UNDP and General Obligations of the Framework Convention on Tobacco Control

1. UNDP and General Obligations of the Framework Convention on Tobacco Control Douglas Webb HIV, Health and Development Group Bureau for Development Policy UNDP, New York

2. UNDP works in seven core areas, many of which are social determinants of health Poverty and inclusive growth Social determinants on which UNDP’s HIV and health work focuses 1 Democratic governance 2 Crisis prevention and recovery 3 Gender 4 HIV, Health and Development 5 Environment and energy 6 Capacity development 7

3. Starting points • Tobacco work is new to most of the UN system, so we are in the early stages of a coherent response • UNDP’s work on social determinants of health is now addressing non-communicable diseases, building on a platform of HIV and AIDS work • UNDP’s mandates are only very recently agreed

4. Many structural determinants impact multiple health conditions at the same time Structural determinant1 contributing to Disease/ condition1 Urbanization, migration Malaria, TB, leishmaniasis, plague, intestinal helminthiasis Anopheles mosquito, malaria vector TB bacillus Conflict, displacement Malaria, measles, diarrhea Climate change Cholera, schistosomiasis, vector-borne diseases (e.g., river blindness, sleeping sickness) Woman with river blindness Income inequality Avg life expectancy, infant mortality, accidents, smoking 1Not exhaustive list; examples only Sources: Pronyk P. at Columbia University,WHO, McMichael T.,Sharma VP; Farmer P., Raviglione MC, Howarth JP, Dick B., Wilkinson RG, and others

5. Structural interventions at a policy level were critical in reducing smoking in the United States Policy intervention(s) • Advertising restrictions • Public awareness campaigns • Cigarette taxes • Anti-smoking legislation • Smoking levels dropped from 52% to 25% over past 30 years • 8 cent cigarette tax alone caused 2 million adults to stop smoking and prevented 60,000 teens from starting Source: McKeown T. et al. 1975, US Centers for Disease Control 2000

6. UNDP Mandate UNDP works in areas related to social determinants of health, including non-communicable diseases (a) decision of the Conference of the Parties FCTC/COP/4(17) in relation to cooperation for implementation of the Convention. (b) the Report of the Secretary-General on Ad Hoc Inter-Agency Task Force on Tobacco Control (July 2012) (c) ECOSOC resolution E/2012/L.18 on the United Nations system-wide coherence on tobacco control (July 2012)

7. ECOSOC Resolution: United Nations system-wide coherence on tobacco control Encourages the Ad Hoc Inter-Agency Task Force to promote effective tobacco control policies and assistance mechanisms at the national level, including through the integration of the World Health Organization Framework Convention on Tobacco Control implementation efforts within the United Nations Development Assistance Frameworks, where appropriate, in order to promote coordinated and complementary work among funds, programmes and specialized agencies;

8. Article 5.1 Discussion paper for the COP being developed by UNDP and the FCS Integrating tobacco control into national health and development planning strategies and frameworks and UNDAFs: experience and best practice recommendations • Articulate the case for the integration of tobacco control plans into national development plans and UNDAFs • Provide an overview of current extent of integration of tobacco control plans into national development plans and UNDAFs • Provide collated information about best practice and recommendations for national action from current experience • Provide recommendations for action at national and global level • Provide list of information resources

9. Desired outcomes • Increased action at national level to integrate tobacco control plans in national development plans and UNDAFs through strengthened multi sectoral commitment. • Increased support provided by UN country teams for the same.

10. Article 5.1 in Africa • 34/41 Parties have some aspect of tobacco control incorporated into national plans/strategies • 15 (37%) Parties have an operational comprehensive multisectoral national tobacco control strategy • 17 (41%) Parties have included tobacco control into national health plans (out of which 2 also have multisectoral plans) • 13 (32%) Parties have referred to any aspect of tobacco in other national strategies (out of which 9 parties also included tobacco in either multisectoral or national health plans)

11. Article 5.1 Globally Of the 120 of the 174 FCTC parties for whom data is available from the 2012 reporting cycle: • 74/120 (62%) indicated a comprehensive multisectoral national tobacco control strategy. • 43 (36%) of parties reported tobacco control being incorporated in national health plans and • 21 (18%) parties reported including tobacco control in other national plans.

12. Non Communicable Diseases and tobacco control • 11 countries have integrated NCDs into their latest UNDAFs • 3 countries have integrated any mention of tobacco into their latest UNDAFs (Burkina Faso, Djibouti, Mauritania) • Only 1 specifically mentions FCTC (Mauritania)

13. Case Study: Ghana

14. Case Study – Ghana; Planning Challenges • Lack of knowledge and representation of FCTC issues in the planning process • FCTC seeks to prevent a tobacco epidemic from occurring in Ghana – not to deal with an existing epidemic – therefore it is not seen as a priority • Development partners and their priorities still have a strong influence on the process. FCTC is not yet a development partner priority in comparison to HIV/AIDS, malaria and TB. • Adapting health plans to development planning formats and M&E created unintended structural problems

15. Case Study – Ghana; • Implementation Challenges • Lack of funds to produce legislative instrument to progress the recently passed tobacco control bill • Lack of funds to promote tobacco control messages down to the district level • No further external nor internal funding allocated to tobacco control as an outcome of the process

16. Case Study – Ghana; Critical Enablers • Planning Key enablers • The thorough GHS health planning process that builds from district level up to a multisectoral national Health Summit to identify Health priorities and objectives • Including NCDs in the Health Plan, facilitated including NCDs in the National Development Plan. • Although FCTC and tobacco control not mentioned specifically in NDP, inclusion of NCDs facilitates including FCTC implementation in operationalizing the NDP

17. Case Study – Ghana; • Implementation Enablers • A National steering committee for tobacco control including, Ghana Health Service, Ghana Education Service, media and the NGO coalition • Media has been educated and sensitized to report on tobacco control. • Health care staff has been given public education through media outlets; including preparing an educational video clip. • Capacity building in public health schools and medical schools has been initiated in order to make the future health workforce advocates of tobacco control (facilitated by FCS and WHO)

18. Case Study – Ghana; Recommendations • The Government side needs to come to a consensus on national priorities; and donors and other development partners should be more flexible and responsive to the country needs and priorities. (whether FCTC or other health issues) • NCDs should get their own section in the plans, not come under a sub-heading • Donors and partners should look beyond specific disease priorities to more broad health service issues; it’s not enough to have the vaccines must also have the means to deliver them to people

19. Emerging UN wide support

20. Health or Tobacco?

21. Areas of collaboration within the Convention

22. Areas of collaboration within the Convention

23. Areas of collaboration within the Convention

24. Areas of collaboration within the Convention

25. Areas of collaboration within the Convention

26. Areas of collaboration within the Convention

27. Potential UNDP roles Some specific opportunities for UNDP in tobacco are emerging • UN system coordination (RC) and UNDAF integration • Post-2015 development agenda • Support to National action plan development • Integration of tobacco/FCTC/NCDs into national development planning • Support to national governance structures on tobacco/NCDs • Anti-corruption and regulatory independence • Intellectual property/TRIPS, trade, and plain packaging • Strengthening law enforcement, justice • Strengthening local government-municipal programming • CSO engagement • Gender and tobacco, human rights

28. Principles of strategies Principles for tobacco strategy development • strategies need to become more fit for purpose and integrated –integrate the tobacco strategies into wider health and development strategies; • A national strategy that is shorter, higher level with emphasis on planning processes that are smarter and lighter on people’s time and money • Strategies and implementation plans should aim for results, prioritizing interventions and represent value for money, determined by the effectiveness, efficiency and equity of the programme that is planned. In particular, strategies and implementation plans must prioritise halting tobacco use initiation and not only invest the bulk of resources in treatment. • Strategies should give more effort and attention to implementation and review, linking interventions to expected results, and then monitoring progress • Developing indicative, medium term budgets with realistic costing of major programme areas, together with ensuring the level of investment is closely aligned with evidence of ‘what works’ and development of scenarios for what interventions are to be prioritised in low, medium and high level funding scenarios

29. Organisational options Tobacco HIV (TB and Malaria) NCDs

30. Conclusions • A multisectoral response is essential • Experiences of Article 5 implementation are now being gathered • Only One third of parties in Africa have a comprehensive multisectoral strategy on tobacco • Around one third of parties mention tobacco in other development or sector plans • Experience suggests that integration of FCTC into other development instruments leads to greater implementation • UN Mandates are recent so work can now accelerate • UN partners can assist if the demand is there at country level • Coordination structures are to be assessed to determine efficiency of different models • There is political capital in tobacco control, isn’t there?