Kuwait: offering help to quit tobacco use
Context
Kuwait ratified the WHO Framework Convention on Tobacco Control (FCTC) on 12 May 2006 and as part of its national tobacco control strategy, it adopted a significant policy of providing assistance to nicotine dependents in quitting smoking. Demonstrating leadership in the Region, Kuwait became the first country to establish cessation clinics, with the initial clinic operating since the early 1980s.
By 1998, the Asma clinic was following established protocols and achieving success. In 2003, a ministerial decree was issued to expand the presence of cessation clinics nationwide. As a result, a clinic was established in each governorate, increasing the total number of clinics to six. Additionally, another clinic was opened to cater specifically to workers in the oil industry at the Al Shuaiba Industrial Area. These clinics offered free services, including medical assessments, nicotine replacement therapy and counselling, for four hours, twice a week, in the afternoon. The cessation success rates for these clinics averaged around 30% over a period of six months.
However, the clinics faced the possibility of closure. The reasons cited for potential closure included the perception that the clinics did not yield successful outcomes, the belief that quitting smoking "cold turkey" was the most effective method and doubts regarding the quality of assistance provided by healthcare professionals.
Initiative
To prevent the potential closure of the cessation clinics, several steps have been undertaken:
Compile evidence highlighting the significance of smoking cessation clinics for any healthcare system aiming to control tobacco consumption. This involved creating a comprehensive report that gathered evidence from relevant literature and incorporated the guidelines outlined in Article 14 of the WHO FCTC.
Conduct an audit of the clinics' operations and provide recommendations regarding the necessity of enhancing doctors' capabilities to meet international standards. This includes the development of patient information sheets and the implementation of a standardized protocol for clinic management.
Implement a training programme for doctors, nurses and health inspectors responsible for running the clinics. The objective of this programme is to enhance their competencies in delivering internationally accredited management within the clinics.
Revise and update the protocol for the treatment of nicotine dependence, ensuring it aligns with current best practices and guidelines.
Challenges and lessons learnt
The preservation of smoking cessation clinics faced various challenges that required immediate attention. These challenges included bureaucratic obstacles within the governmental sector, the need to navigate ministerial administrative restrictions and the importance of securing sustained financial support for clinic operations. Additionally, it was essential to involve doctors from general hospitals in the clinics' operations to ensure their success.
Throughout this process, valuable lessons were learnt, leading to corresponding actions being taken. A primary lesson was the recognition of the significance of incorporating scientific evidence into policy development and implementation. This evidence-based approach played a vital role in making informed decisions regarding tobacco control. Another crucial lesson was the value of constructive criticism in evaluating existing healthcare services and identifying areas for improvement. Acting upon this feedback, subsequent enhancements were implemented. Moreover, the WHO FCTC emerged as a crucial cornerstone in guiding effective tobacco control policies within healthcare systems.
To address the challenges, specific actions were undertaken. Firstly, a step was taken by submitting a scientific report that advocated for the importance of smoking cessation clinics. This report served as a robust defense, utilizing scientific evidence to underscore the clinics' significance and impact. Additionally, the constructive criticism received was embraced as an opportunity for improvement. This led to the implementation of targeted training programmes for healthcare professionals involved in the clinics, resulting in enhanced service quality. Collectively, these actions played a vital role in strengthening the effectiveness and impact of smoking cessation clinics, paving the way for improved tobacco control measures.
Impact
The approach used had a positive impact on the clinics in multiple ways. Firstly, the clinics continue to operate successfully, ensuring their ongoing provision of services. Additionally, there are plans in place to expand the number of cessation clinics, reflecting a commitment to future growth and development in this area.
Next steps
Moving forward, there are important plans to improve the cessation clinics. The National Programme will take over their supervision, ensuring a more coordinated approach. Certification through appropriate training will be required for clinic staff to enhance the quality of services provided. Expanding the training programme to involve doctors at all healthcare levels is also planned, aiming for a comprehensive approach to address tobacco dependence. Additionally, the objective is to increase the number of clinics and operate them in the morning at primary healthcare facilities for better accessibility. These plans demonstrate a strong commitment to improving the clinics and supporting individuals in their journey to quit smoking.
References
MPOWER measures to reduce demand for tobacco
WHO Framework Convention on Tobacco Control
Story originated in 2019.
Kuwait's commitment to tobacco control strengthened as ratification of protocol achieved with multisectoral collaboration
Context
Kuwait ratified the WHO Framework Convention on Tobacco Control (FCTC) on 12 May 2006, demonstrating its commitment to tobacco control. In line with its obligations under the WHO FCTC, Kuwait also signed the Protocol to Eliminate Illicit Trade in Tobacco Products in 2012. However, the process of ratification for this protocol was not finalized until 2019.
Initiative
The process of becoming a Party to the Protocol involved signing and ratifying it. For parties that joined later in the process, signature and ratification were merged. Due to the Protocol's nature as an international law addressing tobacco smuggling, it was necessary to bring the process to the national level. The Ministry of Health, being the leading stakeholder (as the Protocol emerged from the WHO FCTC), played a crucial role. However, other stakeholders such as the ministries of finance and commerce, as well as customs, also played significant roles in achieving the Protocol's ratification.
The National Tobacco Control Programme recognized the importance of engaging with the relevant partners. A copy of the Protocol, accompanied by a letter seeking their opinion on proceeding was shared. In 2015, Kuwait hosted the first regional meeting focused on the Protocol. Representatives from various sectors in all countries of the Gulf Cooperation Council participated in this three-day meeting. The Head of the WHO FCTC Secretariat and eight WHO experts provided detailed information about the Protocol.
The recommendations from this meeting were circulated and further communications were initiated to nominate a focal point. However, the collaboration encountered challenges.
In 2017 and 2018, WHO recommended involving the Ministry of Foreign Affairs, alongside the Ministry of Health to support in the ratification process. Responding to this recommendation, the Ministry of Foreign Affairs, alongside the Ministry of Health called on stakeholders in Kuwait to actively participate, resulting in the successful ratification of the Protocol and Kuwait becoming the 61st Party to the Protocol in February 2019.
Challenges and lessons learnt
Kuwait becoming Party to the Protocol was facilitated by the multisectoral coordination among various stakeholders and ministries involved in this process. Involving a stakeholder (Ministry of Foreign Affairs), alongside the Ministry of Health, who typically handles these matters, proved instrumental in advancing the ratification process and addressing the hesitancy and delays faced by certain stakeholders. Demonstrating committed leadership was crucial in driving the ratification process forward and ensuring its eventual success.
Impact
The involvement of an additional stakeholder, namely the Ministry of Foreign Affairs, alongside the Ministry of Health had a positive impact on the ratification process.
Next steps
Moving forward, the Protocol presents an opportunity to effectively control tobacco by addressing the reduction of its supply. This effort will necessitate increased collaboration among various sectors and a strong commitment at the national level.
References
MPOWER measures to reduce demand for tobacco
Protocol to Eliminate Illicit Trade in Tobacco Products
WHO Framework Convention on Tobacco Control
Story originated in 2019.
Saudi Arabia's tax stamp project boosts regulatory controls and curbs illicit tobacco trade
Context
Saudi Arabia ratified the WHO Framework Convention on Tobacco Control (FCTC) on 9 May 2005. The country took early action in combating illegal trade by establishing a committee to examine illicit trade in tobacco products, as directed by a decision from the Cabinet in 2009. In 2012, the Conference of the Parties to the WHO FCTC adopted the Protocol to Eliminate Illicit Trade in Tobacco Products, which was ratified by Saudi Arabia in 2015.
Initiative
To support the objectives of the WHO FCTC and take action in combating illegal trade, the Saudi Arabian Cabinet issued a resolution in 2014. This resolution authorized the Minister of Health or their representative to sign the Protocol to Eliminate Illicit Trade in Tobacco Products. Subsequently, in 2015, the Shura Council approved Saudi Arabia's participation in the Protocol, recognizing its potential impact on reducing national tobacco use and promoting regional collaboration in curbing the sale and circulation of illicit tobacco products. As a result, Saudi Arabia ratified the Protocol in 2015.
The National Tobacco Control Committee, representing the Ministry of Health, published an informational booklet about the Protocol to Eliminate Illicit Trade in Tobacco Products. In the same year, the activities for World No Tobacco Day were dedicated to raising awareness among the public about the Protocol.
Additionally, Saudi Arabia introduced a tax stamp project for tracking tobacco products, led by the General Authority for Zakat and Income Tax. This system utilizes tax stamps affixed to imported tobacco products, with the distribution or importation of any tobacco products lacking tax stamps being prohibited.
A tax stamp is a distinctive symbol, such as a sticker or encoded digital data, applied to specific products. The stamp is requested, printed and monitored through a tracking programme. Producers and importers must comply with the tax stamp system's specified standards to import and offer these products in the market.
In November 2019, the General Authority for Zakat and Income Tax announced a ban on the sale and distribution of cigarette packages without tax stamps. This decision was based on the executive regulations of the selective tax system, specifically regarding tax stamps, within the framework of the unified agreement for selective tax in countries of the Gulf Cooperation Council.
To assist consumers, the General Authority for Zakat and Income Tax developed a mobile application called "verify” (تحقق). This application allows users to verify the presence of tax stamps by scanning the barcode on cigarette packages. The authority encourages consumers to report illicit products through their official website, the hotline (19993) or the "verify" (تحقق) application.
Impact
The implementation of the tax stamp system in Saudi Arabia has had several notable impacts, including:
Strengthening regulatory controls. The tax stamp system has enabled Saudi Arabia to establish effective regulatory controls for collecting selective goods tax on imports. This ensures that all necessary taxes and fees are duly collected in a systematic and legitimate manner.
Ensuring legitimate product entry. The tax stamp system provides a systematic and legitimate means of verifying the entry of products into Saudi Arabia. This helps prevent illicit trade and ensures that all applicable taxes and fees are properly collected.
Enhancing analysis and auditing capabilities. The tax stamp system has improved the ability of relevant authorities to analyze and audit imported products. This enables them to identify instances of illicit trade in these products and develop strategies to minimize and mitigate such practices as much as possible.
Next steps
Moving forward, as of 24 February 2020, the importation of waterpipe products without tax stamps will be prohibited. Additionally, starting from 18 May 2020, the sale and trade of any waterpipe product lacking tax stamps will be forbidden within Saudi Arabia. Saudi Arabia remains committed to promoting and encouraging other countries in the Region to ratify the Protocol to Eliminate Illicit Trade in Tobacco Products, fostering ongoing cooperation in this regard.
References
MPOWER measures to reduce demand for tobacco
Protocol to Eliminate Illicit Trade in Tobacco Products
WHO Framework Convention on Tobacco Control
Story originated in 2019.
Saudi Arabia: offering help to quit tobacco use
Context
In 2005, Saudi Arabia ratified the WHO Framework Convention on Tobacco Control (FCTC). By 2010, approximately 15% of adolescents reported being current tobacco users. However, health care providers faced significant challenges in assessing and treating smokers due to various barriers. It was crucial to tackle the lack of knowledge and tools necessary for rapid and simple evaluation of tobacco use and the treatment of tobacco dependence. Furthermore, there was a shortage of institutional support for the routine assessment and treatment of tobacco use, resulting in limited training opportunities for tobacco cessation interventions. To enhance the ability of health care providers to address all tobacco users, not just cigarette smokers, extensive efforts were undertaken to integrate tobacco cessation interventions into the existing healthcare system, aiming for a successful strategy implementation.
Initiative
To comply with the guidelines outlined in Article 14 of the WHO FCTC, the Ministry of Health, represented by the National Tobacco Control Committee, enhanced the tobacco cessation guidelines in Saudi Arabia. Starting in 2011, the Ministry initiated the establishment of specialized tobacco cessation clinics, with a total of 262 clinics currently in operation. By integrating these clinics into existing healthcare sectors and ensuring accessible treatment services, the Ministry aimed to deliver a uniform and high-quality standard of care. This clinic project has been expanded to cover all regions within the Saudi Arabia. Additionally, the Ministry launched the '937' hotline for cessation support and developed electronic mobile applications to provide access to cessation services.
Concurrently, the Ministry of Health conducted training programmes for healthcare providers to introduce the new treatment programme, which incorporated both behavioural and therapeutic components. They also introduced online training known as the 'Saudi Certificate for Tobacco Treatment'. In order to offer free, high-quality treatment and preventive services, the Ministry collaborated with the ministries of education, transport and interior as well as the Saudi Food and Drug Authority. These services were made available through 274 hospital clinics, 321 primary healthcare centers, 890 fixed cessation clinics, 100 mobile cessation clinics, 283 home care services and 14 specialized hospitals.
Challenges and lessons learnt
One of the primary challenges faced was the shortage of medical personnel. From this experience, an important lesson learnt was the implementation of an electronic training course offered during official working hours by the General Authority for Medical Specializations. Furthermore, in cases where treatment services were unavailable in the clinic, a shift towards emphasizing awareness and educational aspects of cessation interventions was advised. Utilizing social media platforms proved beneficial in promoting the tobacco cessation programme. Notable successes included:
Equipping physicians and other healthcare providers with the necessary skills and knowledge through training on the smoking cessation programme based on the Saudi manual for cessation services.
Developing a specialized course, the 'Saudi Certificate for Tobacco Treatment' aimed at training physicians to become experts in treating tobacco dependence.
Assisting a significant number of smokers who desired to quit by providing comprehensive behavioural and pharmaceutical treatment services.
Utilizing electronic applications that not only focused on smoking cessation but also assessed user satisfaction with the provided services, as well as serving as a platform for registering clinic auditors.
Enhancing health literacy and awareness of preventive services among the population.
Establishing a tobacco control complaint system and implementing an effective mechanism for handling incoming notifications.
Impact
The development of tobacco cessation clinics has led to their expansion into comprehensive hospital centers, incorporating educational, treatment and control departments. The total number of clinics has notably increased from 461 in 2018 to 1008 in 2019. Similarly, the number of clinic auditors has experienced substantial growth, rising from 51 000 in 2018 to 96 500 in 2019.
Next steps
With an emphasis on community partnerships, the project aims to further expand the provision of tobacco cessation services through collaborations with nongovernmental organizations, private hospitals and malls. Additionally, the Ministry of Health will continue to encourage the utilization of existing services, such as the '937' hotline, the registration of clinics in the ‘appointment’ (موعد) application, and the electronic health information system, to actively contribute to tobacco control efforts.
References
Global Tobacco Surveillance System
MPOWER measures to reduce demand for tobacco
WHO Framework Convention on Tobacco Control
Story originated in 2019.
