Context

Egypt ratified the WHO Framework Convention on Tobacco Control (FCTC) on 25 February 2005. However, Egypt had already initiated national surveys as early as 2000, as part of the Global Tobacco Surveillance System, to assess the prevalence of tobacco use at a national level and develop suitable interventions. In 2007, Egypt emerged as one of the pioneering countries in the Region in terms of effectively monitoring tobacco use.

Initiative

In line with Article 20 of the WHO FCTC, the Ministry of Health and Population has taken the lead in conducting regular national surveys. Egypt has made significant efforts in research and surveillance related to tobacco control. Each survey received financial and technical support, along with training for key personnel in survey methodology, implementation and analysis. Collaborations between the Ministry of Health and Population and local/international partners such as WHO, the Centers for Disease Control and Prevention, and the Central Agency for Public Mobilization and Statistics (CAPMAS) facilitated the execution of national tobacco control studies.

Egypt has implemented surveys as part of the Global Tobacco Surveillance System, including:

The Global Adult Tobacco Survey (GATS). The first nationwide GATS was conducted in 2009.

The Global Youth Tobacco Survey (GYTS). Egypt conducted four rounds of GYTS, with the first round in 2001 and subsequent rounds in 2005, 2009 and 2014.

The Global Health Professions Student Survey (GHPSS). The GHPSS was conducted in medical schools in 2005.

A significant accomplishment was the incorporation of Tobacco Questions for Surveys (TQS) in other national surveys, such as the WHO STEPwise survey for noncommunicable disease risk factors conducted in 2005, 2011/2012 and 2017, and the national Household Income and Expenditure survey by CAPMAS conducted in 2012/2013 and 2017/2018.

Additional national surveys that included TQS were the National Egypt's Health Issues Survey 2015 and the National Health Accounts 2008/2009. The Ministry of Health and Population collaborated with WHO and academic professionals for three national studies in 2014, which examined health costs of tobacco use, assessed illicit tobacco trade and investigated shisha and smokeless tobacco use among youth in universities. Furthermore, in 2016, the Ministry of Health and Population, together with WHO and nongovernmental organizations, conducted a study on tobacco use among secondary school students.

Challenges and lessons learnt

Acquiring official approvals for national surveys involves time-consuming procedures. Nonetheless, a significant accomplishment has been the integration of TQS into regular national surveys, which serves as a valuable step towards addressing the need for specific tobacco-related surveys.

Impact

The information gathered through surveillance provides valuable insights for assessing the necessity of interventions, evaluating initiatives and guiding future policy measures. However, there is a lack of extensive research on evaluation studies that examine the effectiveness of interventions in reducing the prevalence of tobacco use.

Next steps

Conduct regular national surveys on tobacco use, in particular, the Global Youth Tobacco Survey and the Global Adult Tobacco Survey. These surveys will monitor the prevalence and trends of tobacco use in the country, including the emerging use of novel products like electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS).

Collaborate (Ministry of Health and Population) with the Central Agency for Public Mobilization and Statistics (CAPMAS) and WHO to ensure the integration of specific questions related to ENDS/ENNDS in the Tobacco Questions for Surveys as part of ongoing national surveys.

Incorporate tobacco-related questions into the National Health Information System for comprehensive data collection.

Develop performance indicators for all tobacco-related services and prevention policies, and regularly report on these indicators to policymakers and the health committee in the Egyptian parliament. This will help measure the effectiveness of interventions in tobacco control.

Disseminate information and research findings to relevant national stakeholders, ensuring widespread awareness and knowledge.

Provide (Tobacco Control Department) an annual progress report on the implementation of these strategies to the Higher Committee on Tobacco Control.

Reference

Global Tobacco Surveillance System

MPOWER measures to reduce demand for tobacco

WHO Framework Convention on Tobacco Control

Story originated in 2019.

Context

In 2007, Afghanistan implemented its initial legislation to address tobacco advertising and promotion. According to Article 16 of the Afghan Advertisement Procedure, all forms of tobacco product promotion, advertisement and other harmful products were fully prohibited on national TV, radio and magazines. However, this legislation did not extend to other channels of tobacco advertising, promotion and sponsorship. Additionally, it did not establish fines for violations. By 2009, five years after the legislation's implementation, compliance with the existing regulations was reported to be at a moderate level (5 out of 10) in the WHO Report on the Global Epidemic Tobacco of 2013.

Initiative

Following Afghanistan's ratification of the WHO Framework Convention on Tobacco Control (FCTC) on 13 August 2010, progress has been made in tobacco control efforts. A national tobacco control coordination committee, comprising 70 members from relevant ministries, sectors, UN agencies and civil society has been established to hold regular meetings. Additionally, a tobacco control taskforce consisting of 20 members conducts monthly meetings and collaborates with the private sector to support tobacco control events. This strong multisectoral coordination has provided a boost to tobacco control in Afghanistan. In line with the implementation of Article 13 of the WHO FCTC, Afghanistan introduced its first dedicated tobacco control law in 2015. This legislation included a comprehensive ban on tobacco advertising, promotion and sponsorship, as well as the imposition of fines for violations.

To ensure the effective implementation of the law, the Ministry of Public Health has developed and adapted guidelines for its implementation. Various sectors, including municipalities, the union for hotel workers, the environmental health department, the national environment protection administration, the police and the Ministry of transport and tourism have been involved in monitoring law enforcement. Numerous initiatives have been undertaken to raise public awareness and strengthen the enforcement of the law. For example, the Ministry of Public Health has conducted training sessions for hundreds of police officers, published informative articles on tobacco control through social media platforms, participated in interviews with television and radio stations and regularly organized press conferences to commemorate World No Tobacco Day. Furthermore, there has been effective coordination and follow-up with relevant authorities at the national and provincial levels, as well as nongovernmental organizations, to facilitate the implementation of the tobacco control law.

Challenges and lessons learnt

Several challenges have been identified in relation to the tobacco control law. Loopholes in the legislation have allowed for tobacco industry interference, and compliance with the indirect bans has been low. Notably, the law lacks explicit provisions addressing cross-border advertising, the display of tobacco products at points of sale, internet sales of tobacco products and corporate social responsibility of the tobacco industry. In the past year, tobacco companies were able to influence and modify three articles of the tobacco law. In response, the Ministry of Public Health joined forces with the Parliament and the Ministry of Justice to initiate the process of re-amending these articles. It is worth noting that compliance with the direct bans has been relatively high, scoring 8 out of 10 according to the WHO Report on the Global Tobacco Epidemic of 2019. One particularly successful aspect of this initiative has been the collaboration with religious leaders, who have lent their support to the ban on tobacco advertising, promotion and sponsorship.

Impact

While a direct assessment of the ban on smoking in public places in Afghanistan has not been conducted, data from the Global Youth Tobacco Survey in 2010 and 2017 provide valuable insights. The findings indicate a notable decline in certain indicators among youth. Specifically, there was a 13.2% decrease in the proportion of youth reporting being offered free tobacco products or cigarettes by tobacco company representatives. Additionally, there was a significant 24.5% decline in the percentage of youth who reported watching actors smoking on TV. These data suggest a positive impact on youth exposure to tobacco-related influences.

Next steps

To facilitate the effective implementation and enforcement of the tobacco control law, there is a need for enhanced financial and technical support. The aim is to prevent any potential interference from the tobacco industry and ensure the successful implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship. By securing strengthened resources, the efforts to control tobacco use can be bolstered, further protecting public health and advancing tobacco control initiatives.

References

Global Youth Tobacco Survey

MPOWER measures to reduce demand for tobacco

WHO Framework Convention on Tobacco Control

WHO Report on the Global Epidemic Tobacco 2013

WHO Report on the Global Epidemic Tobacco 2019

Story originated in 2019.

Context

In 2007, Afghanistan introduced its first legislation aimed at protecting individuals from tobacco smoke. However, this initial legislation had certain limitations. Article 4 did not encompass all public spaces, including government facilities, indoor private offices and workplaces, restaurants and cafes, and public transportation. Furthermore, it did not establish penalties for non-compliance. Despite being in effect for five years since its implementation in 2009, the compliance rating was reported to be at a low level (2 out of 10) in the WHO Report on the Global Tobacco Epidemic of 2013. Additionally, a survey conducted in 2011 on smoking prevalence among men in Kabul city indicated that 78.3% of non-smokers were exposed to secondhand smoke in public places.

Initiative

Following Afghanistan's ratification of the WHO Framework Convention on Tobacco Control (FCTC) on 13 August 2010, significant efforts have been made to protect people from tobacco smoke through a national tobacco control coordination committee. This committee comprises 70 members from various ministries, sectors, UN agencies and civil society, convening regularly. Additionally, a tobacco control taskforce with 20 members meets monthly and collaborates with the private sector to support tobacco control events. This robust multisectoral coordination has provided a boost to tobacco control in Afghanistan.

Furthermore, several initiatives have been undertaken to raise public awareness and strengthen the implementation of tobacco control legislation. Notably, three national parks in Kabul city, namely Bagh-e-Wahsh, Bagh-e-Babar and Park-e-Shaher have been designated as tobacco-free spaces. The Ministry of Public Health has developed standard operating procedures for the enforcement of tobacco control laws and has conducted training sessions for hundreds of police officers and teachers. Public campaigns through social media, television and radio interviews, and annual observance of World No Tobacco Day with press conferences have also been instrumental in promoting awareness.

In line with Article 11 of the WHO FCTC, Afghanistan enacted its first tobacco control law in 2015, which includes a comprehensive ban on smoking in all public places. To ensure effective implementation of the law, various measures have been initiated. The Ministry of Public Health has formulated guidelines and engaged different sectors, such as municipalities, the union for hotel workers, the environmental health department, the national environment protection administration, the police and the Ministry of transport and tourism to monitor law enforcement. Monitoring plans and checklists for smoking in public places have been developed and implemented. Relevant organizations have been provided with official information about the law, tobacco hazards and health warning messages, along with a request to prominently display no tobacco signs and messages within public spaces. Training programmes have been conducted for hospital staff, teachers in 25 schools and police officials in 17 districts. Strict enforcement measures include requiring individuals to remove tobacco products before entering indoor public places and imposing fines for violators. Additionally, campaigns have been carried out to eliminate waterpipes from 17 districts in Kabul, Herat and Nangarhar. Continuous follow-up with authorities at the capital and provincial levels, as well as collaboration with nongovernmental organizations, ensures the implementation of the tobacco control law is monitored and maintained.

Challenges and lessons learnt

The compliance rate in newly covered public places, including public transportation is high. However, compliance in governmental facilities remains a challenge. The main obstacles to implementing and enforcing the tobacco control law are a shortage of technical personnel and limited budget for capacity building and community awareness campaigns. The significant lesson learnt is the power of multisectoral coordination and the value of partnerships with the private sector to enhance support for the tobacco control programme and encourage cooperation from key stakeholders in tobacco control efforts.

Impact

The effects of the smoking ban in public places in Afghanistan has not been measured. However, according to the most recent Global Youth Tobacco Survey conducted in 2017, 35.3% of youth reported exposure to secondhand smoke in enclosed public places, while 43.0% reported exposure in outdoor public areas. Additionally, Afghanistan conducted the WHO STEPS survey to monitor tobacco use in adults from 2019 to 2020, and the results, which will be shared soon, will provide insights into the impact of the implemented tobacco control measures.

Next steps

The aim is to secure increased financial and technical assistance in order to facilitate the successful implementation and enforcement of the tobacco control law. This support is particularly crucial for protecting individuals from tobacco exposure in public spaces.

References

Global Youth Tobacco Survey

MPOWER measures to reduce demand for tobacco

WHO Framework Convention on Tobacco Control

WHO Report on the Global Epidemic Tobacco 2013

WHO STEPS survey

Story originated in 2019.