Programa Nacional de Control del Tabaquismo

Objectives

Cuba’s 2010–2015 National Tobacco Control Programme presents tobacco use and dependence as a major public-health, social and economic challenge, requiring an integrated, intersectoral and multidisciplinary response. Its overarching aim is to improve health and quality of life, foster generations of non-smokers and make smoking socially unacceptable by reducing active and passive smoking and tobacco-product consumption.[1][2][3][4]The programme has permanent national scope and prioritises children, adolescents, pregnant women, smokers, people exposed to second-hand smoke, non-smokers, patients, and health and education personnel.[5]

• Reduce smoking prevalence in the general population from 32% to 19%, reduce smoking initiation before age 20 from 75% to 65%, and lower per-capita cigarette consumption from 1,641 in 2008 to 1,212 by 2015.[4]

• Reduce passive smoking from 60% to 48%, achieve annual cessation among 3% of smokers, and reduce smoking among health and education workers by 3% each year.[4]

• Prevent tobacco initiation and consumption through health promotion, public education, targeted information and communication, and incorporation of tobacco-related content into general, health and teacher education.[2][6][7]

• Protect people from second-hand smoke by expanding smoke-free workplaces and enclosed public settings, integrating tobacco control into occupational health activities, and promoting healthier homes and local environments.[2][8][9]

• Provide treatment, rehabilitation, counselling and pharmacological support for tobacco dependence, including nicotine replacement therapy and other medicines.[6][8][7]

• Strengthen legal regulation and compliance concerning smoke-free places, sales to people under 18, advertising and sponsorship, health warnings, tobacco-product contents, contraventions and fines.[10][9][11]

• Support tobacco control with surveillance and research on prevalence, consumption, exposure, attitudes, risk perception, cessation, prices and compliance with legislation.[6][8][12]

Implementation

Implementation is organised as a government-led, intersectoral programme coordinated by the Ministry of Public Health, working with central government bodies, public institutions, political, mass, youth and student organisations, communities and local health services.[4][5][13]The approach combines sectoral action plans, locally adapted delivery, legislation enforcement, workforce development, health-service interventions, communication, research and indicator-based evaluation.[5][14][6]

• Coordinate national implementation through the Ministry of Public Health, particularly the Vice-Ministry for Hygiene, Epidemiology and Microbiology and the National Centre for Health Promotion and Education, alongside medical care, social assistance, teaching, research, logistics and other relevant structures.[13]

• Establish an intersectoral working group at national, provincial and municipal levels, supported by a permanent technical advisory group of full-time programme staff and up to 10 experts.[5][14][13]The working group designs, implements, controls and evaluates sectoral anti-smoking plans, while the technical group supports adjustments, reviews, supervision, reporting and nationwide implementation.[14][13]

• Require each participating sector to prepare objectively assessable tobacco-control plans aligned with its institutional responsibilities and existing health legislation.[5]Provincial plans coordinate with health authorities and relevant hygiene, epidemiology, microbiology and health-promotion centres, adapt national measures to local needs, and incorporate municipalities and subordinate bodies.[5]

• Deliver local implementation through provincial and municipal health directors, health-promotion and epidemiology structures, polyclinic directors and Basic Health Teams.[13][6]Basic Health Teams undertake health-promotion, prevention, treatment and rehabilitation activities, while health-sector institutions coordinate with popular councils and community, youth and student organisations.[5][6]

• Engage institutions from health, education, higher education, science, culture, commerce, transport, agriculture, tourism, finance, justice, media, workers’, community, youth and student sectors.[5][14]Named stakeholders also include public-health institutes and directorates, the National School of Public Health, the Cuban Institute of Radio and Television, the Federation of Cuban Women and social workers.[13]

• Expand delivery through health areas, schools, universities, workplaces, health councils, families and other local settings.[7][10]Operational measures include smoke-free workplace initiatives, occupational health actions, cessation and counselling services, communication campaigns, curriculum content, professional development and inclusion of tobacco control on health-council agendas.[8][7][9]

• Apply and strengthen regulation through existing sectoral measures and a proposed legal instrument, including prohibitions on tobacco sales to people under 18, renewed package health warnings, smoke-free rules in National Health System facilities, and applicable measures in education and transport.[10][9][11]Proposed economic and enforcement measures include higher tobacco prices, ending free or preferential cigarette distribution by organisations, and increasing fines, although no values are specified.[10]

• Monitor implementation through a statistical information system led by the Ministry of Public Health, the National Centre for Health Promotion and Education and the National Directorate of Statistics.[6][8]Use periodic provincial and national surveys, research findings and statistical records to assess tobacco use, second-hand smoke exposure, knowledge, attitudes, consumption, cessation, prices and legislative compliance.[8]

• Evaluate programme performance annually and comprehensively through objective indicators, including smoke-free workplaces, cessation-service availability and effectiveness, one-year abstinence, public knowledge, educational implementation and regulatory compliance.[12][9][11]Conduct plan checks, supervisory and control visits, unannounced evaluations, audits and reviews of reports to higher bodies.[13]

• Finance implementation through arrangements not specified in the supplied material; it provides no budget, costs, funding sources, allocations or quantified financing gaps.[8][7][9]

Monitoring & Evaluation

The programme establishes a multi-level monitoring, surveillance and evaluation system for tobacco prevention and control, combining outcome targets, indicator-based assessment, periodic surveys, statistical records, research, supervision and enforcement checks.[4][6][8][12]Evaluation is intended to begin with implementation and to assess strategy-linked indicators annually and comprehensively.[12]

• Monitor core outcomes, including active-smoking prevalence, initiation before age 20, per-capita cigarette consumption, cessation, exposure to second-hand smoke, and smoking among health and education workers.[4][12]
• Operate a statistical information system for monitoring and evaluating actions through key indicators, under the responsibility of the Ministry of Public Health, the National Centre for Health Promotion and Education, and the National Directorate of Statistics.[6][8]
• Undertake surveillance of tobacco-use prevalence, second-hand-smoke exposure, consumption, prices, cessation, risk perception, attitudes, beliefs, knowledge, practices and compliance with tobacco-control legislation.[8]
• Use periodic provincial and national surveys, research findings and statistical records concerning tobacco products and relevant government bodies as surveillance inputs.[8]
• Assign leadership of indicator surveillance to the National Institute of Hygiene and Epidemiology, with contributions from public-health, statistics, agriculture, domestic trade, youth-study and national statistics institutions.[8]
• Require sectors to prepare objectively assessable action plans containing concrete tasks aligned with the programme’s purposes and objectives.[5]
• Assess environmental protection through indicators such as the proportion of smoke-free workplaces and the proportion implementing tobacco-control measures within occupational protection and hygiene activities.[12][9]
• Measure service delivery and treatment results through indicators covering health areas providing cessation or counselling services, services assessed for effectiveness, and one-year abstinence following treatment.[9]
• Measure information, education and communication activity through indicators on public knowledge, campaign performance, educational-centre strategies, curriculum assessment, health-council discussions and staff training.[9]
• Assess legal compliance through measures covering workplaces, health centres, sales to minors, renewed health warnings, and compliance in health, education and transport settings.[9][11]
• Conduct plan checks, supervisory and control visits, unannounced evaluations, audits, report reviews, compliance actions and continuing performance assessment.[13]
• Assign the intersectoral working group responsibility for controlling and evaluating sectoral anti-smoking action plans, supported by a technical group that advises on implementation and adjustments across levels.[14][13]
• Disseminate research and exchange experience through scientific conferences and relevant institutions to support the adoption of findings.[12]

Government control applies to programme actions, while provincial and municipal health directors and polyclinic directors have responsibilities for development, supervision, evaluation and workforce training at their respective levels.[13][6]Historical tobacco-control activity incorporated into the Programme of Economic and Social Measures was controlled by the Executive Committee of the Council of Ministers.[3]The supplied material does not define all indicator methodologies or data sources, specify reporting frequencies beyond annual comprehensive assessment, or set out detailed formal accountability procedures.[4][5][14][9][11]

Costing & Financing

No programme budget, costed implementation plan, funding allocation, funding source, resource-mobilisation arrangement, quantified funding gap or economic assumption is provided.[8][7][10][12][9][11]The programme identifies delivery responsibilities for cessation counselling and pharmacological treatment, including nicotine replacement therapy and other medicines, but gives no associated monetary values.[8]

• Include logistics and economic and finance institutions within the intersectoral structure, without specifying their financial responsibilities or allocations.[5][14]
• Propose increasing tobacco-product prices, without quantifying the increase or identifying a fiscal mechanism, implementation date or expected revenue.[10]
• Propose eliminating free or preferentially priced cigarette distribution by organisations, without estimating its financial effect.[10]
• Propose increasing fines for tobacco-control contraventions, without specifying fine levels, projected receipts or the use of any revenue.[10]

Tobacco consumption and second-hand-smoke exposure are characterised as affecting health and the economy, and prior control efforts were linked to the Programme of Economic and Social Measures.[2][3]However, the material does not provide economic estimates for prevention, treatment, communication, research, enforcement, workforce development or smoke-free-environment measures.[10][12]