Framework Convention on Tobacco Control 2030—A Program to Accelerate the Implementation of World Health Organization Framework Convention for Tobacco Control in Low- and Middle-Income Countries: A Mixed-Methods Evaluation

Abstract

Background FCTC 2030 Programme (2017-2021) was launched to accelerate WHO Framework Convention on Tobacco Control (FCTC) implementation in 15 low- and middle-income countries (LMICs). We evaluated the Programme in six domains: Governance; Smoke-Free Policies; Taxation; Packaging and Health Warnings; Tobacco Advertising, Promotion and Sponsorship (TAPS) bans; International and Regional Cooperation. Methods Following a mixed-methods design, we surveyed (Jun-Sept 2020) FCTC focal persons in 14 of the 15 countries, to understand the Programme’s financial and technical inputs and progress made in each of the six domains. The data were coded in terms of inputs (financial=1, technical=1, or both=2) and progress (none=1, some=2, partial=3, or strong=4) and a correlation was computed between the inputs and progress scores for each domain. We conducted semi-structured interviews with key stakeholders in five countries. We triangulated between the survey and interview findings. Results FCTC 2030 offered substantial financial and technical inputs, responsive to country-needs, across all six domains. There was a high positive correlation between technical inputs and progress in five of the six domains, ranging from r=0.61 for Taxation (p<0.05) to r=0.91 for Smoke-Free Policies (p<0.001). The interviews indicated that the Programme provided timely and relevant evidence and created opportunities for influencing tobacco control debates. Conclusions The FCTC 2030 Programme might have led to variable but significant progress in advancing FCTC implementation in the 15 countries. As expected, much of the progress was in augmenting existing structures and resources for FCTC implementation. The resulting advances are likely to lead to further progress in FCTC policy implementation. IMPLICATIONS What this study adds: In many low- and middle-income countries (LMICs), WHO Framework Convention for Tobacco Control (WHO FCTC) policies are not in place; and even when enshrined in law, they are poorly enforced. It is not clear how financial and technical assistance to high tobacco-burden LMICs can most effectively accelerate the implementation of WHO FCTC policies and offer value for money. Bespoke and responsive assistance, both financial and technical, to LMICs aimed at accelerating the implementation of WHO FCTC policies is likely to lead to progress in tobacco control.

Examining local smoke-free coalitions in Armenia and Georgia: context and outcomes of a matched-pairs community-randomised controlled trial

“…Findings indicated effects on complete smoke-free homes, even beyond increasing rates over time in both intervention and control communities (53.6% at follow-up vs 38.5% at baseline), as well as effects on coalition awareness. These effects were detected despite significant sociopolitical events during the study, including national smoke-free policy implementation (Georgia, 2018; Armenia, 2022), these countries’ participation in the FCTC 2030 initiative,47 the COVID-19 pandemic, and military conflict in Armenia and regionally. Our process evaluation analysis documented diverse representation within the coalitions and their effective use of the funding, training and technical assistance to execute various community-based activities and effect policy change 46.…”

“…For example, in Georgia versus Armenia, there were lower rates of smoke-free homes, controlling for baseline smoke-free home rates; however, over half of Georgian participants reported smoke-free homes at both baseline and follow-up, while the proportion of Armenian participants reporting smoke-free homes increased from ~25% to 39%. Country-based differences likely relate to earlier implementation of smoke-free—and other tobacco control—legislation in Georgia (vs Armenia), as well as Georgia’s earlier participation in the FCTC 2030 initiative 47…”

Advancing progress on tobacco control in low-income and middle-income countries through economic analysis

“…We believe this to be a conservative claim given the demand for the investment cases, that the observed actions align with case findings and recommendations, and corroborative evidence of impact through an independent evaluation of the FCTC 2030 project. 26 …”

Tobacco control in low-income and middle-income countries: findings from WHO FCTC investment cases

“…The FCTC 2030 programme aims to fortify tobacco control governance primarily by implementing FCTC Article 6, which involves increasing tobacco taxation; implement the two FCTC measures on tobacco packaging (Article 11) and on ending tobacco advertising, promotion and sponsorship (Article 13); and support the implementation of other WHO FCTC articles that are deemed national priorities. 7 Moreover, the FCTC 2030 programme aims to bolster tobacco control efforts, enhance capacity, garner support for stronger tobacco control legislation and improve implementation of the national tobacco control plans in phase 1 countries. 7 As part of their applications to FCTC 2030, countries requested a range of support from the project’s priority areas.…”

“… 7 Moreover, the FCTC 2030 programme aims to bolster tobacco control efforts, enhance capacity, garner support for stronger tobacco control legislation and improve implementation of the national tobacco control plans in phase 1 countries. 7 As part of their applications to FCTC 2030, countries requested a range of support from the project’s priority areas. Each country participating in FCTC 2030, however, requested a tobacco control investment case.…”