Canadian Global Tobacco Control Forum (CGTCF): Strengthening Canadian capacity to support global tobacco control

Introduction

The Canadian Global Forum on Tobacco Control (the Forum) is a collaborative activity of leading organizations involved in domestic tobacco control in Canada and leading Canadian organizations involved in supporting international public health. The Forum emerged as a result of 8 years of collaborative work amongst Canadian health charities to support the Framework Convention on Tobacco Control. Since 2003, Forum members have separately and collectively managed programs and activities aimed at implementing the Framework Convention in Canada and abroad.

This project, “Strengthening Canadian capacity to support global tobacco control”, was the fourth collaborative Forum project funded by Health Canada. The first three were funded through the International Affairs Directorate in 2005-06, 2006-07, and 2008-09. The current project was complementary to the most recent IAD-funded project, as it addressed the Canadian technical assistance and management components of the IAD-funded development projects.

This current project included a number of sub-activities:

• Activity A - Strengthen global tobacco control networks: participate in domestic network meetings and in network operations, participate in international network events and operations, monitor developments, identify potential projects and research emergent issues.
• Activity B - Technical support to developing countries in relation to IAD funded international tobacco control grants (B1: Project Strengthening Capacity of Tobacco Control in National Public Health Associations in Africa; B3: Supporting National Action/Capacity Building in Latin America; B4: Protecting Ecuadorian Children from Harmful Second Hand Smoke).
• Activity C - Forum leadership: Team leadership and coordination with other global activities.
• Activity D – Communications: Coordinate communications with the public, with partners, with tobacco control community, including web-site, press releases, symposiums, meetings, publications.
• Activity E - Policy and promotion: Support policy development on global tobacco issues from Canadian civil society perspective.
• Activity F - Project Administration: Financial administration and relationship with donor for Canada-based Forum activities.
• Activity G - Technical Cooperation for FCTC Guideline and Protocol Development: Recruit, engage and support civil society participation in the development of FCTC guidelines, protocols and other policy advances.
• Activity H - Ontario Tobacco Research Unit Online Course Adaptation: Support Francophone African tobacco control partners in adapting the existing French version of OTRU’s online training course for public health professionals in Francophone Africa.
• Activity I – cancelled.
• Activity J - Week-long workshop and related follow-up activities in Ghana to provide international support and assistance to FCTC implementation in Ghana
• Activity K - Technical Cooperation for FCTC Implementation and Monitoring in specific Latin American Countries: Support government and civil society partners in specific Latin American Countries to advance FCTC implementation in the region.
• Activity L - Strengthen Capacity in Tobacco Control in Francophone Africa:  Strengthen the capacity of civil society organizations and government agencies in francophone Africa to successfully address the tobacco epidemic in their region, through improved technical co-operation and assistance.

Physicians for a Smoke-Free Canada was the grant manager for this project; HealthBridge played a key role in some activities and in overall Forum leadership.

Objectives

The objectives of this project were:

• To support the federal tobacco control strategy’s goal of implementing the World Health Organization Framework Convention on Tobacco Control.
• To provide support to tobacco control efforts of NGO and government partners in key countries and regions.
• To strengthen the work of Canadian and international networks on tobacco control.

Results and Impact

At the conclusion of the project, a number of results are evident.

Activity A: Through regular monthly meetings, Forum members stayed informed and increased their engagement in global tobacco control, not only related to the Activities undertaken through the project, but also related to news, events, and other activities of interest in the field. African and policy subcommittees increased the engagement of interested Forum members in specific geographic or thematic areas. The Forum's FCA membership increased the Forum's participation in international networks, further engaged Canadians with international organizations involved in global tobacco control, and increased opportunities for Canada to shape international tobacco control. Participation in international meetings and activities increased the level and profile of Canadian input to global tobacco control, while also increasing opportunities for Canada to influence, at least at a technical level, planning and funding directed at global tobacco control. Participation at COP-3 and INB increased visibility of the Canadian civil society perspective and contributions, while also keeping Forum members up-to-date with guideline developments and decisions and providing opportunities for Canadian contribution to the guidelines. Participation at the 14th World Conference on Tobacco or Health demonstrated Canadian expertise in global tobacco control and the role of the Forum in supporting global tobacco control networking efforts.

Activity B
Activity B1: Strengthening Capacity in Tobacco Control of National Public Health Associations in Africa (managed by CPHA in collaboration with PHAs in Africa) - Eleven mini-projects were supported in Uganda, Cameroon, Niger, Congo, Burkina Faso, Ethiopia, and Tanzania. These mini-projects actively promoted the implementation of FCTC Articles 8, 11, and 12. Through the mini-projects, new needs were identified and more structured actions promoted to improve implementation of the FCTC; opportunities were gained to share information, work together, and gain a better understanding of the impact (social, economic etc.) of tobacco control; tobacco control media networks were established; public awareness was increased; and the participating organizations gained a better understanding of the tobacco consumption and tobacco control situation in their countries while also strengthening their own capacity and visibility in tobacco control.
Activity B3: Supporting National Action/Capacity Building in Latin America (prepared by the Inter American Heart Foundation, in association with partner organizations in Colombia and Mexico): Workshops for journalists facilitated contact and improved relations with national and local media while also mobilizing them as stakeholders. During the course of the sub-project, the Colombian government ratified the FCTC and a resolution for countrywide smoke-free environments was developed and approved. In Mexico, the project team developed the 3rd Report from Civil Society on the Implementation of the FCTC, which was used to raise awareness of and support for smoke-free measures.
Activity B4: No Ifs, Ands or Butts: Protecting Ecuadorian Children from Harmful Second Hand Smoke: Through its work with schools, FESAR gained a better understanding of the SHS problem in Ecuador and contributed to the elaboration of a project of law (bill) that includes FCTC recommendations on the matter. FESAR reported that it observed behavioural changes particularly in children, parents, and teachers who requested more information about SHS.

Activity C: Leadership was demonstrated in a number of different ways. As part of its role in coordinating with global tobacco control activities, HealthBridge provided ongoing technical assistance that demonstrated Canadian expertise in a range of tobacco control areas and facilitated the sharing of that experience globally. Monthly Forum meetings were particularly useful in terms of bringing together the key tobacco control leaders and experts in the member organizations, thereby making Canada's contribution to global tobacco control stronger and more strategic, avoiding duplication, providing advice to each other from different perspectives, and sharing networks and contacts. An internal evaluation fostered an increased understanding and appreciation among Forum members of the advantages and disadvantages of the Forum mechanism for increasing Canadian involvement in global tobacco control, as well as an overall assessment of results achieved.

Activity D: Forum members designed and produced a pamphlet that highlighted the Forum's history, achievements, and ongoing activities. The pamphlet was used to raise public awareness about tobacco control issues. Following the completion of the FCTC Monitoring Report (see Activity E), the Forum issued a news release to bring attention to the report. Based on the news release, the Globe and Mail published a full story about the report. Forum members also developed and disseminated tobacco control information materials, including factsheets on FCTC funding, smuggling, taxation, and graphic health warnings. The Forum hosted a session about the development and maintenance of partnerships to address global tobacco control during the 15th Canadian Conference on International Health (October 2008) and presented a poster at the 14th World Conference on Tobacco or Health that provided information about the Forum and highlighted its achievements to date. By producing and disseminating a variety of materials in more than one way, the Forum raised awareness in Canada and internationally about its existence and Canada's contribution to global tobacco control. The Forum's media engagement also raised public awareness of the FCTC, its objectives, and Canadian obligations through the Framework.

Activity E: The Forum produced and disseminated a FCTC Monitoring Report (shadow report) that demonstrated that there were a number of areas where Canada had failed to fulfill its FCTC obligations, but also others where Canada had surpassed the minimum standards of the FCTC. This report provided a detailed look at each set of Canada's obligations under the FCTC, provided commentary on where Canada's measures were - or were not - in line with treaty requirements, and provided recommendations on measures governments and others should take to strengthen the implementation of the treaty in Canada. Through the production of this report, the Forum increased awareness about Canada's progress towards fulfilling its FCTC obligations. In support of the Forum, PSC produced and disseminated the research paper "The Plot against Plain Packaging: How multinational tobacco companies colluded to use trade arguments they knew were phony to oppose plain packaging and how health ministers in Canada and Australia fell for their chicanery", which provided insight into the strategy and tactics of tobacco companies to block the adoption of plain packaging measures. Also in support of the Forum, CCS published Cigarette Package Health Warnings: International Status Report and disseminated it at COP-3 (English only) and during the WCTOH (English, French Spanish, and Portuguese).

Activity F: Through the activities undertaken in Activity F, the Forum successfully managed a multi-partner, multi-activity project that supported the Federal Tobacco Control Strategy.

Activity G: The Forum contracted cooperants to undertake research studies on the issues of plain packaging in Mexico, waterpipe tobacco control, cross-border tobacco advertising in South East Asia, and the control of bidis and oral tobacco in South Asia. Each of these studies resulted in the production of reports and policy recommendations that were widely disseminated, which led to greater awareness of some key tobacco control issues in developing countries and to the greater contribution of developing country researchers to the body of knowledge informing FCTC guideline development. The Forum facilitated greater developing country participation in FCTC guidelines and policy discussions by sponsoring cooperants to attend and participate in INB (Illicit Trade), COP-3, and other relevant activities. The Forum collaborated with the Inter American Heart Foundation to sponsor the participation of three Latin American cooperants to COP-3 and one cooperant to attend regional Caribbean meetings focused on health warnings. Through their participation at the meetings, the cooperants were able to broadly expand awareness of and support for the FCTC in their own constituencies.

Activity H: Through this Activity, the Ontario Tobacco Research Unit (OTRU) supported Francophone African tobacco control partners to adapt the existing French version of its online training course for public health professionals in Francophone Africa. The three course modules were translated into French, � Canadian � references and images were replaced with African references and images, and reference tobacco brands widely advertised and used in Francophone Africa was added.

Activity J: A series of consultative meetings were held in Accra, Ghana August 18-25 2008 with the participation of stakeholders and other potential supporters of the implementation of the Framework Convention on Tobacco Control. The key finding of the meetings was that there is a high level of commitment in Ghana to implement the FCTC. The subsequent election resulted in a change in government which led to a delay in all government decision making. Nevertheless, the new government has expressed renewed interest in further strengthening tobacco control in Ghana, which led to a series of follow up workshops and meetings. This in turn resulted in a strong commitment from health service workers, the hospitality industry, educational institutions, religious groups, and other civil society groups to support a government initiative to make workplace and public places smoke-free. There is now strong support for comprehensive tobacco control in Ghana. This support is evident among the general public, the media, and key stakeholders in all regions. Partly as a result of Activity J, tobacco control workers in the Ghana Health Services and the Food and Drug Board have gained valuable experience and increased their effectiveness. Tobacco control has become a permanent, sustainable feature of the work of these two institutions. In addition, tobacco control NGOs in Ghana have gained valuable new experience and increased their effectiveness.

Activity K: The purpose of the first component of Activity K was to examine and counter the tobacco industry's claim that the FCTC is an obstacle for free trade in Honduras & Central America. An NGO based in Honduras was contracted by the Forum to produce a technical research paper that included technical, legal, and other arguments that could be used to counter the tobacco industry. The purpose of the second component of Activity K was to develop a set of images for tobacco package warnings that could be used by governments in MERCOSUR and affiliated countries (all Spanish-speaking and Portuguese-speaking countries in South America) and, if possible, within the limitations of copyright restrictions, by all Latin American governments (South America, Central America and the Caribbean). A research protocol was developed in Spanish describing the use of the International Affective Picture System to test emotional responses to warnings images, in combination with questions asking participants their opinion on the effectiveness of different warnings in motivating them to quit smoking. The project team compiled research findings on the effectiveness of various warnings images in Latin America and elsewhere. Through this work, the foundation was laid for Latin American researchers to test the effectiveness of various picture health warning messages. A resource website was developed, linked to the Intergovernmental Commission on Tobacco Control of MERCOSUR, which can be built upon by MERCOSUR in future to disseminate research findings and more image options for picture warnings among member countries, as well as among other Latin American governments. The project team gained copyright to a selection of images for use by governments as picture warnings on tobacco packages during the next three years. Through its participation in the initiative, capacity within the Ministry of Health, Argentina has been enhanced to proceed with research into and implementation of picture warnings.

Activity L: In May 2008, the Forum supported the Tournée des Parlementaires en Faveur de la Loi Antitabac in Niger. The mission raised a significant amount of public support for the tobacco control law, and as a result, the government of Niger adopted the application decree for the country's national law. The Forum supported a Francophone Regional Seminar (Réunion de concertation des acteurs francophones de la lutte antitabac) in July 2008. The outputs of the regional meeting included the development and release of a call for proposals for mini-projects, the creation of a selection committee, and the preparation of a draft document outlining funding priorities for donors. Four mini-projects were implemented in Senegal, Burkina Faso, Ivory Coast, and Chad. A fifth project involved a knowledge exchange mission between Niger and Ivory Coast.

Lessons Learned

Through their participation in the internal evaluation, Forum members identified several areas for improvement in future Forum activities.

Coordination/collaboration: Improving coordination and collaboration could be achieved by sharing information on challenges in different regions and then devising strategies and deciding which organization could do what, before moving to the "partner-activity" stage. This would help to ensure that proposal planning would be done through a much greater synergistic/consultative process among Forum members and that more Forum-proposed activities would demonstrate some form of intra-Forum collaboration. This type of coordination - recognizing a regional or subject-specific issue and working collectively to identify the organizations and approach most suited for addressing the issue - did take place to a much greater extent over the course of the year; using this approach from the beginning of project development would further strengthen Forum-wide coordination and collaboration. More time between the issuing of the Request for Proposals by Health Canada and the deadline for their submission would also facilitate greater coordination and collaboration among Forum members.

Leadership and oversight: The role of "leadership" was understood very differently by different members of the Forum, resulting in occasional confusion about roles and responsibilities. Leadership means different things to different people, and for it to be effective it must be clearly defined and understood by all. More clearly assigning responsibilities and authorities in future Forum endeavours could help to mitigate the issues that arose around different expectations of leadership and results achievement.

Forum membership: Implementing a wider range of communications activities, including developing and disseminating informational materials, publishing research results, making presentations, and undertaking outreach, could help to engage additional Canadian organizations in the Forum. Keeping the core group small would be important to facilitate management and oversight; however, a wide range of organizations could be involved in partner-activities and networking under the Forum umbrella.

Financial management: Approaching financial reporting from the perspective of providing different types of reports - by input (personnel, travel, "other") and by output (activity) - rather than combining all reports into one, could help to make financial management less complicated and cumbersome.

Time-effectiveness: Focusing monthly network meetings on Forum-wide strategizing (moving forward and problem-solving) rather than on partner-activity updates could better engage Forum members. Partner-activity updates are important, but could be provided in a different manner (such as through the circulation of collated monthly reports).

Time frame: Implementing many activities through a multi-partner mechanism necessarily takes more time than implementing a single project through a single organization, which in this project necessitated an extension to achieve all planned results. Future Forum projects should be designed for a longer time period to avoid the need for extensions, and to facilitate the achievement of a higher level of results.

Incorporation: Were the Forum to become an incorporated entity, it would permit enhancement of its international visibility. For example, the Forum could then apply for observer status to the FCTC Conference of the Parties.

Coalition versus full-time Forum Secretariat: Forum members debated the merits and demerits of operating the Forum with a full-time secretariat to ease the administrative and management burden on member agencies. Under this model, the member agencies would provide general policy direction and project personnel to the secretariat, which would be the management and administrative agency. While it was felt that such a structure could ease some of the challenges and difficulties of working together in a coalition, it would also present another set of challenges and difficulties. The definition of roles and responsibilities and communication and coordination between the secretariat and Forum members would be an ongoing challenge. In addition, the operation of a secretariat with full-time staff would surely increase the cost of administration well beyond the 9-10% cost of administration under the coalition model. On balance, the coalition model is preferred.

Recommendations

The internal evaluation found that the Forum mechanism offered a unique means of bringing together Canadian civil society organizations involved in global tobacco control around the table to discuss and put into place coordinated and mutually-supportive activities to enhance the organizational and programmatic capacity of the members' various overseas partners. With the leadership provided by those organizations with access to broader international tobacco control networks, involvement in the Forum enabled those members not previously involved in global tobacco control to increase their engagement. It also facilitated the provision of appropriate and timely assistance to developing country partners. As a result, the Forum will continue to seek ongoing funding to continue its work.