Tobacco Control in the Pacific NZAID TOBACCO CONTROL

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

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

Key elements of the project n Self-selection by the countries n n Project leadership & ownership by countries n S. W. O. T analysis: needs & wishes n Heavy focus on FCTC compliance n 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 3

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

NZ contributors to Stage 2 n n 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 5

Key Conclusions n n n n 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 6

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

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 8

Examples of cessation and training objectives Hospitals • • • Generation of awareness programmes Concentrating on staff initially Establishment of cessation clinics • • • Again, concentrating on staff first All organisations to have a trained practitioner These practitioners to go on to train other practitioners NGOs and local councils 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 9

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 10

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 11

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