Evaluation of tobacco control policies and programmes including implementation of the WHO MPOWER technical package in SEAR Member States Regional Office for South-East Asia (WHO-SEARO) World Health Organization Evaluation Report ACT for Performance and MDF July 10, 2018 ACT FOR PERFORMANCE BV HNK Ede Horapark Bennekomseweg 41 6717 LL, Ede, The Netherlands + 31 (0)615094443 + 31 (0)8008098 ACT FOR PERFORMANCE SARL 16, Immeuble le Palmier Avenue Lukusa, Commune de Gombe Kinshasa, Democratic Republic of Congo + 243 819009055 + 243 990065532 ACT FOR PERFORMANCE INC 1330 Lajoie, Montréal, Canada H2V 1P5 + 1 514 923-4992 www.mdf.nl HNK Ede Horapark Bennekomseweg 41 6717 LL, Ede, The Netherlands MDF Office network: Bangladesh, Belgium, D.R. Congo, Ghana, Indonesia, Kenya, Myanmar, Sri Lanka, and Vietnam Table of contents List of Acronyms ................................................................................................................................................................................. I Acknowledgments ............................................................................................................................................................................. II EXECUTIVE SUMMARY ................................................................................................................................................................... III 1 EVALUATION MANDATE, SCOPE AND OBJECTIVES..................................................................................................... 1 1.1 INTRODUCTION .................................................................................................................................................................................................. 1 1.2 EVALUATION OBJECTIVES AND SCOPE ............................................................................................................................................................ 2 2 POLICY AND PROGRAM SOLUTIONS OFFERED BY WHO AND THE MEMBER STATES .................................... 3 2.1 ROLE OF THE WHO IN THE IMPLEMENTATION OF TOBACCO CONTROL POLICIES .............................................................................. 3 2.2 EXISTING TOBACCO CONTROL ACHIEVEMENTS ........................................................................................................................................ 4 2.3 PROGRESS OF THE MEMBER STATES ON ACHIEVING THE NCD ACTION PLAN TARGETS ................................................................. 4 3 EVALUATION APPROACH ..................................................................................................................................................... 6 3.1 EVALUATION QUESTIONS ....................................................................................................................................................................... 6 3.2 EVALUATION APPROACH ....................................................................................................................................................................... 7 3.3 CONSTRAINTS AND LIMITATIONS ......................................................................................................................................................... 9 4 EVALUATION FINDINGS ...................................................................................................................................................... 10 4.1 RELEVANCE ........................................................................................................................................................................................... 10 4.1.1 Relevance of the mechanisms and policies for tobacco control in SEAR countries .......................................... 10 4.1.2 Relevance of the WHO support to Member states .........................................................................................................12 4.2 EFFICIENCY ........................................................................................................................................................................................... 15 4.2.1 Efficiency of the implementation of tobacco control policies and the MPOWER package ............................ 15 4.2.2 Efficiency of the WHO’s support on Tobacco control in SEAR Member States ................................................... 18 4.3 EFFECTIVENESS .................................................................................................................................................................................... 22 4.3.1 Effectiveness of the implementation of the MPOWER package ................................................................................22 4.3.2 Effectiveness of the implementation of tobacco control policies .............................................................................27 4.3.2 Effectiveness of the WHO support ........................................................................................................................................30 4.4 IMPACT ................................................................................................................................................................................................... 31 4.4.1 Impact of tobacco control policies on tobacco use prevalence rates ..................................................................... 31 4.4.2 Impact of tobacco control policies in reducing risk of premature mortality from target NCDs ................. 38 4.4.3 Role/contribution of WHO in reducing prevalence of tobacco use .........................................................................38 4.5 SUSTAINABILITY ................................................................................................................................................................................... 39 4.5.1 Sustainability of the existing tobacco control policies and programmes.................................................................... 39 4.5.2 The WHO’s role to support sustainable tobacco control measures and policies ............................................... 40 5 CONCLUSIONS ......................................................................................................................................................................... 43 5.1 CONCLUSION #1 RELEVANCE .................................................................................................................................................................. 43 5.2 CONCLUSION #2 EFFICIENCY: ................................................................................................................................................................. 43 5.3 CONCLUSION #3 EFFECTIVENESS ........................................................................................................................................................... 44 5.4 CONCLUSION #4 IMPACT .......................................................................................................................................................................... 47 5.5 CONCLUSION #5 SUSTAINABILITY .......................................................................................................................................................... 48 6 RECOMMENDATIONS ........................................................................................................................................................... 49 6.1 RECOMMENDATIONS FOR WHO ............................................................................................................................................................. 49 6.1.1 Approach ........................................................................................................................................................................................49 6.1.2 Institutional strengthening.....................................................................................................................................................49 6.1.3 Management and governance ...............................................................................................................................................51 6.2 RECOMMENDATIONS FOR THE SEAR COUNTRIES ................................................................................................................................ 51 ANNEX A SPECIFIC COUNTRY FINDINGS .......................................................................................................................... 54 BANGLADESH .......................................................................................................................................................................................................... 54 BHUTAN ................................................................................................................................................................................................................... 56 DEMOCRATIC PEOPLE’S REPUBLIC OF KOREA .................................................................................................................................................. 59 INDIA ........................................................................................................................................................................................................................ 60 INDONESIA .............................................................................................................................................................................................................