Strategy for Tobacco Cessation in Sri Lanka 2020-2025

Objectives

Implement Article 14 of the World Health Organization Framework Convention on Tobacco Control through a Sri Lanka-specific strategy that promotes cessation and treatment for tobacco dependence, combining community and clinical approaches.[1]The overarching aim is to build a national culture of quitting and rejecting all forms of tobacco use, reduce tobacco-related harm, and strengthen people’s and communities’ capacity to address the determinants of tobacco and other substance use.[2][3]

• Prioritise community cessation as the principal strategic approach, reflecting an expert consultation’s assessment that it is more cost-effective than clinical cessation services.[1]
• Promote tobacco-free villages, regions and workplaces that create supportive environments for quitting and increase demand for cessation support.[3]
• Enable tobacco users, affected people and communities to recognise and address the social and environmental determinants of use, including tobacco-industry strategies that can undermine tobacco-control progress.[2][3]
• Strengthen clinical cessation throughout the country through brief interventions, screening, counselling, targeted treatment and specialist addiction services for people with more complex medical or psychiatric needs.[2][4]
• Integrate cessation with non-communicable disease prevention, oral health, drug de-addiction, tuberculosis control, mental-health and substance-use treatment programmes.[2][3]
• Protect and reinforce the self-efficacy of people attempting to quit independently, ensuring that clinical counselling and wider population interventions support rather than weaken community-led cessation.[2]

Implementation

Deliver cessation through a multi-level model spanning national programmes, divisional and Medical Officer of Health areas, and village or community initiatives.[1][2]The approach combines population-based community mobilisation with routine brief advice in health services, dedicated clinical support for people requiring specialist care, and coordinated monitoring by national health and tobacco-control institutions.[2][4][5]

• Coordinate national action through government and non-government agencies, reinforce political and public commitment to cessation, and engage regional agencies in supporting quitting across communities.[2]
• Collaborate with the Ministry of Health, schools, universities, local government agencies, non-governmental organisations, the National Authority on Tobacco and Alcohol, the World Health Organization and community organisations.[3]
• Use Divisional Secretariats, Medical Officer of Health units, health-promotion officers, field officers, community policing committees and village-level groups as networks for local delivery.[2][3]
• Develop tobacco-free workplace initiatives, recognise effective institutions publicly, organise competitions, showcase good practice, and involve schoolchildren and local government officials in cessation promotion.[3]
• Provide brief intervention to tobacco users, undertake opportunistic screening and counselling at first contact and in primary care, and offer targeted interventions to people with medical or psychiatric conditions.[2]
• Establish or strengthen dedicated de-addiction or addiction clinics at suitable Base Hospitals, staffed by clinical psychiatry personnel, and train health workers, dental personnel and psychiatrists in cessation interventions and refresher skills.[2][4]
• Use predominantly non-pharmacological treatment, including counselling and specific psychotherapies, while allowing medication for people with co-morbid medical or psychiatric conditions.[2]The source raises concerns that nicotine replacement therapy and other cessation medicines may be unnecessary or potentially harmful in the described Sri Lankan context, and that their promotion may reduce users’ self-efficacy.[4][5]
• Expand the Quitline to 10 stations, link it with mental-health or addiction clinics, and provide counselling that addresses environmental determinants, relapse and tobacco-industry behaviour alongside standard cessation support.[4]
• Assign institutional directors and Medical Officers in Charge responsibility for service delivery and reporting through the existing health-system leadership structure to the Non-Communicable Disease Directorate.[4]
• Monitor and document community cessation through the Directorates of Non-Communicable Disease and Mental Health and the National Authority on Tobacco and Alcohol.[5]Map activity across Medical Officer of Health areas, Divisional Secretariats, villages and Grama Niladhari areas.[5]
• Assess community progress through measures such as estimated money saved, tobacco outlets ceasing sales and workplaces discouraging tobacco use.[5]Evaluate addiction services rigorously across infrastructure, staffing, training, referrals, patients, treatments, follow-up and short-, medium- and long-term quit rates.[5]

Monitoring & Evaluation

Monitoring is assigned principally to the Non-Communicable Disease Directorate, the Mental Health Directorate and the National Authority on Tobacco and Alcohol, with local service structures contributing implementation records and reports.[5]Although an appendix on monitoring implementation is listed, its content is not available in the supplied extract.[1]

• Record and document community cessation activities through the Directorates of Non-Communicable Disease and Mental Health and the National Authority on Tobacco and Alcohol.[5]
• Map implementation across Medical Officer of Health areas, Divisional Secretariats and other local administrative units, including villages and Grama Niladhari areas undertaking community-wide cessation activities.[5]
• Assess community outcomes through measures such as estimated money saved, tobacco retailers that have ceased selling tobacco, and workplaces that discourage all forms of tobacco use.[5]
• Evaluate addiction and cessation services rigorously, including infrastructure, facilities, workforce numbers and training, referral arrangements, patient attendance, treatments provided, follow-up, and short-, medium- and long-term quit rates.[5]
• Require institutional directors and Medical Officers in Charge to oversee cessation services within the existing health-system leadership structure and report to the Non-Communicable Disease Directorate.[4]
• Recognise that the supplied sections do not specify reporting frequency, indicator definitions, targets, data-quality procedures, independent evaluation arrangements, or wider surveillance methods.[1][5]

Costing & Financing

Community cessation is presented as more cost effective than clinical cessation services, based on a 2019 expert consultation, and brief cessation advice in primary care is characterised as a low-cost intervention.[1][2]However, the supplied material provides no quantified strategy budget, detailed costing, financing allocation, funding source, resource-mobilisation plan, funding gap or numerical economic assumption.[1][2][3][4][5]

• Prioritise community cessation as the approach considered more cost effective than clinical services in the national context.[1]
• Use estimated money saved within an area as a possible indicator of community cessation progress, without specifying a monetary valuation method or estimate.[5]
• Recognise that community cessation is described as potentially cheaper than alternative approaches, but no comparative cost analysis or economic model is provided.[3][5]
• Note that medication may be used for people with co-morbid medical or psychiatric conditions, while clinical treatment is otherwise predominantly non-pharmacological.[2]
• Consider the source’s caution that nicotine replacement therapy and other cessation medicines may be unnecessary or potentially harmful in the Sri Lankan context described, and that promotion of such medicines may weaken users’ self-efficacy.[4][5]