Significant Initiatives/Achievements of Tobacco Control Cell

Tobacco use is the single largest preventable cause of death in the world.In Pakistan, tobacco is a cause of death of around 160,100 persons every year. Around 1200 Pakistani children between age of 6 & 15 start smoking every day.

According to Global Adult Tobacco Survey, 2015 almost 24 million (19.1%) adults currently use tobacco in any form. That accounts for 15.6 million (12.4%) adults who currently smoke tobacco, including 3.7 million adults using water pipes, hookah or shisha, and another 9.6 million (7.7%) adults who use smokeless tobacco.

To address this major health issue, the Federal Government has taken a number of initiatives. These inter-alia include (i) promulgation of the Cigarette (Printing of Warning) Ordinance, 1979 and the Prohibition of Smoking and Protection of Non-smokers Health Ordinance, 2002 (ii) signing and rectification of Framework Convention on Tobacco Control (FCTC) (iii) creation of National Tobacco Control Cell in 2007.

The Government of Pakistan signed and ratified the Framework Convention of Tobacco Control (FCTC) in 2004. Under Article 5.2 of the FCTC, the Parties to the said treaty are mandated to put in place proper and effective national coordination mechanism for multi-sectoral coordination of tobacco control efforts. In order to fulfil obligations under this Article, Tobacco Control Cell was created in Ministry of Health (Defunct) on 1st July, 2007, as a part of non-development budget. The objective of Tobacco Control Cell is to reduce prevalence of tobacco use in Pakistan by taking administrative, legislative and coordination measures for implementation of FCTC Articles. Currently, the Cell has been placed under Ministry of National Health Services, Regulations and Coordination (Mo NHSR&C). Tobacco Control Cell is also mandated to achieve the target set in Sustainable Development Goals (SDGs) i.e. SDG 3 (a): Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC).

Tobacco Control Cell, since its inception, is implementing demand and supply reduction strategies to reduce prevalence of tobacco use in Pakistan. Following are some major achievements of the Cell:

Legislative/Policy Measures

1. Prohibition of Smoking and Protection of Non-Smoker’s Health Ordinance, 2002
1. Ban on smoking in places of public work or use
2. Ban on smoking in public service vehicles
3. Regulation of tobacco advertisements
4. Ban on sale of cigarettes to under-18s
5. Ban on sale or storage of cigarettes/tobacco products in/near educational institutions.
6. Mandatory display of “No Smoking” signs at public places.
2. Cigarette (Printing of Warning) Ordinance, 1979: Amendment in 2002
   1. Ban on possessing, selling or offering for sale packets of cigarettes without health warning.
3. Ban on sale of cigarettes in loose form.
4. Ban on import of Sheesha (tobacco and non-tobacco) and related substances.
5. Ban on tobacco advertisements in Print, Electronic and Outdoor Media (through billboard a poster or banner affixed outside a shop, kiosk, or mobile trolley etc.).
6. Ban on manufacturing, importing and selling of cigarette packs having less than 20 cigarette sticks.
7. Enhancing size of Pictorial Health Warning to be printed on cigarette packs and outers (50% from 1st June, 2018 and 60% from 1st June, 2019 as approved by the Cabinet).
8. Ban on free samples, cash rebates, discounts and sponsorship of events.
9. Declaration of places of public work or use completely smoke-free/ Illegalization of “Designated Smoking Areas”.
10. Increased FED on cigarette packs in 2016-17 and 2015-16 budgets (but decreased prices in 2017-18 Budgets. The M/o NHSRC is analyzing the impact and approaching relevant forums to get the decision reversed).

Infrastructure development / Institutionalization

1. Restructuring/Strengthening of  National Tobacco Control Cell at Federal Level. PC-1 amounting to Rs.28.701 has been approved. M/o Planning has been requested to re-appropriate funds.
2. Establishment of  Provincial TCC at KPK and Balochistan. Punjab and Sindh committed same.
3. Formation of National Technical Advisory Group (TAG) at Federal Level.
4. Formation of Technical Working Group on Tobacco Taxation.
5. Notified Provincial Implementation & Monitoring Committees / Taskforces.
6. Notified Districts Implementation & Monitoring Committees.

Awareness / Capacity Building

1. Launched 2 national mass media campaigns on tobacco control with assistance of World Lung Foundation (2015 & 2016).
2. More than 402 capacity building sessions with law enforcement officers & authorized persons (12,000 officers were trained).
3. Provincial and District Implementation Committees meetings.
4. Development, printing and direct dissemination to districts of communication materials  (1,157,000 units)
5. Installation of plates / posters carrying “Smoking is an Offense” message in ministries.
6. Installation of 200 boards with tobacco control messages at public places in Islamabad.
7. Coordination with PEMRA to air tobacco control messages as mandatory airing of public service messages (Some channels have aired).
8. Development and dissemination of advocacy kits on tobacco control (for parliamentarians and journalists).
9. TV/ Radio Programmes/ Newspapers Articles / City branding.
10. Production and airing of two documentary  films in national and regional languages.
11. Incorporation of tobacco control messages in curriculum (Punjab has incorporated).
12. Branding of buses with tobacco control messages in Islamabad/ Rawalpinidi.

Enforcement

1. Letters to Provincial CMs to enforce tobacco control laws.
2. Letter to all federal secretaries and provincial chief secretaries to enforce tobacco control laws and nominate focal persons from their departments.
3. Capacity building of law enforcement officers / authorized persons.
4. Raids by law enforcement teams.
5. Penalized Philip Morris Pakistan by Hyderabad Court, on violation of tobacco advertisement guidelines.
6. Registration of 1396 cases across the country under various sections of 2002 Ordinance.
7. Directions by provincial IGs for strict enforcement of tobacco control laws.

Monitoring Tobacco Use

1. Conducted Global Adult Tobacco Survey (GATS), 2015 first time in Pakistan.
2. Conducted Pakistan Demographic Health Survey (PDHS), 2012-13.
3. Conducted Global Youth Tobacco Survey (GYTS), 2013.

FCTC Assessment Exercises

1. Conducted FCTC Needs Assessment Exercise (14-17 March, 2017).
2. Conducted FCTC Impact Assessment Exercise (2-5 May, 2016).