TFI Newsletter 1Vol. 1 No.1, 2008

REDUCING TOBACCO USEBloomberg Global Initiative

in South-East Asia Region

Every year, 1.2 million people in the South-East Asia Region die from tobacco-related illnessesEvery year, 1.2 million people in the South-East Asia Region die from tobacco-related illnessesEvery year, 1.2 million people in the South-East Asia Region die from tobacco-related illnessesEvery year, 1.2 million people in the South-East Asia Region die from tobacco-related illnessesEvery year, 1.2 million people in the South-East Asia Region die from tobacco-related illnesses

Vol. 1 No. 1, 2008

Message from the Regional DirectorI am pleased to learn that the Tobacco Free Initiative isgoing to bring out a quarterly newsletter on the BloombergGlobal Initiative to Reduce Tobacco Use. I appreciate thiscommendable effort as it would disseminate the informationon activities and efforts being undertaken and good workbeing done in our Region under the initiative. I am surethat the newsletter will also serve as an advocacy tool

and mechanism for information sharing and exchange in the Region amongthe Bloomberg Foundation and the Bloomberg Partners. It should alsoenhance the knowledge of policy-makers and tobacco control stakeholdersabout the tobacco control efforts and opportunities provided by thisimportant initiative. I also feel that the newsletter will demonstrate thetransparency, accountability and efficiency with which this initiative is beingcarried out in the Region.

I understand that the initiative works through definite, stated objectivesand outputs. However, given the positive effects and complementarity thatthe initiative can bring overall tobacco control efforts, these objectivesand outputs should be linked to issues like public education, awareness-raising and multisectoral dimensions of tobacco control to ensuresustainability and strengthening of the tobacco control programme.

I wish the newsletter all the success.

Samlee Plianbangchang, M.D., Dr. P.H. Regional Director

IntroductionThe South-East Asia (SEA) Region is particularly affected by the tobaccoepidemic. It is both one of the largest producers and largest consumers oftobacco and tobacco products in the world. Out of 5.1 million annual globaldeaths, 1.2 million deaths occur in this Region. Recent surveys have shownthat the prevalence of tobacco use among youth and health professionalstudents are alarming, and there is also a huge prevalence of Bidi andsmokeless products. … continues in page 15

The Bloomberg Global Initiative(BGI) to Reduce Tobacco Use wasestablished by Mr. MichaelBloomberg, Mayor of New York City,with a fund amounting to US$ 125million to fight against the tobaccoepidemic.

The initiative focuses on thefollowing four components:Refine and optimize tobaccocontrol programmes to helpsmokers stop and prevent childrenfrom starting;support public sector efforts topass and enforce key laws andimplement effective policies, inparticular to tax cigarettes, preventsmuggling, change the image oftobacco and protect workers fromexposure to other people’s smoke;support advocates’ efforts toeducate communities about theharms of tobacco and to enhancetobacco control activities so as tohelp make the world tobacco-free;and develop a rigorous system tomonitor the status of globaltobacco use.

15 low and middle incomecountries have been selected underthe initiative based on the criteriaof having 10 million or moresmokers. These four are in theSouth-East Asia Region:Bangladesh, India, Indonesiaand Thailand.http://www.searo.who.inthttp://www.tobaccocontrolgrants.org/

Regional BGI ProgressNational Coordination Mechanisms .............. 2

National Action Plans (NAP) ......................... 3

Grant Mechanism .......................................... 4

Global Tobacco Control Report (GTCR) ....... 5

Global Adult Tobacco Survey (GATS) ........... 6

Economic Analysis for Advocacy ............... 6

World No Tobacco Day ................................. 7

Orientation Workshop .................................... 8

TFI Website ................................................... 9

Other Areas of Work ..................................... 9

TB and Tobacco ......................................... 9

Tobacco, Poverty & MDGs ....................... 9

Opportunities and Challenges ..................... 10

Best Practices from Countries .................... 11

Contents

TFI Newsletter

2 TFI NewsletterVol. 1 No.1, 2008

Regional BGI Progress

SEARO is providing regional and in-countryleadership to use the opportunity provided by theBloomberg Initiative for strengthening nationalcapacity for tobacco control as well as monitoringthe progress of implementation of the Initiative.SEARO’s main priorities in the Initiative are toestablish effective national coordination mechanismfor tobacco control and to produce tangible resultsin order to demonstrate the successes of the Initiativein the Region so that resources for tobacco controlcontinues to flow to the Region to tackle the tobaccoepidemic in an effective manner.

Towards effective nationalcoordination mechanisms andstructure for tobacco controlSince the inception of the BGI, SEARO has been makingrelentless efforts to raise awareness among the policy-makers in the Region about the initiative. SEAROorganized a regional consultation and has been providingtechnical support to countries. The Regional Office isalso assisting countries to strengthen their capacity both

in public and private sectors in formulating, implementingand managing tobacco-control related activities andprojects. To this effect, it helped organize national capacitybuilding workshops for overall development andmanagement of projects in all the Bloomberg Focuscountries in the Region.

The Regional High-Level Consultation on the BGIorganized in SEARO in February 2007 was meant toenhance the high-level policy-makers’ understandingof BGI; to ensure better coordination among Bloombergpartners, WHO and the selected Bloomberg countries;and to generate ownership and commitment of theBloomberg countries to the project. High-levelparticipants from four Bloomberg Focus countries(Bangladesh, India, Indonesia and Thailand), theBloomberg Foundation, World Lung Federation,Campaign for Tobacco Free Kids, CDC and CDCFoundation, John Hopkins Bloomberg School of PublicHealth, the International Union Against Tuberculosis andLung Diseases (The Union) and India Resource Centreattended the meeting.

A Regional Parliamentarian Forum on Tobacco,Alcohol and Funding of Health Promotion organized inOctober 2007 in Bali recommended to utilize WHOtechnical assistance for tobacco control legislation; toimplement the WHO FCTC; and to improve publicawareness, education and inter sectoral cooperation.

In order to ensure close collaboration andmultisectoral action for tobacco control, bilateralmeetings were organized with the Ministries of Health,Finance, Agriculture, Manpower, Department ofEnvironment and various research organizations,University of Indonesia and NGOs in Indonesia. One ofthe main objectives of these meetings was to explorethe possibility of expanding and strengthening nationalcoordination and capacity building for tobacco controlunder the BGI and to provide platforms for nationalmultisectoral coordination. As a follow-up to thesemeetings, the Ministry of Health, Indonesia has agreedto hold a national multisectoral meeting on the economicsof tobacco, which will be a model for similar activitiesacross the Region. SEARO would be closely involved inthe organization of this meeting and provide necessarytechnical assistance.

In Bangladesh, a national workshop about BGIorganized in March 2007 addressed to governmentorganizations and NGOs. A National Tobacco ControlCell (NTCC) has been established in the Ministry ofHealth and Family Welfare (MoH&FW) of Bangladesh.

TFI Newsletter 3Vol. 1 No.1, 2008

Providing support for anapproved national tobacco controlaction plan (NAP) including a plan forsustained funding for tobaccocontrol efforts, supported by a broadcoalition of government and NGOsTechnical assistance has been provided to hold nationalworkshops, to finalize the National Action Plan (NAP)and to start their implementation in all Bloomberg focuscountries. Support was provided to countries tostrengthen and amend the tobacco control legislation tomake it compatible with the WHO FCTC through effectivenational coordination, and technical assistance has beenprovided to develop national tobacco control legislationin Indonesia.

In Bangladesh, a workshop was organized inDecember 2007 to present and disseminate the NationalStrategic Plan of Action (NSPA). The Secretary, MoH&FWchaired the workshop, which was attended by participantsfrom other relevant ministries and key nationalstakeholders, including government and NGOs. Thedissemination of the NSPA was highly appreciated.SEARO facilitated sharing of this useful document withall countries in order to encourage them to develop themfor their own countries, especially as the WHO FCTCprovides for developing and implementing suchdocument. On the other hand, preparatory work is inprogress with government organizations, NGOs andBloomberg partners to review amendments toBangladesh Tobacco Control Legislation includinglitigation issues in compliance with WHO FCTC. Allrelevant laws and regulations have been compiled andprinted in the form of a book, which has been distributedto all key stakeholders to enhance enforcement. Thishas allowed a better understating of the law andprevented the relevant stakeholders from falling prey tomisleading information given by the tobacco industry.

The National Task Force for Tobacco Control was alsoformed, and preparatory work for organizing technicalworkshops on enforcement of the tobacco control lawis in progress.

The officer in charge for Tobacco Control Law 2005at the Directorate of Health Services has been given thetask to monitor the compliance of the law and mobilized20 mobile courts, which is currently on-going in severaldistricts in the country and has been a success story forenforcement of the national tobacco control legislation.

In India, a multi-stakeholder task force meeting foradvancing tobacco control was organized in March 2007under the Chairmanship of the Union Health Minister.Representatives from key Ministries and Departmentssuch as Labour, Information & Broadcasting, Commerceand Consumer Affairs, as well as civil societyorganizations participated in the meeting. A brainstormingsession was conducted to review the status ofimplementation of tobacco control activities at centraland state levels; and strategies were discussed formultisectoral action towards effective implementation ofthe National Tobacco Control Programme. This wasfollowed by a meeting in April 2007 with participants fromdifferent states to sensitize them about the launch of theNational Tobacco Control Programme and BGI.

With support from WHO and BGI, capacity for tobaccocontrol has been built at national and subnational levelsby providing additional manpower resources andinfrastructure for the Central Tobacco Control Cell andState Tobacco Control Cells in six main regions of thecountry (North, South, East, West, Central and Northeast) to ensure implementation of the national laws andWHO FCTC at state level. The states that have beensupported are Delhi, Tamil Nadu, West Bengal, Gujarat,Madhya Pradesh and Assam.

In Indonesia, the Directorate for Non-CommunicableDisease Control was appointed as focal point for internaltobacco control related activities within the Government andthe National Commission for Tobacco Control Managementwas proposed as the coordinating institution among NGOs.WHO Indonesia facilitated meetings to develop guidelinesfor an effective national coordination mechanism. A meetingof the MoH Working Group on tobacco control was held on28 February 2007 to discuss the current situation at nationallevel in preparation for a one-day national meeting organizedin May 2007 to disseminate information on the currentsituation of tobacco control in Indonesia amongstakeholders.

In Thailand, a Tobacco Free Initiative Network hasbeen established with participants from the Tobacco FreeInitiative partners to establish a mechanism for thenetworks’ sustainability. Coordination was also done with

key stakeholders to develop the Youth Leaders for a Non-Smoking Camps project. Consultation with the MoH andthe Disease Control Department on policy and strategyto strengthen the National Focal Unit for Tobacco Controlwas done. Coordination with the Department of Health toincorporate Smoke-Free Environments into the HealthySettings standard criteria and indicators is ongoing. Andcoordination is also going on with the Bureau ofOccupational and Environmental Health to considerincorporation of smoke-free environments into theNational Environment Surveillance System and theOccupational Hazard Indicators.

4 TFI NewsletterVol. 1 No.1, 2008

In India, a planning workshop was organized foreffective implementation of the National Tobacco ControlPlan. The national and state tobacco control consultantsand state focal points participated in this meeting held inNovember 2007 and a state-wise action plan for tobaccocontrol was formulated.

WHO and MoH&FW compiled and published acompendium of rules and notifications on the Cigarettesand other Tobacco Products (Prohibition of Advertisementand Regulations of Trade and Commerce, Production,Supply and Distribution) Act, 2003.

Assistance was provided to the India Resource Center(IRC) in ensuring participation of the Tobacco ControlCells resource persons and other officials for the trainingcourse organized by The Union on Human ResourcesDevelopment and Management in Puri, Orissa.

In Indonesia, a tobacco control workshop on HealthSector Capacity Building was held in September 2007.The workshop had the participation of 22 provinces and 6universities, and resulted in formulation of the Plan ofAction for 2008. Technical assistance to strengthen theNGO network for tobacco control was extended to theIndonesian Public Health Association (IPHA) for theNational Conference in Palembang in August 2007. WHOIndonesia organized and sponsored a meeting of theParliamentarian Forum in October 2007, where thetobacco control legislation strategy was discussed withemphasis on its ratification and laws relating toadvertisement and health warnings. In addition,participation of three government tobacco control officers,one senior researcher and a lawyer in the Taipeh ApactConference on Tobacco and Health in October 2007 wasalso supported.

Active engagement in the GrantMechanism

The Grant Mechanism has been established in orderto support projects to develop and deliver high impacttobacco control interventions. The funding is availablethrough a competitive application process for grantwhich is available to both GOs and NGOs. Theapplication for grant is received twice a year in theform of submission of Project Idea. WHO providestechnical support to the applicants in developing andreviewing project ideas and formulation of fullproposals once the project idea is invited to submitthe same. WHO also provides technical support toimplement the projects funded under the GrantMechanism. Grant Mechanism is a useful source offunds for tobacco control projects and activities.

The Regional Office shared and disseminatedinformation about the Grant Mechanism both inBloomberg and non-Bloomberg countries in the Regionthrough SEARO/TFI webpage and also through directcommunications with all WHO Country Offices as wellas MoH and NGOs. SEARO also developed anddisseminated frequently asked questions (FAQ) on BGI.Generic tools such as the consultants’ toolkit were alsodisseminated with advice on how to fill out the projectidea form, successful examples of projects ideas, factsheets and Power Point Presentations.

The Regional Office and country offices assisted GOsand NGOs in applying in the first, second and third roundsof grant application under the Bloomberg GrantMechanism Workshops and on-the-job training activitieswere organized, as well as group and individualconsultations were dispatched to countries to help themwrite project ideas and full proposals.

In round one, a total of 12 proposals wererecommended for funding for an approximate total valueof US$ 4.1 million. In round two, WHO had a significantrole in supporting interested GOs and NGOs in projectidea and project proposal writing. A total of 34 projectideas were reviewed and 26 of them were submitted tothe Grant Mechanism; 19 were requested to submit fullproposals, and finally 11 were recommended for funding,for an approximate total value of US$ 7 million. Fiveprojects are in the area of tobacco control policy, four inthe area of smoke-free environments, one in the area ofTax/price and one in the area of advertisement bans.

WHO is also providing technical support to GOs andNGOs on how best to implement the projects that havereceived funding in rounds one and two.

In Bangladesh, a capacity building workshop onproject proposal writing was organized in coordinationwith the IRC in March 2007. A total of 18 participantsfrom various ministries and NGOs were trained. A secondnational workshop on project proposal writing wasorganized in the first week of June 2007 in Dhaka; it wasattended by both state and non-state organizations. Aone-day workshop on “Effective Proposal Writing” washeld on 25 August to assist those institutions who wererequested to develop full project proposals for round twosubmissions.

A total of seven full project proposals were submitted,of which three were recommended for funding: a proposalby the Tobacco Control Cell to enforce and amend thenational tobacco control legislation for full complianceof the WHO FCTC; a second proposal from theConsumers Association of Bangladesh to strengthentobacco control law regarding packaging; and a third onefrom Unnayan Shamannay on advocacy for effective tax

TFI Newsletter 5Vol. 1 No.1, 2008

Monitoring and evaluating tobaccocontrol policies through the GlobalTobacco Control Report (GTCR)

The objective of the GTCR is to monitor a core ofessential tobacco control policy initiatives, and to reporton their implementation on an annual basis, for allWHO Member States. The GTCR provides a highlystructured and focused framework through whichprogress towards the implementation of defined,concrete tobacco control measures at country levelwill be compared in a standardized manner acrosscountries. Information provided in the GTCR will showgaps between optimal and existing policies and helpdevelop a strong advocacy message for effectivetobacco control.

and price measures on all tobacco products to curbtobacco use in Bangladesh.

WHO Bangladesh provided support to ensureparticipation in a training course on Budget Monitoringand Financial Reporting for Tobacco Control organizedby the Union and Work for Better Bangladesh (WBB)trust in September-October 2007.

In India, a national workshop on BGI was organizedin May 2007 to promote interest in the grants and to trainparticipants in proposal writing, with participation ofrepresentatives from around 50 civil societyorganizations, state governments and institutions.

In collaboration with IRC, a capacity building workshopon leadership and general management was held in June2007; a second one on budget management and financialreporting in August 2007; and a third one on humanresource development in October 2007.

A total of three full proposals were recommended forfunding: a proposal from the Government of Delhi forSmoke-Free Delhi by 2009; a second proposal fromPasumai Thaayagam Foundation for Smoke-FreeChennai; and a third proposal from the Government ofTamil Nadu for Smoke-Free Chennai.

In Indonesia, a national capacity building workshopwas organized in May 2007 to provide training on projectproposal writing. Technical support was provided to theMinistry of Health and intergovernmental agencies, healthprofessional societies and NGOs to develop project ideasin June 2007, and a second meeting was organized inJakarta in September 2007 for full project proposal. Aworkshop was organized, in coordination with the IRC inSeptember 2007 to enhance proposal writing capabilities.WHO also facilitated the training course sponsored byThe Union on Human Resources Development andManagement in Bandung in November 2007, attendedby 23 tobacco control activists.

Three proposals were recommended for funding: aproposal from the National Commission for ChildProtection to advocate for a comprehensive ban ontobacco advertising, promotion and sponsorship; asecond one from the Directorate of Non-CommunicableDisease Control to build the capacity of public healthsystems to implement effective tobacco control; and athird one from the Yayasan Lembaga KonsumenIndonesia (Indonesian Consumer Foundation) andCenter for Religious and Community Studies for advocacyand enforcement of smoke-free areas and advertisementban in Java.

WHO Indonesia supported the IPHA, a first roundgrantee for project implementation, and the journalist groupPena Indonesia to develop a workshop on “Understanding

Tobacco Industry Through Secret Documents”. Theworkshop was held on 6 November and 40 personsparticipated (focal points, tobacco network and tobaccoactivists in media). By the end of the workshop theydeclared the formation of an Alliance of Tobacco ControlJournalists. This activity is part of WHO’s technical supportto IPHA.

A meeting was organized in Jakarta in December 2007with NGOs and research institutes in order to providefurther information on round three and the grantmechanism process.

In Thailand, four workshops were organized by theWHO country office in August and September 2007 withparticipation of all key TFI partners to develop a full projectproposal: “Towards 100% Smoke-Free EnvironmentThailand”.

The proposal was recommended for funding and willbe implemented countrywide by the network of GOs andNGOs, including WHO. The MoH will be responsible forits implementation and sustainability as the coordinatorof this two-year project.

BGI activities in non-Bloomberg FocusCountriesSEARO has made efforts to extend opportunities providedby the BGI Grant Mechanism to non-BGI countries ofthe Region. The information was disseminated in themeeting of National Tobacco Control Managers held inMarch 2007 in Yangon, Myanmar and Member Stateswere encouraged to apply for grants of the BGI GrantMechanism. SEARO supported the non-BGI countriesto submit their project ideas.

6 TFI NewsletterVol. 1 No.1, 2008

All countries in the Region, including the four Bloombergfocus countries participated in the GTCR validationexercise and signed the final validation sheets. SEAROworked closely with the country informants who aremainly from MoH to gather data for the GTCR.Completion of the GTCR by SEARO first among allregions and even before the deadline is a testimony toclose coordination between regional and country offices.

Based on the information collected the WHO Reporton the Global Tobacco Epidemic-MPOWER waspublished and launched by WHO Director-General andthe Mayor of New York City on February 7, 2008. Thepublication contains in-depth information about the currenttobacco situation, prevention and control efforts andintroduces six packages named after “MPOWER” to helpand encourage countries to design, develop andimplement tobacco control programmes. The MPOWERpackage includes monitoring tobacco use and preventionpolicies, protecting people from tobacco smoke,assistance to smokers to quit, warning against the dangersof tobacco, enforcing bans on tobacco advertising,promotion and sponsorship and raising taxes on tobacco.

Generation of economic analysisfor advocacy and policy/capacitybuilding for countries in the area oftaxationSEARO has disseminatedthe second edition of theBangladesh Health CostStudy, which presents keyeconomic information oftobacco related illnessesand is being used as a toolfor advocacy in the area oftobacco taxation and othereconomic measures fortobacco control. Thefindings of the study reporthave been usedextensively by anti-tobacco stakeholders andas a result of WHO and NGO advocacy, tax on cigaretteshas been increased 5-10 percent in Bangladesh. Tariffvalues of all kinds of cigarettes were raised in the fiscalbudget 2007-2008.

In Indonesia, two economic studies conducted by theUniversity of Indonesia (Demographic Institute and theInstitute for Social Economic Research, Education andInformation) have been identified to be supported for finalanalysis and presentation at a WHO-sponsored NationalConference on Legislation to be held in the first quarterof 2008.

Following bilateral meetings with the Ministries ofHealth, Finance, Agriculture and Manpower of Indonesia,it was agreed that a national workshop on the economicsof tobacco control would be organized during 2008. TheMoH has agreed to coordinate and organize this nationalworkshop with the support of WHO. The objective of the

Adult tobacco survey to measuretrends in exposure to tobacco and itssmoke and measure the impact oftobacco control policies

Currently standardized and comparable adult tobaccoprevalence data are not available. Under the BGI, GATShas provided the opportunity to generate such data.

SEARO has been involved in developing the protocolfor GATS. SEARO also pilot tested the GATS protocolin India. All the BGI countries in the Region are nowengaged in GATS implementation. Out of six first-phaseGATS countries, three are from SEAR – Bangladesh,India and Thailand. Indonesia is a second-phase countryfor GATS implementation. GATS Country EngagementMission took place in all four countries. Theimplementing national institutes and the GATS NationalTechnical Advisory Committees have also been

GATS is a standard global adult tobacco survey thatconsistently tracks prevalence (cigarette smokingand other tobacco use) exposure to risk, secondhandsmoke, cessation, risk perceptions, knowledge andattitudes, exposure to media as well as price andtaxation issues. GATS will become a new componentof the GTSS.

designated and established for carrying out the survey.Meanwhile, technical missions already visitedBangladesh and Thailand and both the countries arenow pre-testing country-specific GATS protocols; thetechnical mission will visit India and Indonesia soon.As per the set time line, GATS is expected to becompleted by the first quarter of 2009 with the releaseof data both in Bangladesh and Thailand. Completionof GATS would be a milestone in the area of tobaccosurveillance when standard comparable adult tobaccoprevalence data would be available; the same shouldbe used for policy and programme change.

TFI Newsletter 7Vol. 1 No.1, 2008

World No Tobacco Day

WNTD 2007: Smoke-Free EnvironmentsThe theme of the World No Tobacco Day (WNTD) 2007was “Smoke-Free Environments”. In order to createawareness against tobacco and advocate for creatingsmoke-free places, SEARO developed Information,Education and Communication (IEC) materials andprovided assistance to countries to observe the day andto disseminate the theme through the year. The WorldNo Tobacco Day was observed on 31 May in all thecountries of the Region, including the Bloomberg focuscountries. A video message by the Regional Director,WHO South-East Asia Region, was developed anddisseminated via telecast for the 31 May activities. A“Profile on Smoke-Free Environments in the South-EastAsia Region” was developed, published anddisseminated among all the eleven SEA countries in theRegion. Each Member state also developed, producedand disseminated their country specific IEC materials inappropriate local languages.

In Bangladesh, week-long activities were organizedin all 64 districts of the country. A national seminarattended by the Health Minister was organized;information was disseminated through all major print andelectronic media; a week-long mobile court wasconducted in different parts of the country to enforcesmoke-free provisions of the national tobacco controllegislation; NGOs were supported to make advocacy and

meeting will be to share information, research and studiesthat will provide key information for the ministries to makedecisions. In preparation of this workshop, WHO decidedto provide technical assistance for the ongoing HealthCost Study undertaken by the School of Public Health,University of Indonesia. The University of Indonesia(Demographic Institute and School of Public Health)agreed to explore the possibility to undertake an analysisof the Ministry of Finance’s roadmap for tax on tobaccoproducts, including a critical review of current taxstructure and recommendations for further tax increases,which can be presented at the proposed nationalcoordination meeting to discuss economic aspects oftobacco control. The Demographic Institute agreed toexplore the possibility to undertake an assessment onchild labor and the tobacco industry in Indonesia, whilethe Centre for Policy and Socio-Economic Research ofthe Ministry of Agriculture agreed to develop a study ontobacco crop diversification.

SEARO would support a study on health costs oftobacco use in India in 2008.

smoke-free campaigns throughout the country; adeclaration of Smoke-Free Hospitals was issued, whichmay lead to the development of a Smoke-Free Hospitalnetwork; a tobacco fact sheet was distributed alongwith stickers in public places and transports; musicconcerts were organized in major parks of Dhaka city; adeclaration for a Smoke-Free National Zoo was issued;and a meeting was held with lawyers to advocate forSmoke-Free court premises.

As a result of advocacy activities in Bangladesh andmeetings with the Motor Launch Owner Association, rivertransports of several routes have become smoke-freeand in general smoke-free places are more frequentlyobserved (e.g. several universities and municipalities).A link was established with the Healthy Settingprogramme towards smoke-free environments. A projectwas initiated to sensitize the school authorities to declarethe schools in sub-district level smoke-free through theUpazilla Primary and Secondary School EducationOfficers.

In India, several interventions around the country weresupported to promote the theme of Smoke-FreeEnvironments. Street plays and magic shows wereorganized in various parts of the country. A nationalworkshop organized by the consumer group VOICE fortrade unions, public & private sector corporations, stategovernment representatives, consumer groups and civilsociety to promote smoke-free workplaces; a book onreal-life stories of former tobacco users “Through theHaze” was launched and distributed with thematicposters; the Strategic Movement Against Rising TobaccoThreat (SMART) was launched in three panchayats ofKerala state; the Cancer Institute collaborated with Auto-rickshaw Associations of Chennai to sensitize leadersand drivers and distribute information, education andcommunication materials. Campaigns on “Best Anti-Tobacco Auto Association” and “Donate one tobaccoproduct and save 14 minutes of your life” were observed.In addition, the Voluntary Health Association of Indiaorganized an awareness campaign for Smoke-FreeEnvironments and the rights of non-smokers amongschool children educators, youth groups, communities,women’s groups, civil society groups and the media, infive states. A quit helpline was initiated in Punjab, MadhyaPradesh and Himachal Pradesh to help tobacco usersquit their addiction.

A workshop to help law enforcers and civil societyorganizations to develop strategies for creating Smoke-Free cities was organized in December 2007. Theworkshop highlighted and shared strategies ofChandigarh Administration and civil society in makingthe city of Chandigarh “Smoke-Free”.

8 TFI NewsletterVol. 1 No.1, 2008

BGI Orientation WorkshopA BGI Orientation Workshop was organized by SEARO,the first of its kind conducted by any Region or TFI/HQ,in early January 2008 in Yogyakarta, Indonesia. Theworkshop was attended by all the BGI staff from SEAROand four Bloomberg Focus Countries – Bangladesh,India, Indonesia and Thailand - with the overall goal ofensuring effective implementation of the project in 2008with a full-fledged Bloomberg Team both at regional andcountry levels. The main objectives of the workshopwere to: 1) provide orientation on BGI components toall BGI staff; 2) review 2007 BGI activities in the regionaland country offices and to share experiences of theinterventions under the initiative; 3) improve coordinationand understanding between SEARO and country officesfor effective development and implementation of theproject; and 4) draft BGI Regional and Country Workplans for 2008.

In Indonesia, advocacy for Smoke-FreeEnvironments was done by organizing national andsubnational workshops. The MoH organized a series ofevents; a meeting on Tobacco Free Zones (TFZ) in thedistricts of Bogor, Cirebon, Palembang and Enrekangwas organized, and a manual for changing the imageof smoking and a guide book on TFZ development wereprinted and distributed to the participants. A pledgingceremony by junior and senior high school students onChild Protection Against the Danger of Smoking wasorganized. Advocacy communication materials ontobacco control using mass media were distributed; aworkshop was organized on Health Sector CapacityBuilding in September 2007, where smoke-freeenvironment initiatives were presented by Jakartaprovince, Bogor City and Lumajang District. The threeproposals were followed by discussions on the 2008 Planof Action to put forward a “national” consensus to extendsmoke-free public places in regional settings, and theJakarta Clean Air Act experience was disseminated to22 provinces.

WHO Indonesia continued to monitor localgovernment initiatives for Smoke-Free Jurisdictions(Jakarta, Bogor, Cirebon, Lumajang, Palembang); andset up a plan for a workshop to produce a template forsmoke-free regulations for local governments and localparliaments. WHO provided technical support to the

IPHA for arranging meetings with the universities locatedin Yogyakarta in order to advocate for smoke-freeuniversities.

In Thailand, a meeting of 70 hotel executives and 10Tobacco Free Initiative partners was convened by WHOCountry Office for a smoke-free hotel programme. A linkon WHO Thailand website containing the list of smoke-free hotels was established and a recommendation wasgiven to all UN agencies and MoH to select only smoke-free hotels to organize meetings and accommodateguests. There has been a satisfactory increase in thenumber of hotels participating in the project to morethan 200.

WHO Thailand coordinated with the Department ofDisease Control, Department of Mental Health,Department of Health, ASH Thailand Foundation andother organizations to review the anti-tobacco youthcamps undertaken by them and are discussing planningto develop more comprehensive and effective models ofyouth leaders’ activities and youth camps for tobaccocontrol.

World No Tobacco Day special events were organizedby the MoH and other GOs and NGOs with emphasison Smoke-Free Youth and Smoke-Free Environmentsin Thailand.

WNTD 2008: Tobacco-Free YouthThe information on the theme has already beendisseminated among all countries and SEARO iscoordinating with them to developed country-specific IECmaterials for advocacy surrounding the theme. SEAROwould also develop region-specific IEC materials anddisseminate them among the countries.

World No Tobacco Day celebration in Indonesia.

World No Tobacco Day celebration in Thailand.

TFI Newsletter 9Vol. 1 No.1, 2008

TFI WebsiteIn order to ensure efficient information management andcommunication, technology is essential in informationdissemination. As the Internet is the primary informationresource for many users, it is important that the TFIwebsite be improved and updated. The existingshortcomings of the current website are being addressedto improve its user-friendliness; information has beenupdated and reorganized, links to important TFI pagesare being made accessible from the main page.Additional links to other useful tobacco websites wereappended on the relevant pages. The overall goal ofdevelopment of the current website is to improve thesame for enhancing its value as a resource for tobaccouse in the SEA Region with the main objective to make

The workshop provided a first-hand orientation tothe BGI Staff about the Regional Tobacco ControlProgramme and its relation with the BGI. It dealt at lengthwith the main BGI components like the grant mechanism,GATS and thematic issues like smoke-free jurisdictions,taxation, advertisement bans, public education andWNTD 2008, theme for which is Tobacco-Free Youth.

This was followed by country presentations. Each BGICountry Team presented a SWOT (strengths,weaknesses, opportunities and threats) analysis oftobacco control and BGI implementation in each countryand shared their experiences and best practices in keyBGI areas of focus. The overwhelming feedback of theworkshop was that there was a lack of adequatecoordination among BGI Partners at the country level andthat some BGI Partners are independently working withNGOs that have received funds from BGI’s grantmechanism without adequate knowledge of both MoHand the WHO country office. Thus, MoH and the WHOcountry office are not aware of the contributions of theseNGOs to the national tobacco control programme whilethe main objective of the BGI is to strengthen this nationalprogramme by coordinating efforts made by both stateand non-state partners at the country level. A specialsession was organized on project development,implementation, monitoring and reporting.

The workshop was also used to finalize BGI Regionaland Country Work plans for 2008. All work plans mainlyfocus on achieving BGI goals and areas like generationof economic evidence for advocacy & policy change;dissemination of these findings by organizing nationalmultisectoral workshops as well as communication andpublic education for behavioural change were givenimportance in each work plan.

Other Areas of Work

TB and TobaccoGiven the close link between TB and tobacco andconsidering the fact that integration of the twoprogrammes can significantly reduce morbidity andmortality from TB, SEARO is undertaking activities topromote coordination and collaboration between TB andTobacco Control programmes through collaborationbetween Tobacco Free Initiative and WHO Stop TB byintegrating tuberculosis (TB) and tobacco controlactivities within the health system through the PracticalApproach to Lung Health (PAL) which includes elementsof tobacco cessation and protection from second-handsmoke.

In May 2007, WHO met with the Government of Nepaland agreed to launch the PAL pilot project in the country.A workplan was prepared and the National WorkingGroup for PAL implementation was formed by theNational Tuberculosis Program (NTP). A sensitizationmeeting was held in August 2007 which was attendedby 62 participants. Training for district-level healthworkers of the Out Patient Department (OPD) and thatof all the PHC centers was also conducted in two phasesin September and October 2007. The pilot project isexpected to be completed by June 2008. The completionof the project is expected to integrate tobacco controlelements in the TB control programme through PAL.

A similar project to be implemented during 2008 hasbeen planned for Bangladesh and Indonesia. SEAROwill organize a Global Expert Group Meeting on TB andTobacco in 2008 in Indonesia. SEARO is also makingefforts to mobilize resources for TB and tobacco fromthe BGI.

tobacco information available for facilitating policy andprogramme change; to present the information in a user-friendly manner; and to highlight areas of focus for TFI.

As the database is an important component of theTFI page, particular attention has been given to updateand redesign this section, so as to boost user-friendlinessand information retrieval.

Given the introduction of the BGI, a new page on theInitiative has been added to the existing website. Currentefforts are being made to incorporate a blog for the BGIteam to facilitate communication and informationsharing. In addition new pages on TB and Tobacco;Tobacco, Poverty & MDGs; and World No Tobacco Dayhave been added.

10 TFI NewsletterVol. 1 No.1, 2008

Tobacco, Poverty and the MillenniumDevelopment GoalsThe United Nations Ad Hoc Interagency Task Force onTobacco Control prepared a Report on Tobacco Controland Poverty for the UN Secretary-General on the work ofthe task force in this area. The Secretary-Generalpresented the Report to the Substantive Session of theEconomic and Social Council (ECOSOC) in 2004. Thereport highlighted the link between tobacco, poverty andthe developing world. The Report reiterated the linkbetween economic development and poverty reductionand argued for ill-effects of tobacco use to be addressedas a development priority. It also argued that there is astrong link between tobacco and the MillenniumDevelopment Goals (MDGs), in particular through thenexus of diseases, poverty, hunger and gender. Thereport recommended the inclusion of tobacco controlissues in programmes aimed at achieving the MDGs andin the agenda of the United Nations Development Groupand Regional Economic Commissions.

SEARO is the only Region that has taken this work ofthe task force to the regional and country levels. SEAROcollaborated with UN ESCAP to discuss tobacco controlissues in the first session of the Sub-Committee onHealth and Development of the Economic and SocialCommission for Asia and Pacific (ESCAP) in December2004. The meeting urged that the actions onnoncommunicable diseases including tobacco controlbe integrated into the MDGs. SEARO is the only Regionthat is using the Report of the UN Secretary-General byorganizing sub regional and regional workshops in poorcountries like Bangladesh, Myanmar and Nepal in theregion. SEARO organized an Intercountry Meeting onTobacco Control, Poverty Reduction and MDGs in August2007 in Dhaka, Bangladesh involving country-based UNagencies and other intergovernmental agencies. As perthe decision of the meeting, SEARO is now collaboratingwith these three countries to organize national workshopsinvolving country-based UN agencies who are membersof the UN Ad HoC Interagency Task Force on TobaccoControl and also all relevant ministries of the government.

Opportunities and ChallengesDespite the commitment of the countries in theRegion to tobacco control, the efforts of thegovernments have been inadequate due mainly tolack of resources – both human and financial. Thefinancial support to tobacco control has been scarce.BGI has not only brought in resources for publicsector to scale up efforts for tobacco control, it hasequally provided opportunity to non-state sectors,including NGOs, to get actively engaged in tobaccocontrol activities to supplement and complementgovernment efforts. All these efforts should contributeto strengthening regional tobacco controlprogrammes, in particular, in areas like developmentof tobacco control legislation, generation of tobaccocontrol data and information for advocacy.

On the other hand, BGI resources are channeledto countries and WHO through a process that ismainly managed by foundations and NGOs that areprimary partners of the BGI. Both the BGI focuscountries and WHO are dependent on theseorganizations. This process and lack of adequatecoordination among all the BGI partners are affectingthe progression of the initiative, in particular, in termsof contributions of the initiative to the national tobaccocontrol efforts. Moreover, BGI focuses mainly onshort-term measures for achieving results within ashort period of time without giving due importanceto the sustenance aspects of the tobacco controlprogramme. Areas like public education andbehavioral changes, which can make the tobaccocontrol programme sustainable, are also not beingadequately addressed.

Countries and Ministries of Health need to guidethe whole process of the initiative at the country levelthrough strengthening country coordinationmechanisms to ensure effective and adequatecoordination among all BGI partners and synergizingefforts of both public and private sectors forstrengthening national capacity for tobacco control.

TFI Newsletter 11Vol. 1 No.1, 2008

Best practices from countries

Basic facts on tobacco• 48.6% of male and 25.4% of female adults (15+years) use any tobacco products;

• 5.8% students (13-15 years) currently use any form of tobacco (Dhaka);

• More than 57 thousand people died due to tobacco use in 2004;

• Annual revenue collected from tobacco products is 24.8 billion takas, whereas the annual cost of tobacco-related illnesses attributable to tobacco usage is estimated at 50.9 billion takas including 5.8 billion takasfor second hand smoking in 2004;

• Bangladesh has a comprehensive tobacco control legislation.

Bangladesh

The National Tobacco Control CellBangladesh was the first country to sign the WHO FCTCand one of the first 20 countries to ratify the convention. It isalso the first country to establish a full-fledged NationalTobacco Control Cell (NTCC) under BGI in order to steerall the national actions for tobacco control, includingimplementation of the WHO FCTC in the country.

In 2005, Bangladesh enacted a tobacco control law inaccordance with some of the provisions of WHO FCTCand in 2006 the National Strategic Plan of Action for TobaccoControl 2007-2010 was finalized. The goal of the Plan ofAction is to reduce tobacco consumption, promotecessation of tobacco use, and protect non-smokers fromexposure to second-hand smoke and to protect people fromthe devastating consequences of tobacco use.

As part of the strategies to implement the Plan ofAction, a Tobacco Control Cell was planned with adesignated National Focal Point for Tobacco Control inthe Ministry of Health and relevant focal points at variousdecentralized levels along with a multisectoral NationalTobacco Committee comprising governmentaldepartments and agencies such as health and familywelfare, foreign affairs, trade, finance, education,agriculture, information, women and children affairs, legaland justice, industry and others as appropriate. It shouldalso include NGOs such as health professional societies,health charities, academic institutions and religiousgroups (except anyone connected to the tobaccoindustry). The role of this Committee is to addressnational and cross-border tobacco control issuesparticularly law implementations and actions to addressthe requirements of the WHO FCTC.

The NTCC was established at the beginning of 2007,with support from the BGI. It is a functional arm of theMinistry of Health for tobacco control activities, and forthe first time the tobacco control programme has bothhuman and financial resources for action, which is a veryimportant step for tobacco control in Bangladesh.

The NTCC is headed by the Joint Secretary and day-to-day supervision is by the NTCC Coordinator, who isthe Deputy Secretary of the Ministry of Health.

Expecting the NTCC to gain credibility as a referencecentre for all tobacco control activities in the country,technical and financial support are being provided by theWHO country and regional offices.

In 2007, week-long World No Tobacco Day activitieswere coordinated by the NTCC. In addition, workshopson capacity building, tobacco use, cessation and grantproposal development were also conducted by the NTCC.

The NTCC has applied for funds from the BGI grantmechanism and the proposal was recommended forfunding. The objective of the proposal is to strengthenthe enforcement of all current provisions of the nationaltobacco control legislation through the establishment ofa multisectoral taskforce on tobacco control at multiplelevels (national, divisional, sub-divisional); the review oflegislation enforcement; strengthening capacity ofenforcement; increasing awareness and understandingabout the existing legislation. It is also meant to identifygaps in the national tobacco control legislation in thecontext of the WHO FCTC and propose a draft that iscompliant with the WHO FCTC, develop a revised draftfor consideration of policy-makers and advocate for theneeded change.

12 TFI NewsletterVol. 1 No.1, 2008

Basic facts on tobacco• 57% of male and 11% of female adults (15-49 years) use any form of tobacco;

• 14.1% students (13-15 years) currently use any form of tobacco;

• Nearly one million people die of tobacco related deaths annually;

• Revenue collected from tobacco products annually in India is 78 billion rupees whilst annual direct healthcost of three tobacco related diseases (cancer, coronary artery diseases and chronic obstructive lungdiseases) is 308 billion rupees;

• India has a comprehensive tobacco control legislation.

India

Smoke-Free Chandigarh: A model for thedeveloping worldBurning Brain Society (BBS) was instrumental in bringingabout the change towards a Smoke-Free Chandigarh. Ittook four years of sustained advocacy to bring Chandigarhfrom the Cigarette and Other Tobacco Products Act in2005 to the first smoke-free city in India in 2007.

The organization reportedly undertook an aggressiveactivist approach to create the momentum for completeadherence to tobacco control laws. As an innovation, BBS

used the provisions of the Right to Information Act (2005)to put pressure on the government. Over 300 Right toInformation (RTI) petitions were filed by BBS over a periodof one year. The RTI petitions sought detailed informationfrom each government department on the implementationand enforcement of various provisions of tobacco controllaws and if they were not implemented, the name of theperson responsible for neglecting his/her duty.Simultaneously, the organization lobbied with theadministration for a smoke-free city and performed otherroutine advocacy activities and media strategies,including the display of more than 1800 warning boardsin all government offices.

All educational institutes became 100 per cent smoke-free. Chandigarh Police agreed to initiate lawenforcement activities and requested BBS to train thepolicemen on the provisions of law. Soon the compliancerate was 70%.

It brought tremendous confidence to theadministration that the “Smoke-Free City” initiativeproposed by BBS was feasible. A series of notificationsand government orders were promulgated. Finally on 15July 2007, Chandigarh was declared a smoke-free city.

The challenges and limitations were immense.Besides the tobacco industry interference, there wereno financial resources to carry on the initiative. The whole

To enforce the Tobacco Control Law several mobilecourts were organized. Billboards on smoking wereremoved from several fast-food corners, snooker playingplaces and restaurants. The Dhaka MetropolitanMagistrate led the drive. A dozen commercial firms werefined and a similar number of people was arrested forviolating the existing tobacco control law. In all 64 districtsoutside Dhaka, similar mobile courts were formed toenforce the tobacco control law. The local administration

fined and arrested owners of those shops and firmsviolating the ad ban on smoking. Signboards onpromotion of cigarette smoking were removed in manyplaces outside Dhaka during the drive.

All these actions have led the NTCC to become ahub for national coordination of all tobacco controlactivities and a reference and support centre for alltobacco control stakeholders, including NGOs.

TFI Newsletter 13Vol. 1 No.1, 2008

Basic facts on tobacco• 63.2% of male and 4.5% of female adults (15+years) smoke daily;

• 13.5% students (13-15 years) currently use any form of tobacco;

• Revenue collected from tobacco products annually in Indonesia is 32.6 trillion Rupiah;

• There are some tobacco control measures both at the national and provincial levels, including JakartaClean Air Act.

Indonesia

Cirebon’s Journey to Become a Smoke-FreeCityIndonesia is the world fifth largest country with the highesttobacco consumption prevalence, and is the sixthprincipal tobacco-producer nation. The country is not yeta party to the WHO FCTC. Some legislations such asHealth Act 1992, Press Act 1999, Broadcasting Act 2002,Consumer Protection Act1999, and GovernmentRegulations on Tobacco Control for Health Act 1999,2000&2003 have been in place to regulate tobacco use,tobacco advertisements, health warnings in tobaccoproducts and contents of cigarettes. Local governments’regulations exist for Jakarta, Bogor and Cirebon tomanage air pollution including tobacco control in closedpublic areas. But the national and local governments havebeen unable to effectively enforce the existing acts.

Tobacco control in Indonesia faces large oppositionand resistance to tobacco control laws and WHO FCTCfrom various sectors of the government. The tobaccoindustry protection exceeds health promotion interests,mainly because tobacco revenue is still considered as aprominent income both by central and local governments.In addition, the tobacco industry has an aggressiveadvertising campaign and sponsors main sports, musicand educational events. Although anti-tobacco NGOs arethere, their alliance is still weak to counter tobacco controlchallenges in the country. These NGOs are largelyJakarta-based and could only implement sporadic, smallactivities.

In the current national tobacco control regulation of2003 smoking is prohibited in public places, health andeducational facilities, playgrounds, worship places andpublic transport. Designated smoking rooms in publicand work places may be provided as long as they areequipped with air absorbers. Local governments arerequired to enact their own smoke-free policies. Followingthis regulation, several local governments -JakartaProvince, Bogor City and Cirebon City- of the countryhave developed local regulations, which include elementsof tobacco control.

Cirebon is the third largest city in West Java Provinceand was the winner of the national award “Clean andHealthy City” in 2004 and 2005. But the smoke-freeconcept was not included as part of the criteria for thisaward.

The NGOs and civil society took this opportunity andstrived to include smoke-free elements for the city tobecome a truly “Clean and Healthy City”. The mainmessage from the civil society was that the “Clean andHealthy” award was a very big achievement for Cirebon,but that the city should become a model for Indonesia andinclude smoke-free policies in the city’s regulation.

The civil society started by undertaking an advocacycampaign addressed to several key persons includingthe city’s Mayor through different channels.

They commenced with the head of the local healthoffice with an aim to eventually convince the mayor and

initiative was carried out independently by BBS.According to its chairman, Mr. Hemant Goswami, “evento date, sustaining the effort remains a challenge. Westill do not have any resources and the Administration isalso waiting for any form of support from the UnionGovernment. Tobacco industry has infiltrated into thegovernment ranks and is trying all the tricks to upset asuccessful model. Fighting them and handling themisinformation campaign is a continuous work. All ourefforts are currently focused on sustaining this initiative.”

The successful Chandigarh model and the strategiesused can be reproduced in other places in India and otherdeveloping countries with similar conditions. It has nowbeen proved that at a low cost, civil society organizationscan be instrumental in creating full compliance in asmoke-free city.

Hemant Goswami can be reached atgoswami@hemant.org.

Website: http://www.burningbrain.org

14 TFI NewsletterVol. 1 No.1, 2008

Basic facts on tobacco• 40.2% of male and 2.4% of female adults (+15 years) smoke regularly;

• 15.7% students (13-15 years) currently use any form of tobacco;

• Nearly 42 thousands people die of tobacco related deaths annually (41,183 in 2004);

• Revenue collected from tobacco products annually in Thailand is 43,207 million baht (2003), whilst costson tobacco related diseases are 45,550 million baht (2003);

• Thailand has a comprehensive tobacco control legislation;

• 2% of tobacco tax is earmarked for health promotion activities including tobacco control.

Thailand

Implementing Packaging and LabellingregulationsSince the 1980’s the Government of Thailand has initiatedaction towards tobacco control. In late 1988, an inter-agency policy committee for tobacco control called theNational Committee for Control of Tobacco Use (NCCTU)was approved and came into force in early 1989. Thiscommittee is composed of the Ministries of Public Health,Education, Agriculture, Interior, Finance, and the PrimeMinister’s office; Deputy Permanent Secretary for Healthof the Bangkok Metropolitan Administration; Directors-General of Departments of Health, Medical Services,Excise, Public Relations; President of the ReportersAssociation of Thailand; Secretary-General of theMedical Council; and five experts. The NCCTU is nowresponsible for formulating the country’s policy ontobacco control. To this end it has initiated severaltobacco control policies, one of which was a regulationmandating health warnings.

During the initial implementation phase, a major globaltobacco company which produces some of the most

famous brands around the world pointed out four keyelements that the Rules on Cigarette Labelling and LabelContent would impose an undue burden on the companyfor the prescribed textual health warnings; impair the useof the company’s valuable trademarks by obscuring themarks on the pack face, thereby undermining thetrademarks’ functions of brand identification andcommunication with the company’s customers; and limitthe right of the company to communicate with itscustomers through its display of trademarks and logos.The company argued that trademarks are valuablecompany property and protected by the Trademark ActB.E. (Buddhist Era) 2534, the Penal Code, as well as byWTO TRIPS, of which Thailand is a member.

However, the reality is that the trademarks are stillthere and not obscured. The Government also has theright to clearly inform the people about the health hazardsof smoking and the Trademark Act B.E.2534 that prohibitsdestruction or imitation of trademarks and that the healthwarning pictograms would do neither.

continued with the chairman of FOKASIH, the mostinfluential NGO, who offered to present the idea to thelocal parliament. And finally, the society succeeded inconvincing the local Islamic Institute.

Soon, an intersectoral meeting of the localgovernment, City Health Office, Community WelfareDivision and the local parliament was convened at theCity Hall and the meeting decided for a Smoke-FreeCirebon. The media was also involved and articles onthis issue were published.

It was agreed that the best regulation to be undertakenwas a “Mayor’s Decree on Smoke-Free Areas”, becauseit was the fastest approval process and would avoid losingthe momentum or risk being overridden by other priorities.The Mayor’s decree should, however, be considered only

as a transition process to a Local Smoke-Free Act. Publicpressure started to build up: a radio station conductedan interactive public dialogue, several shopping mallsimplemented smoke-free policies ahead of time and theoffice of Ministry of Education issued an internal letter ororder for smoke-free schools. The smoke-free policy waslaunched during the National Health Day 2006 and a post-decree community campaign was implemented from allparties involved.

The experience in Cirebon shows that for a successfulsmoke-free campaign, proper planning andunderstanding of the local situation are essential. It wasvery important to mobilize public support and finally, thereis a need for proactive monitoring and to have the capacityto provide technical assistance.

TFI Newsletter 15Vol. 1 No.1, 2008

Regulation on packaging and labelling has been quitesuccessful from a law enforcement point of view. Therehave been several scientific studies on the impact ofcigarette package textual health warnings on tobaccouse. Not only the graphic health warnings have createdimmense public awareness, there is also widespreadsupport from the media and all sectors of society.

Thailand’s experience has shown that packagelabelling is an important measure in controlling tobacco.Its legal system enables it to be easily implementedbecause packaging and labelling is a part of the law andregulation. To ensure competence and efficiency,

changes and improvements at appropriate and consistentintervals are to be taken into account. Textual healthwarnings have been changed to colored pictures withwarning statements on the dangers of cigarettes underthe determined size of not less than 50% of the largestarea on the external side of the package. This hasconsequently been in line with the Canadian experience,which could have better impact upon smokers. At present,the policy intervention on labelling and packaging,including health warnings, has been applicable to alltobacco products including cigars and pipe tobacco.

…Continues from introduction

Tobacco control programmes in the countries of thisRegion face tremendous impediments due to inadequateand weak infrastructure, legislation, regulations and acts,and lack of both financial and human resources as wellas frail mechanisms to enforce existing tobacco controlmeasures. In addition, the tobacco industry wields hugeinfluence over the economy and polity of the Regionthrough misleading economic arguments againsteffective tobacco control. Nonetheless, countries in theRegion are committed to tobacco control, as well as tothe implementation of the WHO Framework Conventionon Tobacco Control (FCTC). They played acommendable role in the negotiations of the conventionand are now trying their best to implement it in an effectiveway for meeting their treaty obligations.

Against this backdrop, WHO’s Tobacco Free Initiative(TFI) in the SEA Region is focusing on national capacitybuilding for tobacco control; advocacy to develop tobaccocontrol programmes based on the WHO FCTC;supporting countries to develop tobacco controlmeasures, including a national strategy and plan ofaction, legislation, other measures and guidelines forenforcement, promotion and compliance; promotingmultisectoral collaboration; education, training,communication and public awareness; advocacy,surveillance, research and sharing of information; andpartnership development among governments, donors,NGOs, national foundations and collaborating centres.

Tobacco surveillance has been an area of importancefor the regional tobacco control programme. Efforts havebeen made to implement a series of surveys such as theGlobal Youth Tobacco Survey (GYTS), the Global SchoolPersonnel Survey (GSPS) and the Global HealthProfessional Students Survey (GHPSS) using standardprotocols.

However, absence of a standard protocol for adulttobacco survey has been a weak spot for the GlobalTobacco Surveillance System (GTSS).

Research has been another important area of focusand a number of researches have been undertaken togenerate evidence for policy and programme formulation.Studies on Economics of Tobacco Control, Health Costsof Tobacco Use, Smokeless Tobacco Products, Povertyand Tobacco, Women and Tobacco, Implications ofSouth-Asian Free Trade Agreement on Tobacco Tradeand Crops Substitution, etc. have been undertaken inthe Region.

While tobacco control continues to be one of SEARO’spriority areas of work with countries’ steadfastcommitment to the issue, the Bloomberg Global Initiativeto Reduce Tobacco Use (BGI) came into fore withadditional resources – both human and financial, tostrengthen capacity of both public and private sectorsfor strengthening national tobacco control in low andmiddle income high burden countries.

The initiative is expected to supplement andcomplement the regional tobacco control efforts and alsoto implement the WHO FCTC in an effective way. Theinitiative includes tobacco control components likecapacity building to strengthen government’s capacity fortobacco control (coordination mechanisms, legislationand enforcement); developing a rigorous system tomonitor the status of global tobacco use such as theGlobal Tobacco Control Report (GTCR) and the GlobalAdult Tobacco Survey (GATS); the generation ofeconomic analysis for advocacy and policy setting;Advocacy - World No Tobacco Day. The GATS is animportant component of the initiative which is expectedto make the GTSS completed and should generatecomparable adult tobacco prevalence data by using astandard global protocol.

16 TFI NewsletterVol. 1 No.1, 2008

Organizational structure in SEA Region

Deputy Regional Director, Dr. Poonam Khetrapal Singh

Department of Non-Communicable Diseases & Mental HealthDr U Than Sein

TOBACCO FREE INITIATIVE

Dr Khalilur Rahman – Coordinator for Tobacco ControlDr Kamar Rezwan – Project Officer for TB and TobaccoprojectDr Niki Shrestha – Junior Public Health ProfessionalMs Putu K Duff – Secondment from Canadian PublicHealth Association (CPHA)Ms Tarun Sharma – Secretary

Ms Maria L Restrepo – Project Officer – BGIDr Dhirendra N Sinha – Surveillance Officer – BGIMr Ikhtiar M Chowdhury – Communication Officer – BGIMr Namit Tripathi – Secretary – BGI

WR Bangladesh

Dr M Mostafa Zaman –NPO (NCD)

Mr Iqbal Kabir –NPO for Information,Educationand Communication – BGI

Ms Nusrat Jahan –NPO for Law Enforcement –BGI

Ms Ishrat Chowdhury –NPO for Grant Management –BGI

Dr Sohel R Choudhury –NPO for Surveillance – BGI

Published by Tobacco-Free Initiative Unit,WHO South-East Asia Region

Please contact: Dr Khalilur RahmanMs Maria Restrepo, restrepom@searo.who.int

Bloomberg Global InitiativeTo Reduce Tobacco Use

WR Thailand

Dr Sawat Ramaboot –Adviser TFI

Dr Chai Kritiyapichatkul –NPO – BGI

Dr Gun Chernrungroj –NPO for Surveillance – BGI

Two support staff – BGI

WR Indonesia

Dr Albert Maramis –NPO (MH and Tobacco)

Dr Widyastuti Wibisana –NPO – BGI

Dr Yodi Christiani –NPO for Surveillance – BGI

One support staff – BGI

WR India

Ms Vineet Munish Gill –NPO (Tobacco)

Dr K D Maiti –NPO for Surveillance – BGI

Ms Hemi Shah –National Consultant – BGI

Ms Parul Pandey –National Consultant – BGI

Mr Praveen K Sinha –National Consultant – BGI

12 State Consultants – BGI

1 Support Staff – BGI

Quarterly Publication