ATSA-CAMEROON

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ATSA-CAMEROON
CAMEROON
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REINFORCING POLICIES FOR SMOKE-FREE PUBLIC SPACES
AND HEALTH WARNINGS ON CIGARETTE PACKS IN THE
ANTI-SMOKING CAMPAIGN IN CAMEROON

• The African Tobacco Situational Analyses (ATSA)
  is an initiative launched by the IDRC and the
  Bill Melinda Gates Foundation (BMGF) which aims
  to understand the determining factors likely to
  ensure the success of tobacco control and orient
  the development and implementation of tobacco
  control strategies in Africa in the short and
  long terms.
• ATSA-Cameroon is comprised of research professors
  from the Universités de Yaoundé 1 and 2 members
  of the Expert Panel on smoking officers of the
  Ministry of public health members/activists from
  civil society organizations and the media. The
  ATSA-Cameroon team is represented here by Dr. Z.
  Njoumemi and Dr. H. Mimche. The ATSA project is
  being carried out by the Ministry of public
  health and the School of Medecine and Biomedical
  Sciences of the Université de Yaoundé 1.
• ATSA Pre-conference, Mumbai, India, March 7, 2009.

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EVALUATION OF THE BASELINE SITUATION IN CAMEROON

• Epidemiology of Smoking
• Prevalence 17.5 of the population are tobacco
  smokers,
• of which 28.8 are men and 8.1 are women.
• Smoke exposure 37 of Cameroonians are exposed
  to tobacco smoke in public spaces and home
  environments.
• Around 15 of young people under 15 years old are
  affected,
• with a much higher prevalence in schools, where
  44 of students have tried tobacco,
• of which 5 before the age of 7.
• In university settings, 60 of smokers are
  approximately 20 years old
• boys start smoking at 15 years old and girls at
  18 years old.

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The Baseline Situation in 2008 (GYTS)

• 15.2 of students have already tried smoking a
  cigarette (of which 21.8 of boys and 9.2 of
  girls)
• 31.2 of students experimented with tobacco
  before the age of 10
• 10.9 of non-smoking students are considering
  experimenting with tobacco in the next 12 months
  (before the end of 2009)
• 45 of students are exposed to tobacco smoke in
  public spaces
• 75.7 of students think that tobacco smoke is
  harmful to the overall health of society
• 87.7 are in favour of banning smoking in
  public spaces

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FCTC and the National Policy on Tobacco Control
Act No. 64/LF/23 of November 13, 1964 regarding
public health protection. Act No. 90/O31 of
August 10, 1990 governing commercial activity in
Cameroon. Act No. 98/004 of April 14, 1998
regarding the orientation of education in
Cameroon this act prohibits the sale of
alcoholic beverages, tobacco and drugs in
educational institutions. Act No. 2005/005 of
July 24, 2005 authorizing the President of the
Republic to ratify the WHO Framework Convention
on Tobacco Control (FCTC). Act No. 2006/018 of
December 29, 2006 governing advertising in
Cameroon. Decree No. 93/720/PM of November 22,
1993 setting out the enforcement approach of Act
No. 90/O31. Decree No. 2005/440 Bis of October
31, 2005 regarding the ratification of the WHO
Framework Convention on Tobacco Control (FCTC).
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FCTC and the National Policy on Tobacco Control

• Order No. 0016/AI/MINDIC/MSP/CAB of June 8, 1998
  regarding health warnings on the packaging of
  tobacco-based products.
• Order No. 967 MINSANTE/MINCOMMERCE of June 25,
  2007 regarding health warnings on the packaging
  of tobacco-based products.
• Decision No. 0222/D/MSP/SG/DMPNP of November 8,
  1988 regarding the smoking ban in Ministry of
  public health institutions and training courses.
• Decision No. 0180/D/MSP/SG/DPS of May 28, 2004
  regarding the creation and implementation of the
  Expert Panel on smoking.
• Letter No. 07/788/CF/L/MINEFI/DRH/SP of June 15,
  2007 relating to the smoking ban in Ministry of
  economy and finance buildings at that time.
• Circular Letter No. 012/B1/1464/MINEDUB/SG/DRH/SDS
  SAPPS of August 17, 2007 relating to the creation
  of smoke-free spaces and anti-tobacco clubs in
  educational environments.
• Circular Letter No. 19/07MINESEC/SG/DRH/SDSSAPPS
  of September 11, 2007 relating to the creation of
  anti-tobacco clubs in educational environments
  and making educational institutions "smoke-free
  spaces."
• MEMORANDUM No. 1913 of June 12, 2007 of the
  Government Delegate to the Communauté Urbaine de
  Yaoundé Yaoundé urban community organization
  informing all employees and visitors to respect
  the slogan "no smoking inside."

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CAMEROON'S NUMBER ONE PRIORITY IN CONTROLLING
TOBACCO

• I - Promotion of smoke-free public spaces 100
  smoke-free public spaces is the only proven way
  to effectively protect non-smokers from the
  harmful effects of passive smoking and help
  smokers to give up tobacco. Smoking bans in
  public spaces reduce the social acceptability of
  tobacco and discourage youth and adult
  non-smokers from starting smoking. In Cameroon,
  approximately 37 of the population (more than
  6,000,000 people) are exposed to second-hand
  smoke in public spaces. Promotion of smoke-free
  school, university and socio-educational public
  spaces is crucial to reducing smoking rates among
  students, for which the prevalence of smoking is
  rising it was at 15.2 among students aged 13-15
  and 25.3 among educators in 2008. This is why
  the government of Cameroon would like public and
  work spaces to be 100 smoke-free, so much so
  that policies and ratified laws are on the verge
  of being adopted at the national level to provide
  legal and regulatory bases for the promotion of
  smoke-free public spaces in Cameroon.

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GOAL AND OBJECTIVES OF CAMEROON'S NUMBER ONE
PRIORITY IN CONTROLLING TOBACCO

• Public spaces include restaurants, bars, taxis
  and any and all other public transportation,
  busses, bus and train stations, airport
  terminals, community recreation spaces, movie
  theatres, video arcades, sports fields and
  centres, community and local markets, malls,
  shopping centres, government and community
  buildings, primary and secondary schools,
  universities, institutes of higher education,
  socio-educational centres, public gardens,
  theatres, conference halls, public libraries,
  fairs, etc.
• Goal To promote the establishment of and
  compliance with smoke-free public spaces in
  Cameroon.
• General Objective Protect non-smoking
  populations from second-hand smoke and reduce the
  social acceptibility of tobacco to discourage
  young people and adults from picking up smoking
  and help smokers to stop in order to create
  public spaces in the Mfoundi area and models of
  "smoke-free zones" in Cameroon.

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GOAL AND OBJECTIVES OF CAMEROON'S NUMBER ONE
PRIORITY IN CONTROLLING TOBACCO (Cont. 1)

• SPECIFIC OBJECTIVES
• 1 To conduct a baseline study on the
  existence, level of application, effectiveness,
  opportunities and constraints of implementing
  legislation and internal and external regulatory
  measures in the anti-tobacco campaign in all
  listed public spaces publics in the Mfoundi area.
  
• 2 To advocate, raise awareness and involve all
  stakeholders and participants including the media
  and civil society organizations in the process of
  establishing a total smoking ban in all listed
  public spaces in the Mfoundi area.
• 3 - To strengthen the abilities of all
  stakeholders and participants including the media
  and civil society organizations in order to
  mobilize the political, administrative and
  community responsible parties and the public to
  support the establishment, strengthening and
  spread of the total smoking ban in all listed
  public spaces in the Mfoundi area.
  

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GOAL AND OBJECTIVES OF CAMEROON'S NUMBER ONE
PRIORITY IN CONTROLLING TOBACCO (Cont. 2)

• SPECIFIC OBJECTIVES (Cont.)
• 4 To establish, enforce, monitor and evalute
  the total ban of smoking in all listed public
  spaces in the Mfoundi area.
• 5 To create, copy and distribute a document
  summarizing data on the successes made and best
  practice principles of "smoke-free" public spaces
  in order to inform political decision-makers,
  anti-smoking activitists and the media and help
  them in their efforts to replicate them and
  spread them to all public spaces throughout
  Cameroon's other areas.
  

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PLAYERS INVOLVED IN THE IMPLEMENTATION OF
CAMEROON'S NUMBER ONE PRIORITY

• Ministry of territorial administration and
  decentralization (Office of territorial
  management, Office of civil protection, etc.)
• Prefecture and subprefectures of the Mfoundi
  area
• Tobacco control associations and civil society
  and public health organizations registered at the
  Mfoundi prefecture
• Communauté Urbaine de Yaoundé Yaoundé urban
  community organization and Mairies
  dArrondissements du Mfoundi Administration of
  the Mfoundi arrondissements
• Ministry of public health (Office of health
  promotion, the Expert Panel on smoking, National
  committee for the fight against drugs, National
  epidemiology committee, etc.)
• Health services of the Mfoundi sanitary
  districts
• The directors, administrative personnel,
  teachers, and students of primary and secondary
  schools, socio-educational centres and
  universities of Mfoundi
• 
  

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PLAYERS INVOLVED IN THE IMPLEMENTATION OF
CAMEROON'S NUMBER ONE PRIORITY (2)

• The Ministries of commerce small and
  medium-sized enterprises social affairs the
  status and promotion of women youth, sports and
  physical education primary and secondary
  education higher education communications, etc.
• Public and private print and audiovisual media
• Members of Parliament and Mfoundi opinion and
  political leaders
• Mfoundi religious leaders and traditional chiefs
• The managers and persons in charge of the public
  spaces in Mfoundi
• The unions and insurance companies of managers,
  workers, and users of Mfoundi's public spaces
• The people of Mfoundi
  

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CAMEROON'S NUMBER TWO PRIORITY IN CONTROLLING
TOBACCO

• The participants in the consultation workshop
  have reservations on the effectiveness of the
  scope and impact of Order No. 967/MINSANTE/MINCOMM
  ERCE of June 25, 2007 regarding health warnings
  on the packaging of tobacco-based products. Given
  that tobacco is consumed by the majority of
  smokers in the form of cigarettes sold mostly in
  retail establishments to poor and/or illiterate
  consumers, and so that the regulatory measures
  are properly implemented, it will be necessary to
  document the proportion and characteristics of
  the smokers exposed (or not) to the
  awareness-raising and dissuasion messages on the
  packaging of tobacco-based products in Cameroon.
  What is the level of compliance with and
  knowledge of the health warnings written on the
  packages of tobacco-based products and what are
  the beliefs, perceptions, attitudes and practices
  of cigarette vendors, smokers and non-smokers
  with regard to this labeling/warning policy or
  health warnings on cigarette packs? What effect
  do written health warning labels (not illustrated
  with images or photos) regarding the health
  consequences of smoking have on the demand and
  consumption of cigarettes? What obstacles prevent
  the written health warning label (with no images
  or photos) policy from being effective? How can
  we strengthen or redirect this written warning
  label policy with health warnings illustrated
  with images or colour photos on the health
  consequences of smoking?

II - Evaluation of the effectiveness of the
health warning label policy tobacco seriously
harms the health of smokers and that of the
people around them, tar 14mg, nicotine 1.2mg
on at least 50 of the total surface of each of
the two main sides of cigarette packs in
Cameroon. The scope and impact of the health
labels are not guaranteed to be as effective in
changing the behaviour of smokers as they are in
changing that of non-smokers. Given that tobacco
is consumed by the majority of smokers in the
form of cigarettes that are sold mostly in retail
establishments to poor and/or illiterate
consumers, this written warning label policy must
be strengthened or redirected with health
warnings with illustrated images or colour photos
on the health consequences of smoking. Printing
illustrated health warnings requires a synergy of
actions. However, civil society
players/partipants are not familiar with each
other and are poorly known by their government
counterparts. Because of this, it is difficult to
rely on civil society organization networks,
including the media, that currently are
participating or could participate in the fight
against tobacco and that are fundamental to the
improvement of both institutional and individual
capabilities to implement anti-smoking.
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GOAL AND OBJECTIVES OF CAMEROON'S NUMBER TWO
PRIORITY IN CONTROLLING TOBACCO IN CAMEROON

• Goal To promote printing of health warnings on
  cigarette packs in Cameroon.
• General objective To mobilize all participants
  to reinforce the policy of labeling cigarette
  packs with images or colour photos with the aim
  of improving awareness of the risks of smoking on
  the health of youth and adult smokers and
  non-smokers so that they change and adopt
  behaviours that are in line with Cameroon's
  anti-smoking campaign.
• Specific objectives
• 1 - To conduct a pilot study in the Mfoundi area
  on the knowledge, attitudes, perceptions,
  practices and behaviours of smoking and
  non-smoking populations with regard to the
  non-illustrated written health warnings on the
  dangers of smoking

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GOAL AND OBJECTIVES OF CAMEROON'S NUMBER TWO
PRIORITY IN CONTROLLING TOBACCO (Cont. 1)

• Specific objectives (Cont.)
• 2 - To establish a map of the profiles of the
  non-governmental organizations and/or
  associations working in tobacco control in
  Cameroon
• 3 - To lead an advocacy and awareness-raising
  campaign with the aim of involving all the
  governmental and non-governmental participants,
  including the media and civil society
  organizations, in the process of printing health
  warnings illustrated with images or colour photos
  on cigarette packs in Cameroon
• 4 - To design, validate and get all the
  governmental and non-governmental participants,
  including the media and civil society
  organizations, to adopt the project of health
  warnings illustrated with images or colour photos
  on cigarette packs in Cameroon
• 5 To establish, enforce, monitor and evaluate
  the health warnings illustrated with images or
  colour photos on cigarette packs in Cameroon.

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PLAYERS INVOLVED IN THE IMPLEMENTATION OF
CAMEROON'S NUMBER TWO PRIORITY

• Cameroon's prefectures and subprefectures
• Associations and anti-smoking civil society and
  public health organizations registered at
  prefectures and subprefecturs and the regional
  cooperative registries of the Ministry of
  agriculture
• Cameroon's urban communities and urban and rural
  administrations
• Ministry of public health (Office of health
  promotion, the Expert Panel on smoking, National
  committee for the fight against drugs, National
  epidemiology committee, etc.)
• Regional health delegations and the health
  services of Cameroon's sanitary districts
• The Ministries of commerce small and
  medium-sized enterprises social affairs the
  status and promotion of women youth, sports and
  physical education primary and secondary
  education higher education communications, etc.
• Public and private print and audiovisual media
• Research institutions and community
  organizations

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Lessons Learned

• The results of the GYTS 2008 reveal a slight
  increase in the prevalence of smoking among young
  Cameroonians
• Development and validation of the National Policy
  on Tobacco Control in Cameroon document (with the
  active participation of members of the
  ATSA-Cameroon team) in February 2009
• Development and validation of the National Bill
  on Tobacco Control in Cameroon (with the active
  participation of members of the ATSA-Cameroon
  team) in February 2009
• Submission of the National Bill on Tobacco
  Control in Cameroon for debate, deliberation and
  adoption by the Deputies of the National Assembly
  of Cameroon in March-April 2009
• Redirection of the ATSA strategy toward concrete
  and operational interventions in favour of short
  and long-term tobacco control policies in
  Cameroon
• Increased political will and mobilization of
  local players/participants in favour of tobacco
  control in the society
• Introduction of questions regarding tobacco and
  health at the College of Medicine and Biomedical
  Sciences, Université de Yaoundé I

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Importants Points of the Work Plan

• More comprehensive and multisectorial operational
  definition SMOKE-FREE PUBLIC SPACES in Mfoundi
  or Smoke-free Yaoundé
• Promote the establishment of and compliance with
  SMOKE-FREE PUBLIC SPACES and ILLUSTRATED HEALTH
  WARNINGS on cigarette packs
• Specific objectives that are attainable in the
  short term (after 6-8 months of intervention
  efforts)

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Long-term Goals

• Completely enforce the ban on tobacco
  advertising, promotion and sponsorship in the
  media and all other advertising media
• Limit access to tobacco products through tax
  increases, a ban on selling cigarettes to
  youth/minors as well as the sale by minors.
  Combat the smuggling of tobacco products in
  border areas.

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ATSA -Cameroon Team
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END OF THE PRESENTATION
THANK YOU FOR YOUR ATTENTION