Plan Stratégique National de Lutte Antitabac en RDC

Objectives

The 2021–2025 National Strategic Plan for Tobacco Control in the Democratic Republic of the Congo aims to protect the population from the health, social, environmental and economic harms of tobacco use and exposure to tobacco smoke, while strengthening implementation of the World Health Organization Framework Convention on Tobacco Control.[1][2]It frames tobacco control as part of the response to non-communicable diseases, universal health coverage, national health development and the Sustainable Development Goals.[3][4][5]

• Reduce tobacco-related morbidity, disability and premature mortality through an integrated multisectoral approach.[2]
• Adopt a tobacco-control law and implementing regulations by the end of 2022, align legislation with Convention obligations, and protect public health policy from tobacco-industry interests.[6][2][5]
• Reduce smoking prevalence from 25% to 20% by 2025 and reduce demand for, and financial access to, tobacco products.[2][7]
• Increase to 90% by 2025 the proportion of the population aware of tobacco harms and tobacco-industry strategies.[8][5]
• Protect people from tobacco smoke through comprehensive smoke-free indoor public places, workplaces and public transport, without designated smoking areas.[6]
• Regulate tobacco-product composition, emissions, packaging and labelling, including prominent graphic and health warnings.[9][8][7]
• Prohibit tobacco advertising, promotion and sponsorship, including industry corporate social-responsibility activities, and enforce sanctions for non-compliance.[8][10]
• Increase tobacco taxation, apply taxes beyond cigarettes, reduce illicit tobacco trade, and ratify and implement the Protocol to Eliminate Illicit Trade in Tobacco Products.[11][9][10]
• Provide diagnosis, treatment and support for tobacco dependence through primary health care, community services and general referral hospitals.[9][12][13]
• Strengthen evidence on tobacco use, behaviours, attitudes and practices through surveys, research and integration of tobacco indicators into health information systems and relevant population surveys.[8][14][7]

Implementation

Implementation is designed as a decentralised, multisectoral programme led by the Ministry of Public Health through the National Programme for the Control of Addictions and Toxic Substances, combining legal reform, prevention, enforcement, cessation care, surveillance and fiscal measures.[15][9][4]National coordination is intended to connect central policy functions with provincial oversight, health-zone delivery and community-level action.[16][4]

• Establish and operate a national multisectoral tobacco-control committee chaired by the Ministry of Public Health, supported by operational subcommittees and provincial coordination structures or focal points.[14][17][4]
• Engage relevant ministries and agencies, including those responsible for transport, tourism, environment, education, communication, interior, commerce, justice, social affairs, finance and planning, alongside police services, civil society, parliamentarians, driver associations and hospitality-sector associations.[6][9][17]
• Assign the Ministry of Public Health responsibility for strategic direction, resource mobilisation, annual action planning, partnership management, coordination and advocacy for legislative adoption.[17][4]
• Integrate tobacco-control priorities into national and provincial health and development plans, minimum and complementary packages of activities, and health-zone operational planning.[11][13][4]
• Strengthen provincial health divisions and inspectorates to supervise implementation, integrate priorities into provincial plans, take corrective measures and support health zones in applying national standards.[4]
• Develop and disseminate legislation, regulations, standards, cessation guidance, education materials and public-awareness messages, including free national radio and television airtime for prevention information.[15][9]
• Build capacity among tobacco-control personnel, health workers, standards and quality-control services, border and duty-free services, and product-traceability systems.[10][5]
• Support cessation service delivery by developing national guidelines, training multidisciplinary teams, establishing or strengthening hospital services, integrating management of tobacco dependence into primary health care and supervising activities across levels.[12][13][7]
• Conduct surveys and research through protocols, trained research teams, field investigators, data analysis and dissemination, including studies among military personnel, police and children living outside family or institutional settings.[12][14]
• Establish monitoring and evaluation through the national multisectoral committee, including a planned and budgeted mid-term evaluation, annual action-plan review, progress analysis and use of findings for decision-making.[17][5]
• Track legal, institutional, awareness, cessation and outcome indicators, including law and regulation adoption, trained health workers, treatment units and recipients, tobacco-use prevalence, tobacco taxes, cigarette import rates and non-compliant tobacco products.[5]
• Mobilise sustainable financing and manage resources transparently, including through ministry and partner contributions, a dedicated tobacco-control budget line and budgeted multisectoral action plans.[11][6][17]The plan includes activity-level costs in US dollars for selected legal, regulatory, enforcement and coordination actions, although the supplied material does not specify allocations by financing source.[18]

Monitoring & Evaluation

The plan combines population surveillance, implementation follow-up, regulatory compliance and multisectoral oversight, but much of the detailed monitoring architecture remains to be established. Its evidence base includes earlier tobacco surveys and assessments, while the 2021–2025 framework envisages routine indicators, research and a budgeted mid-term evaluation.[16][19][4][5]

• Use evidence from the 2008 Global Youth Tobacco Survey, the 2013–2014 Demographic and Health Survey, and a 2010 Ministry of Health and World Health Organization workplace survey to describe tobacco use, smoking exposure and related behaviours among young people, adults, households and workers.[16][19]
• Conduct nationally representative surveys and targeted studies on tobacco prevalence, behaviours, attitudes and practices, including research among military personnel, police and children living outside family or institutional settings.[19][8][12][14]
• Integrate tobacco-use indicators into the national health information system and specified surveys, including EDES, STEPS and GATS, and analyse and disseminate findings for programme decision-making.[14][7]
• Monitor implementation of cessation services, surveys, research and tobacco-control activities at all levels, including supervision of tobacco-dependence management in primary healthcare, health zones and referral hospitals.[12][13]
• Track outcome targets including a reduction in smoking prevalence from 25% to 20% by 2025, a 90% public-awareness target by 2025, legal and institutional development, tobacco-product access, illicit trade and treatment for tobacco dependence.[2][8][7][5]
• Measure legal and regulatory progress through indicators covering adoption of a Framework Convention-aligned tobacco-control law, implementing regulations, national-language translations, regulation of electronic cigarettes and shisha, and ratification of the illicit-trade protocol.[5]
• Assess service and awareness indicators, including cessation guidance, trained health workers, health-zone treatment units, numbers receiving dependence treatment, public knowledge of tobacco harms and awareness of tobacco-industry strategies.[5]
• Monitor tobacco-industry advertising, promotion and sponsorship, tobacco-product composition and emissions, product quality, traceability, fiscal stamps and cryptograms, with sanctions envisaged for breaches of advertising restrictions and other legal requirements.[15][8][10]

The National Programme for the Control of Addictions and Toxic Substances is mandated to follow up programme activities, undertake epidemiological surveillance, conduct studies and formulate recommendations.[15]The national multisectoral committee is intended to establish the monitoring and evaluation mechanism, review implementation, validate annual action plans and provide strategic direction; provincial committees, health divisions and health-zone teams have corresponding oversight, corrective-action and reporting roles.[17][4][5]A formally planned and budgeted mid-term evaluation is included.[5]

Earlier implementation assessments identified substantial weaknesses, including incomplete Convention implementation, weak national coordination, geographically limited programme coverage and the absence of an enacted comprehensive law at that time.[20][11]Although activity milestones and survey measures are described, the extracts do not provide a consolidated indicator matrix, standard indicator definitions, reporting timetable, evaluation methodology or fully specified assignment of accountability for all targets.[18][13][21]

Costing & Financing

Financing is framed as necessary for implementation, coordination, enforcement, surveillance, cessation and public communication, but the extracts provide only selected activity costs rather than a complete financing plan. The Ministry of Public Health is expected to mobilise resources, relevant ministries are expected to contribute budget and personnel, and the multisectoral mechanism is intended to support sustainable, transparent and rational resource management.[2][17][4]

• Recognise inadequate technical and financial support as a constraint on provincial coordination, nationwide coverage and follow-up activities, including the prior smoke-free-spaces campaign.[22][11]
• Create a dedicated tobacco-control budget line within the Ministry of Public Health and prepare budgeted multisectoral action plans, including for smoke-free environments.[11][6]
• Use financial support from the World Health Organization and the Secretariat of the WHO Framework Convention on Tobacco Control for preparation of the updated plan; the extracts do not quantify this support.[23]
• Apply regular tobacco-tax increases and taxation across tobacco products to raise prices, reduce demand and increase public revenue; one proposed value-added tax and excise-duty rate is 18%.[2][10]
• Budget the mid-term evaluation and mobilise resources through the Ministry of Public Health, without a stated monetary allocation or identified funding gap.[4][5]

The costed 2021–2025 implementation table assigns United States dollar values to legal, regulatory, enforcement, coordination and public-awareness activities, but its government, partner and other-source funding columns do not identify allocations.[18]It includes costs for adopting and promulgating legislation, tobacco-product regulations, enforcement and dissemination, restrictions on sales to minors, integration into national planning, World No Tobacco Day and multisectoral committees.[18]Two additional explicitly costed activities concern implementation of the illicit-trade protocol and strengthening conformity-assessment capacity.[24]

Macroeconomic conditions may constrain health financing: reported annual growth was 6% and inflation 15.9% during 2002–2008, while 2009 growth was 2.7% and inflation 45%.[25]Gross domestic product per capita fell from 174.5 United States dollars in 2008 to 156.8 United States dollars in 2009, and health-sector investment and operating budgets experienced pressures from emergencies, disasters, security and humanitarian needs.[25]The extracts do not specify a total tobacco-control budget, expenditure forecast, monetary funding gap, source-by-source allocation, cost-effectiveness estimate or broader economic assumptions.[6][18][5]