Tobacco Control in the Pacific

1. Tobacco Control in the Pacific NZAID TOBACCO CONTROL PROJECT 2003 - 2006

2. NZAID project • Stage 1 (Cooks and Tonga) • Stage 2: (Samoa, Solomons, Tuvalu, Vanuatu) • 4 year project • Focus on: • FCTC • key elements of effective tobacco control • population level interventions • capacity building

3. Key elements of the project • Self-selection by the countries • Project leadership & ownership by • countries • S.W.O.T analysis: needs & wishes • Heavy focus on FCTC compliance • Covers population level interventions : • national plan of action (if none exist) • tax policy • development (and implementation) of legislation • confronting tobacco industry • capacity building – health promotion, cessation, enforcement of legislation

4. Key elements (cont.) • Significant commitment to in-country support (av. 15 visits per country) • Application of best practice – but local solutions • Use of workshops – Govt & Non-Govt capacity building • Community / NGO involvement, including Outer Islands • Collaboration with other regional agencies • Evaluation

5. NZ contributors to Stage 2 • Policy, legislation, enforcement, sustainable funding: Allen & Clarke • Cessation: Pacific Island Heartbeat and Denise Barlow • Health Promotion: Zebra Associates and Liz Price • Advocacy: Te Reo Marama, Smokefree Coalition

6. Key Conclusions • Further countries need help • Risk: PICTA • Risk: Tobacco factories, support for manufacturing and growing • Risk: Fragmentation of effort – need for coordination between funders • Crucial that projects be locally owned • Flexibility in implementation • Sustainability of efforts: practical efforts promoted that can be continued by the countries: STEPWise approach

7. Establishment of Smoking Cessation Services Establishment of ongoing smoking cessation training for Health Professionals

8. Process – what worked best A three tiered process: • Initial visit to • Meet key contacts who would positively influence the project • Arrange venue and other practical details • Meet prospective participants and issue pre course work • Facilitate the five day training • Day 1 – Brief intervention • Days 2,3,4 – Cessation training • Day 5 – Finalisation of specific objectives and train the trainer for future facilitators • Follow up visit/s to • Assist in achievement of objectives • Identify areas of difficulty • Continue desk support as needed

9. Examples of cessation and training objectives Hospitals • Generation of awareness programmes • Concentrating on staff initially • Establishment of cessation clinics NGOs and local councils • Again, concentrating on staff first • All organisations to have a trained practitioner • These practitioners to go on to train other practitioners Ministry of Health • Mainly NCD coordinators and health promoters, who incorporate information on the dangers of tobacco use and the provision of ‘brief advice’ into community and clinic activities • Creation of cessation resources • Coordination of cessation and training activities nationally • Establishment of reporting protocols on tobacco use and cessation statistics

10. Positives • The enthusiasm and interest of health professionals in this ‘new’ area of health work • Their commitment to incorporating smoking cessation into their wider activities • Their innovation in adapting materials and processes so they are effective in their own health settings e.g. one hour introductory presentation to colleagues • Health services are generally free of charge so advice and treatment is freely available to all • Quit rates to date (quitting now becoming more widespread) compare favourably, especially as medications are not generally affordable to the public

11. Lessons for next time • Have a stepped approach for the introduction of cessation services and training (people will not want to quit until they are convinced that smoking is injurious to health) • As other tobacco control strategies are being implemented, work closely with health promotion on educational materials relating to specific illnesses caused or aggravated by tobacco use • Train health professionals in this specific knowledge, in the provision of ‘brief advice’ and in the incorporation of this into their day to day activities, providing them with a template for smoking cessation treatment • Subsequently train these health professionals in intensive smoking cessation support and assist in the establishment of cessation services and training • Be at pains to ensure, each step of the way, that the provision of ongoing education and services is sustainable