Politique Nationale de Lutte Antitabac

Objectives

Mauritania’s national tobacco-control policy seeks to protect present and future generations from the health, social, environmental and economic harms of tobacco use and exposure to tobacco smoke, thereby reducing tobacco-related illness, deaths, smoking prevalence and second-hand-smoke exposure.[1][2]It operationalises the World Health Organization Framework Convention on Tobacco Control, which Mauritania ratified in 2005, and is linked to a strategic plan and draft tobacco-control legislation.[1][2]

• Implement the Convention and its additional protocols, integrate tobacco control into national sectoral policies and strategies, and protect policy-making from tobacco-industry interference.[3]
• Apply the MPOWER package: monitor tobacco use and prevention policies; protect people from smoke; offer cessation support; warn of tobacco harms; enforce advertising, promotion and sponsorship bans; and raise tobacco taxes.[1][3]
• Ground action in equity, social justice, solidarity and universal access to prevention and cessation services, while ensuring that people understand tobacco’s health effects, addictive nature and risk of death.[4]
• Prioritise legislation and enforcement, professional capacity, public communication, product regulation and labelling, demand reduction, cessation, action on illicit trade and sales to minors, viable alternatives, liability, research, surveillance and information exchange.[3]

The policy responds to tobacco as a major risk factor for chronic non-communicable diseases in a health system facing rapid urbanisation, a young population, rural poverty and environmental pressures.[5][6][7]Tobacco use includes both smoked and smokeless products: reported prevalence is 27.5% among boys and 17.7% among girls for smoked tobacco, compared with 34.1% among men and 5.7% among women; smokeless tobacco use is reported at 5.7% among men and 28.3% among women.[8]Tobacco-attributable mortality is reported as 2% of deaths from non-communicable diseases, or 30.5 per 100,000 inhabitants.[8]

The policy sits within a three-tier public health system, spanning peripheral, intermediate and tertiary services, and alongside programmes for reproductive health, immunisation, communicable diseases, child health, nutrition, mental health, non-communicable diseases and tobacco control.[7][9]The supplied extracts identify foundations, principles, policy orientations, goals, objectives, strategies and priority areas, but do not provide the full substantive wording of all objectives or quantified national targets.[10]

Implementation

Implementation combines national leadership, multisectoral coordination, decentralised delivery and rolling planning. Three-year tobacco-control plans are to be translated into operational plans with stakeholder participation, while the policy may be revised when necessary.[1][11]Activities are to be financed principally through the State budget and technical and financial partners, with additional public and private resources sought except from the tobacco industry; no budget amounts, costs or funding gaps are specified.[11]

• Lead national implementation through the Ministry of Health and the National Tobacco Control Programme, established in 2007 to apply Convention guidance and recommendations.[2][3]
• Guide implementation through a national multisectoral, multidisciplinary committee and the programme’s steering committee, involving relevant government and civil-society stakeholders.[4][11]
• Coordinate and follow up field activities through Regional Health Action Directorates and chief medical officers in Moughataa health districts.[9][3]
• Deliver community activities through community health workers, civil-society organisations and grassroots organisations contracted by the Ministry of Health.[3]
• Use the public-service pyramid, including 530 health posts and 67 health centres at operational level, intermediate hospitals and predominantly Nouakchott-based tertiary referral institutions.[7][9]
• Undertake multimedia awareness and training for journalists, pupils, teachers, elected representatives and committee members; engage parliamentarians; mark tobacco-free days; and develop or update tobacco-control policy and strategic planning.[2]
• Maintain government smoke-free measures, including the 2005 circular prohibiting tobacco use in public and private health facilities.[2]

Participating ministries include Health; Sports and Youth; Communication and Parliamentary Relations; Finance; Trade; National Education; Environment; Islamic Affairs; and Equipment and Transport.[4]The Ministry of Finance, non-governmental organisations, the World Health Organization and the Centre for Tobacco Control in Africa are also identified as contributors or supporters.[12][13]Policy development was led by a national committee chaired by the Minister of Health’s technical adviser and coordinated by the Director of Disease Control, received technical support from the World Health Organization country office and an expert from the Centre for Tobacco Control in Africa, and was validated through a national technical workshop.[1][12]

Monitoring should include surveillance of tobacco consumption and prevention policies, monitoring of the tobacco industry, national capacity assessment, research and information exchange.[2][3]Mauritania completed a tobacco-control country-capacity assessment and situational analysis in 2012.[4]Central Ministry of Health bodies steer and follow up intermediate structures, regional teams coordinate operational structures, and district management teams manage daily programme implementation.[9]The extracts do not specify a detailed indicator set, reporting timetable, surveillance frequency, quantitative accountability targets or formal evaluation methodology.[10][8][3]

Implementation must also take account of private provision, which is concentrated largely in Nouakchott, Nouadhibou, Kiffa and Rosso and includes clinics, medical and dental practices, nursing practices, pharmacies and pharmaceutical depots.[8]The extracts identify weak integration and regulation of this sector, reliance on public staff and referral services, and concerns over non-compliant pharmaceutical facilities and medicine-supply controls.[8]

Monitoring & Evaluation

Monitoring and evaluation centre on surveillance of tobacco use, monitoring tobacco-prevention policies and the tobacco industry, assessing national capacity, and using evidence to guide and review tobacco-control implementation.[1][2][4][3]Implementation oversight is organised across national, regional and district levels, but the available material does not provide a consolidated results framework, quantitative targets or reporting timetable.[9][3][11]

• Monitor tobacco consumption and tobacco-prevention policies as core elements of the national tobacco-control approach.[1][3]
• Conduct assessments of tobacco-control capacity and situational needs; Mauritania completed a country-capacity assessment in 2012.[4]
• Use epidemiological evidence to inform action, including reported smoked-tobacco prevalence of 27.5% among boys, 17.7% among girls, 34.1% among men and 5.7% among women, alongside smokeless-tobacco use of 5.7% among men and 28.3% among women.[8]
• Track tobacco-attributable mortality, reported as 2% of deaths from non-communicable diseases, or 30.5 per 100,000 inhabitants.[8]
• Coordinate and follow up implementation through the Ministry of Health, the National Tobacco Control Programme, regional health directorates, chief medical officers of Moughataa health districts and a multisectoral, multidisciplinary committee.[9][3][11]
• Use programme-specific coordinations to pilot, coordinate and monitor interventions, while central Ministry of Health bodies oversee intermediate structures and regional teams oversee operational structures.[9]
• Review and revise the national tobacco-control policy when necessary, supported by three-year plans translated into operational plans.[11]
• Strengthen unspecified monitoring arrangements, as the extracts do not set out indicator definitions, data sources, surveillance frequency, evaluation methods, reporting requirements, assigned accountability consequences or quantified performance targets.[10][6][7][9][11]

Costing & Financing

Financing for tobacco control is intended to come principally from the State budget and technical and financial partners, with additional resource mobilisation from public and private actors other than the tobacco industry.[11]Tobacco taxation is a named policy measure, but no tax rate, earmarking arrangement or projected revenue is specified.[1]The available extracts contain no implementation budget, costing framework, expenditure estimates, allocations, unit costs, funding-gap analysis or economic assumptions for the tobacco-control policy or wider health action plan.[1][12][6][7][9][11]

• Finance implementation through the State budget and contributions from technical and financial partners.[11]
• Mobilise supplementary resources from other public and private actors while excluding tobacco-industry financing.[11]
• Increase tobacco taxation as part of the tobacco-control package, alongside measures to reduce demand and protect people from tobacco smoke.[1][3]
• Recognise technical and financial support from the World Health Organization and the Centre for Tobacco Control in Africa for policy preparation and validation.[12]
• Consider the economic context described in the extracts: 46.3% of the population lived below a minimum poverty threshold of 67,316 Ouguiyas per person per year, and rural poverty affected six in ten people.[6]
• Note reported tobacco imports valued at 3,160,042,934 Ouguiyas, equivalent to USD 10,730,000, in 2012; the extracts do not link these figures to a tobacco-control budget or revenue estimate.[6]
• Specify future financing details, as the extracts identify partnership and financing as implementation components but provide no quantified budget, allocation by activity, funding source breakdown, financing gap or resource-mobilisation target.[14][11]