxation in particular presents a win-win opportunity for both public health and treasury coffers. In reality, ministry of finance engagement with ministries of health on tobacco control needs strengthening. Weak capacity to counter fallacious economic arguments put forward by the tobacco industry is also partly to blame. The result is that Africa claims more than half of the 30 lowest tobacco tax rates in the world.
- Institutional capacity for programmatic change. The technical capacity gaps notwithstanding, the greatest need is for institutional capacity development, namely in the areas of performance management, project management and resource mobilization. Indeed, while 35 governments have national agencies for tobacco control, nearly one third of these do not have clearly defined national objectives for tobacco control (WHO, 2011). Most also have a national multisectoral steering committee. But it is an ad hoc group, with no secretariat. So while there is some infrastructure in place, including both capital and human assets, the resulting activities lack continuity.
- Cross-sector and cross-country capacity for alignment and coordination. The African Region played a prominent role during the negotiations of the WHO FCTC, speaking in one strong voice and helping countries reach a consensus towards the adoption of the treaty. Unfortunately, coordinated actions have not been sustained for the critical phase of country implementation of the treaty. This has had implications in a number of important areas, including agricultural cooperation and tobacco industry interference in tobacco control policy development, as well as more specifically in the area of taxation. Coordinated work on tobacco control among countries of the same sub region can help address such concerns, as the countries of the East African Community and the West African Economic and Monetary Union have already demonstrated in the context of tobacco taxation.
In February 2008, WHO convened a meeting of African civil society and government to agree on the technical assistance needs for Africa. This "Geneva Consensus" identified the most urgent needs in addressing the capacity gaps:
- Technical: Good practices, lessons learned, advocacy and technical toolkits, norms and guidelines, etc., from African countries or adapted to the African context as appropriate.
- Institutional: National and subregional resources, including human resource capacity and a pool of experts, institutional and management capacity, infrastructure, internal and external funding.
- Cross-sector and cross-country: Networking and partnership building for collaboration that is multisectoral and multidisciplinary, at both the national and subnational levels.
The February 2008 brainstorming in Geneva resulted in an idea to develop subregional structures, or "African tobacco control Hubs", for leveraging technical and institutional capacity across the stakeholder groups already existing on the ground, as well as for coordination of what participants worried were becoming piecemeal initiatives by the few international organizations with tobacco control operations in the region. Participants had a clear vision about how the Hubs would operate and what their activities would be. They suggested that they meet again to clearly define the objectives, the structure and the activities of the Hubs. Hosted by the Government of Ghana, the meeting took place on 26–27 June 2008 in Accra and was attended by more than 30 civil society and governmental participants from 15 countries. The consensus reached at that meeting (hereafter, "Accra Consensus”) reads as follows:
The Accra Consensus on African tobacco control hubs
The African tobacco control hub is a cross-sectoral partnership of governmental and nongovernmental organizations sharing a common vision of containing the tobacco epidemic across the region. The partners are aligned and coordinated as one countervailing force against the interference of the tobacco industry. One partner, the hub host, provides a convening space, a command centre and a resource base for the Hub partners. These hub partners will assess the capacities needed in their respective countries and in the Region as a whole and will collaborate to deliver the tobacco control products and services that governments, civil society and development partners are demanding (ref. Geneva Consensus). The hub is designed so that its activities are to become self-financing in time.
Through the grant support from BMGF, in 2011 WHO has helped establish the Center for Tobacco Control in Africa (CTCA), under the Makerere University, Uganda bringing to fruition the concept of a regional hub envisioned in the Accra consensus.
WHO is mobilizing resources and partnerships to respond
Since 2007, and as part of the Bloomberg Initiative to Reduce Tobacco Use, WHO has supported a wide array of tobacco control stakeholders, both governmental and nongovernmental, in developing project ideas and full proposals to a competitively awarded grants programme.
In 2009, the Bill & Melinda Gates Foundation provided approximately USD 10 million to WHO to work with African countries to prevent further increases in the prevalence of tobacco use across the African region, with two complementary objectives:
- to support rapid, evidence-based strengthening of tobacco control strategies in at least one of the demand-reduction strategies in at least three countries of the African region
- to develop local capacity of an African tobacco control resource centre, enabling it to sustain the improvements achieved under Objective 1 and support similar improvements in two additional countries
The project has since seen 4 rounds of grant and funding support to WHO, exceeding $25 Million, for technical assistance, and for building capacity to implement sustained tobacco control interventions.
Centre for tobacco control in Africa
In 2011, as a predominantly bottom-up approach to tobacco control in the African region, WHO issued the call for proposals for the establishment of the resource centre and shortlisted the Makerere University, Uganda to set up the Centre for tobacco control in Africa (CTCA), the centre's operations is now stable, and WHO has transitioned away from the management of CTCA, as an independent entity.
Partners to the project
Other African tobacco control partners
The African tobacco control is led by a loose network of global/regional, consisting of Africa Capacity Building Foundation (ACBF), Campaign for Tobacco Free Kids (CTFK), Tax Justice Network (TJN), apart from WHO. In addition, there are other stakeholders such as the Africa Tobacco Control Regional Initiative (ATCRI), Africa Tobacco Control Alliance (ATCA), Framework Convention Alliance (FCA) and the International Union Against Tuberculosis and Lung Disease (The Union) that are engaged in supporting the countries in the region.
Bloomberg Initiative to reduce tobacco use
The Bloomberg Initiative to reduce tobacco use was launched in 2006. Funded by Bloomberg Philanthropies, the initiative seeks to strengthen tobacco control efforts to reduce the toll of tobacco in low- and middle-income countries, by implementing proven tobacco control policies, such as creating smoke-free public places, banning tobacco advertising, increasing taxes on tobacco products, and raising public awareness about the dangers associated to tobacco use. Jointly with its partners in the initiative, WHO works with countries for the implementation of the best buy and good buy measures to reduce tobacco use. Known as MPOWER, this package of six measures was launched by the WHO in 2008 to support scale up of specific provisions of the WHO FCTC on the ground. Supported by partners at all levels and rigorously tracked, MPOWER helps countries design and carry out policy, particularly in developing countries where the tobacco industry actively seeks new markets.
Bloomberg initiative components
The Bloomberg Initiative – coordinated by the five key partner organizations – focuses on the following four components:
- To refine and optimize tobacco control programs to help smokers stop using tobacco and to prevent children from starting.
- To support public sector efforts to pass and enforce key laws and implement effective policies, including taxing cigarettes, preventing smuggling, altering the image of tobacco and protecting workers from exposure to second-hand smoke.
- To support advocates’ efforts to educate communities about the harms of tobacco and to enhance tobacco control activities that work towards a tobacco-free world.
- To develop a rigorous system to monitor the status of global tobacco use.
Work of WHO with countries as part of the Bloomberg Initiative
The Bloomberg Initiative to reduce tobacco use is funding activities to promote freedom from smoking and reduce tobacco use in low- and middle-income countries, with special emphasis in Bangladesh, China, India, Indonesia, but also in other high-burden countries such as Brazil, Mexico, Pakistan, Philippines, Thailand, Turkey, Ukraine, and Vietnam.
Bloomberg initiative components
The Bloomberg Initiative – coordinated by the five key partner organizations – focuses on the following four components:
- To refine and optimize tobacco control programs to help smokers stop using tobacco and to prevent children from starting.
- To support public sector efforts to pass and enforce key laws and implement effective policies, including taxing cigarettes, preventing smuggling, altering the image of tobacco and protecting workers from exposure to second-hand smoke.
- To support advocates’ efforts to educate communities about the harms of tobacco and to enhance tobacco control activities that work towards a tobacco-free world.
- To develop a rigorous system to monitor the status of global tobacco use.
Publications
All →