Framework Convention on Tobacco Control 2030 Strategy:Nepal

Nepal signed the WHO FCTC on 3rd December 2003, and ratified on 7th November 2006 and became a Party to the WHO FCTC on February 5, 2007. Based on the WHO FCTC, the government has enacted law and procedural documents aiming at tobacco control. The Tobacco Product (Control and Regulatory) Act 2011 is the primary law governing tobacco control in Nepal.

The Tobacco Product (Control and Regulatory) Act 2011, The Tobacco Product (Control and Regulatory) Regulations 2012, Tobacco Product (Control and Regulatory) Directives 2014, and the Directives for Printing and Labelling of Warning Message and Picture in the Box, Packet, Wrapper, Carton, Parcel and Packaging of Tobacco Product, 2011 (Amendment 2014) covers most of the articles of FCTC. In Nepal, nearly one in two men consumes some form of tobacco products.

One in three men are current smokers. 2 out of 5 people are exposed to secondhand smoke at home and at workplace. The WHO Report on the Global Tobacco Epidemic, 2015 revealed that tobacco consumption in Nepal is high and that of youth is exceptionally high. The NCD Risk Factors STEPS Survey Nepal, 2013 reports 18.5% of adults over 15 years of age (27% men, 10.3% women) in Nepal are current smokers. 22% males and 9.6% females smoke daily. 26.9% male and 10.1% female currently smoke cigarettes. 22% males and 9 % females smoke cigarettes daily. A similar proportion 17.8% (31% male and 4.8% female) use smokeless tobacco. A total of 30.8% people aged 15 years and above use tobacco in Nepal.

According to Global Youth Tobacco Survey 2011, 20.4 % youths (24.6% males and 16.4% females) are current tobacco users. About 9.0% currently use any smoked tobacco products (11.4% males and 6.5% females). About 3.1% (5.5% males and 0.8% females) are current cigarette smokers. According to the
Global School Health Survey 2015, 7.2% (9.5% male, 4.8% female) are current tobacco users. 5% (6.8% male, 3 % female) are current cigarette smokers.

As a result, there are a higher age-standardized death rates and disability- adjusted life years from NCDs than communicable diseases (CDs). One fourth of the population (one third in 55 and above age) has hypertension and 15% have diabetes, 7% have chronic respiratory diseases and 8,000-10,000 new
cancer patients annually. Similarly, the NCDs account for more than 80% of outpatient. Among outpatient visits: Chronic obstructive pulmonary diseases (COPD) is at 43%, cardiovascular disease 40% diabetes mellitus (12%) and cancer (5%). The NCDs account for more than 60% of deaths in Nepal.
Tobacco attributable deaths in Nepal are 11% (15% male and 2% female). Therefore, there is an urgent need to maximize the tobacco control initiatives by focusing the strategic attention more into execution of existing policy, strategy and national plans.

Policy Initiatives

In the recent years, major efforts by the Ministry of Health have emphasized on tax and non-tax following measures on tobacco control:

• Monitoring tobacco use: GYTS, GSPS GHPSS and GSHS have been conducted on regular basis through WHO support and WHO Steps Survey is another milestone.• Protection-Smoke free public places: The law bans using all tobacco products and smoking in public places, workplaces and public transportations.
• Offer quit to tobacco users- a brief intervention: At the primary health care level of few districts, Nepal has adopted the brief intervention (5A’s approach) to support tobacco users to quit. This intervention is included in the Package of Essential Noncommunicable Diseases (PEN) interventions since January 2017.
• Warn dangers of tobacco use-Pictorial Warning and Messages: Nepal’s Current provision of 90% of the coverage of tobacco product packet with pictorial health warnings and messages, effective from 15 May 2015 is largest pictorial warning messages in the world and got global award.
• Enforce tobacco advertisement, promotion and sponsorship: The law prohibits any forms of advertisement, promotion and sponsorship in any media is in place and well compiled
• Raising tobacco tax: A total tax of 26.3 % of the retail price of the most popular brand of cigarette is levied in Nepal. Recently the government has announced an increase in tobacco tax and its reached to approximately 27%.
• Tobacco control campaigns for raising awareness: Nepal conducts a national tobacco control mass media campaign such as radio, Television, print at regular intervals to raise public awareness on the dangers of tobacco use.
• Sales of tobacco products: The government of Nepal introduced the provision of designated shops which have obtained license for sale of tobacco products effective March 15, 2017. 

KEY COMPONENTS OF THE STRATEGY

• Ministry of Health (MoH), Government of Nepal (GoN) in line with the need assessment recommendations, will strongly advocate executing the existing policies, acts and plans from 2017. The focus of this strategy will be on strengthening the execution of existing policy, strategy and plans related to:
• Creation of a functional national multi-sectoral coordination mechanism for tobacco control that focuses largely on:
  Strengthening legislation and policy environment (strategy, planning and execution);
  Use of tax to finance development innovations
  Strict enforcement of legal provisions on tobacco control
  Protection of people from exposure to tobacco smoke (smoke free public places, workplaces and public transportations and households too)
  Ban on sales to and by minors Increase in tobacco taxes (tobacco taxes in Nepal tends to be the smallest in the South-East Asian region) Higher tax can contribute to less demand and revenue generation;
  Effective enforcement and implementation of packaging and labeling for moving toward plain packaging
  Comprehensive ban of Tobacco advertising, promotion and sponsorship including ban display of tobacco products at the point of sale
• Create supportive environment for tobacco free generation
• Comprehensive system to provide tobacco cessation support to public
• Preventing interference of tobacco industry in policy development and implementation
• Integrating tobacco control as the priority agenda in other health and non-health initiatives
• Introducing tobacco control elements into school and university curricula to maximize knowledge, awareness and skills
• Engagement of civil society in enforcing tobacco control law
• Strong media engagement for advocacy and enforcement of laws and regulations and enhance awareness on danger of tobacco use.

IMPACT

Reduced prevalence of tobacco use in the longer term in Nepal.

OUTCOME

The overall outcome of the project is the strengthened implementation of the WHO Framework Convention on Tobacco Control in Nepal.

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