Strengthening of smoke-free policies and their enforcement for smoke-free Hanoi

Introduction

Developing smoke-free public places to protect non-smokers from the harmful effects of secondhand smoke is one of the priorities of the National Policies for Tobacco Control issued by the Vietnamese Government in December 2000. The implementation and enforcement of smoke-free public places is also a requirement of the FCTC, of which Vietnam is a party. However, implementation has been a significant challenge for the Vietnamese government, given the current high prevalence of smoking in the country, widespread public acceptance of smoking, weak enforcement measures, lack of skilled institutional leadership, low levels of public support for and compliance with smoke-free policies, and lack local government acceptance that the issue is important.

HealthBridge, the Government of Vietnam, and other agencies have carried out several pilot projects to implement smoke-free policies in specific settings in Vietnam, such as schools, restaurants, and public transportation. Although these projects provided useful experience in developing procedures to implement smoke-free policies, they also encountered challenges due to the lack of local government support, limitations in mobilizing community support, and very sporadic enforcement by authorized officials. Lessons learned through the implementation of those projects will be critical to the success of this proposed project.

In order to address problems related to a reluctant public and inadequate enforcement, a model smoke-free public places policy needs to be implemented in an entire community using comprehensive measures including advocacy, enforcement strengthening measures, and public education. The implementation of such a model in all settings within a defined geographic area would also test and improve the efficiency of public education and advocacy efforts. This project aims to implement community-wide smoke-free policy and thereby develop a smoke-free model city in Vietnam, to help the Government scale up the model to other provinces and cities.

Objectives

The project's objectives are:

• To increase political commitment of local government to implement and enforce smoke-free policies in public places and workplaces.
• To improve the local skills and infrastructure required to develop, plan, and implement measures to effectively enforce smoke-free policies in local settings.
• To increase civil society’s (including business owners) and public involvement in supporting and monitoring smoke-free policy implementation.

Results and Impact

Since the project's commencement in April 2008, the following has been achieved:

Objective 1

• MOUs signed with the Vietnam Public Health Association and the Hanoi Union of Friendship Organisations (HAUFO).
• Project Steering Committee convened, with representatives from HAUFO (as the chair) and the Departments of (i) Health, (ii) Education and Training, (iii) Justice, (iv) Transportation, (v) Culture, Sports and Tourism, (vi) Information and Communication, (vii) Trade and Industry (viii) ,Foreign Affairs, (ix) Hanoi Broadcasting and Television, (x) Hanoi Moi Newspaper, (xi) Hanoi Trade Union, and (xii) HNPC Bureau. 
• Fact sheets and toolkits drafted and reviewed by members of the Viet Nam Tobacco Control core group and by SEATCA experts. The toolkits were revised and adapted for different audiences, including policy makers and practitioners, the general public, etc.
• On September 30 2008, the Hanoi People’s Committee (PC) issued Plan No. 14/KH-UBND titled Overall Plan of Implementation of Smoke Free Offices and Public Places. This document reflects the strong commitment of the Hanoi local Government towards the implementation of smoke-free Hanoi. This plan includes detailed solutions for the organisation of the plan’s implementation, including capacity building, communication for behaviour change, community mobilisation, monitoring, and financial resources. Eight specific steps were outlined in the plan, including timing and deadlines for actions to be undertaken between 2008 and 2010. The issuance of Plan No.14 was the result of the significant efforts undertaken during the first six months of this project in policy lobbying and advocacy. The process of drafting of the Plan had begun in July 2008 with technical cooperation and legal consultation provided by the project team and consultants. The draft of the Plan was sent by the project team to the Bureau of the Hanoi People’s Committee for approval and finalization, which took place with only minor changes to the initial draft
• A number of departments and district-level people’s committees then issued their own plans for smoke-free implementation in order to meet the implementation requirements outlined in the overall Plan.  
• The leaders of the Departments of Health, Education, Transportation, and Culture demonstrated their support for the implementation of the smoke-free policy in their respective sectors by attending 3 steering committee meetings. At these meetings, the leaders participated in planning meetings and gave speeches during training.  
• To further encourage Hanoi leaders to support and promote the concept of smoke-free Hanoi, the project team organized a meeting with WHO Representative and the Vice President of the Hanoi People’s Committee on May 29, 2009. The event was broadcasted by media.
• Separate projects being implemented by CDS and VPHA in six other Vietnamese provinces have used the Plan No. 14/KH-UBND titled Overall Plan of Implementation of Smoke Free Offices and Public Places – previously developed by the Hanoi People’s Committee (PC) as the foundation upon which Smoke-Free Hanoi is to be implemented – as the background for a draft legal document to implement smoke-free policies in those jurisdictions.
• Numerous media advocacy activities undertaken, including TV talk shows and a cycling event.
• Review undertaken of existing legislative documents related to smoke-free policy. A draft report that includes in-depth critical analysis of the strengths and limitations of these existing documents was prepared.
• Journalism workshop hosted, entitled “Building a smoke free environment” for 46 journalists in Hanoi.
• On the occasion of World No Tobacco Day and in light of the 1,000 year anniversary of Hanoi on May 30th, 2008, the project team hosted a workshop and press meeting entitled “Hanoi towards a Smoke Free City” to launch the project. Approximately 70 representatives of various departments/branches of the Hanoi People’s Committee, WHO, ministries, international and local NGOs, and reporters and journalists attended the workshop. The event was chaired by the Director of the Hanoi Department of Health. The HNPC declared its intention to try to establish Hanoi as the first smoke-free city in Vietnam by implementing and enforcing the government’s tobacco control and smoke-free policies in offices and public settings.

 

Objective 2

• The project team reviewed and updated guidelines related to smoke-free environments in schools (including vocational schools), public transportation, and restaurants. Also developed and disseminated guidelines and IEC materials for the implementation of SF hospitals and entertainment venues. Guidelines for the implementation of smoke-free health facilities previously developed by VINACOSH and HealthBridge in 2005 were used and disseminated during training workshops for trainers in the health sector of Hanoi.
• A study tour to Davao (Philippines) for steering committee members was undertaken; participants included representatives of HNPC, the Departments of Health, Education, Transportation, Justice, and Foreign Affairs, Hanoi Moi Newspaper, and HAUFO.
• No-smoking signs, including stickers and plastic signs were designed and produced. More than 24,000 plastic no smoking signs and 81,000 no smoking stickers (5,000 stickers for buses and 7,500 stickers for taxis) were disseminated at various health, education, transportation and cultural facilities, including government offices and public settings. The size and designs of the signs and stickers were varied to be suitable to different settings.
• Many training workshops held for implementing sectors (including the 4 focus departments of health, education, transportation, culture, sports and tourism, other departments of the Hanoi People’s Committee, 29 district People’s Committees, and Central Hospitals located in Hanoi). All of the training programs included discussions around: (1) the harmful effects of smoking and second hand smoke, (2) the necessity and benefits of smoke-free offices/ public places, (3) the introduction of Plan No. 14/UBND, (4) definitions of smoke-free office/hospital/school/public places/bus/taxi/ and how to implement, monitor, and evaluate them, (5) the introduction of an action plan template for implementing agencies, and (6) sharing of experiences related to smoke-free hospital/taxi/bus/school implementation, including discussion and recommendations for enforcement of existing smoke-free regulations and policies. The trainers and speakers included representatives of the WHO, Ministry of Health – VINACOSH, Departments of Justice of Hanoi People’s Committee, HealthBridge Canada in Vietnam, and Thanh Nhan hospital (a good model of a smoke-free hospital).
• Action plans have been developed in several sectors: Health sector:  About 80% of health facilities have developed action plans for SF implementation; Transportation sector: Mailinh Group and Hanoi Transerco (taxi companies) have issued rules including regulations related to  a no smoking ban for both drivers and customers in their vehicles.

 

Objective 3

• A press meeting to launch the project was organised on May 30th, 2008; 28 reporters from newspapers based in Hanoi attended. A press release to launch the project was also disseminated to health reporters from media organizations in Hanoi and approximately 40 provinces. This generated significant and entirely positive coverage:
  • 14 news stories about the project launch were collected
  • 11 online newspapers also covered the event.
  • The project launch was published in the TV news program three times.
• Several fact sheets on the harmful effects of smoking, the benefits of implementing smoke-free policy, and how to create a 100% smoke-free environment were developed and disseminated.
• Information advertising Smoke-free Hanoi was printed on 10,000 copies of the Hanoi tourism map; this was done in cooperation with the Hanoi Centre for Tourism Development and Promotion
• Cycling event : participation of 350 students of 7 universities and 50 senior persons of Hanoi UNESCO Elderly Club. 100 T-shirts, 200 hats and 120 flags with the smoke free HN logo were distributed to the participants.

The baseline survey and public poll on smoke-free offices and public places was conducted at the beginning of the project; ongoing monitoring shows that significant progress in implementing smoke-free policies is evident in the target sectors.

Lessons Learned

None noted yet.

Recommendations

None noted yet.