To this
end, the WHO FCTC requires Parties to establish
or reinforce and finance a national coordinating
mechanism or focal point to develop, implement,
periodically update, and review comprehensive
multi-sectoral national tobacco control strategies,
plans, and programmes (Articles 5.1 and 5.2).
Generally many countries still lack the necessary
structural, human, financial, and technical
resources to implement cost-effective and
sustainable tobacco control programmes.
Few
national governments in ASEAN have a sufficient
number of staff working full-time on tobacco
control.
Both Singapore and Thailand have strong
tobacco control policies in place with support from
a significant number of national-level tobacco
control staff, while other countries in the region
need to build national capacity (human, financial,
and technical) to carry out effective and sustainable
tobacco control programmes to combat the tobacco
epidemic.
| Country | National mechanism for tobacco control | Governmental funding mechanisms for tobacco control |
|---|---|---|
| Brunei | National Committee for Tobacco Control Multi-sectoral Taskforce for Health |
Yes |
| Cambodia | Committee for Tobacco Control (CFTC) | No |
| Indonesia | None, only Ministry of Health (MOH) Focal Point* | Yes** |
| Lao PDR | National Tobacco Control Committee | Yes |
| Malaysia | Framework Convention on Tobacco Control (FCTC) Secretariat | Yes |
| Myanmar | Central Board of the Control of Smoking and Consumption of Tobacco Products | No |
| Philippines | Department of Health (Health Promotion Bureau, Disease Prevention and Control Bureau, and Bureau of International Health Cooperation) and the Food and Drug Administration | Yes |
| Singapore | Health Promotion Board | Yes |
| Thailand | National Tobacco Products Control Committee | Yes |
| Vietnam | Vietnam Tobacco Control Fund (VNTCF) | Yes |
*Tobacco-Related Disease Control unit, Directorate of Non-communicable Diseases (NCDs), Ministry of Health.
**Local Government mechanism through Local Tobacco Tax and Excise Sharing Fund.
Article 6 Guidelines recommend countries “dedicate revenue” to fund tobacco control and other health promotion activities. Article 26 requires all Parties to secure and provide financial support for the implementation of various tobacco control programs and activities to meet the objectives of the convention.
Tobacco control and health budgets in ASEAN
-
- Tobacco control (per capita USD)
- Health (USD)
- Health (per capita USD)
| COUNTRY | Tobacco control (USD) | Tobacco control (per capita USD) | Health (USD) | Health (per capita USD) |
|---|---|---|---|---|
| Myanmar (2016) | 4,800 (MMK 10.08 million) | 0.00009 (MMK 0.19) | ||
| Lao PDR (2022) | 46,187 (LAK 879.1 million) | 0.006 (LAK 118.4) | ||
| Vietnam (2022) | 17.15 million (VND 405 billion) | 0.176 (VND 4,155) | 5.09 billion (VND 120.11 trillion) | 52,181 (VND 1.23 million) |
| Philippines (2022/2023) | 1.17 million (PHP 62 million) | 0.01 (PHP 0.60) | 5.69 billion (PHP 314.7 billion) | 49.51 (PHP 2,737) |
| Brunei Darussalam (2021/2022) | 31,466 (BND 42,522) | 0.070 (BND 0.095) | 286.54 million (BND 387.21 million) | 643.36 (BND 869.41) |
| Cambodia (2022) | 27,153 (KHR 110 million) | 0.0016 (KHR 6.63) | ||
| Thailand (2022) | 8.98 million (THB 310 million) | 0.13 (THB 4.33) | 11.08 billion (THB 382.68 billion) | 154.7 (THB 5,344) |
| Malaysia (2023) | 113,378 (MYR 500,000) | 0.0034 (MYR 0.015) | 8.231 billion (MYR 36.3 billion) | 245.2 (MYR 1,081) |
| Indonesia (2023) | 835,729 (IDR 12.5 billion)* | 0.003 (IDR 45.7) | 11.94 billion (IDR 178.7 trillion) | 43.62 (IDR 652,778) |
| Singapore (2023) | 435.8 million (SGD 591 million)** | 73.35 (SGD 99.48) | 12.68 billion (SGD 17.2 billion) | 2,134 (SGD 2,895) |
*In Indonesia, the budget for tobacco-related programmes comes from the operational budget of the Health Promotion Centre.
**In Singapore, budget of USD 435.8 million (SGD 591 million) is for all non-communicable diseases (NCDs) programmes and not solely for tobacco control.
The global tobacco control funding gap is currently estimated at USD 27.4 billion. The current average annual amount of domestic funding for tobacco control per country is USD 15 million, half of what’s needed to scale-up FCTC policies implementation.
The Way Forward: Innovative National Financing Solutions
In many countries tobacco control is often not a national priority. Consequently, domestic resources
for WHO FCTC implementation are far from secure and must compete with other programmes for
government funding. An effective way to address this is the introduction of dedicated surcharge
taxes
on tobacco and alcohol, which can aid in reducing consumption of these harmful products and, more
importantly, provide a more secure funding stream for health promotion and tobacco control
programmes.
Four out of ten ASEAN countries have established health promotion or tobacco control funds through
surcharged taxes (Thailand, Lao PDR and Vietnam) and treasury budget (Singapore).
| Type and Year Established | Type | Governed and chaired by | Report to | Role of organization | |||
|---|---|---|---|---|---|---|---|
| Granting agency | Policy development | Implementing health promotion programmes | Building capacity | ||||
| Thai Health Promotion Foundation (ThaiHealth) (2001) | Autonomous agency | Board of Governors and chaired by Prime Minister | Cabinet and to both houses of Parliament | ✓ | ✓ | ✓ | ✓ |
| Singapore Health Promotion Board (2001) | Statutory Board under MOH | Board of Directors and chaired by independent Chairman | Minister of Health and Parliament | ✓ | ✓ | ✓ | |
| Vietnam Tobacco Control Fund (2013) | Semi-autonomous agency and a unit in MOH | Inter-sectoral Management Board chaired by Minister of Health | Government Office and National Assembly | ✓ | ✓ | ||
| Lao PDR Tobacco Control Fund (2013) | Unit in MOH | Tobacco Control Fund Council (National Tobacco Control Committee chaired by Director General of Finance and Planning Department, Ministry of Health) | National Tobacco Control Committee and Government Cabinet | ✓ | ✓ | ||
Health promotion fund resource hub
The Southeast Asia Tobacco Control Alliance (SEATCA)
and the Thai Health Promotion Foundation (ThaiHealth),
established an online of Health Promotion Fund Resource
Hub and Health Promotion Fund E-learning course.
The HPF Hub (hpfhub.info) serves as one-stop resource for
innovative sustainable financing mechanisms for health
promotion. The HPF Hub provides a comprehensive guide
to understand the importance of a health promotion fund,
fiscal mechanisms to secure a long-term sustainable fund,
fund management, and practical steps to establishing a
Health Promotion Fund alongside evaluation and assessment
frameworks.
In addition, the HPF Hub offers a free e-learning course on
“Innovative and Sustainable Financing for Health Promotion
and Tobacco Control”.
Recognizing most countries are still facing inadequate and
sustainable funding to address health and economic burdens
caused by NCD, this e-learning provides an online learning
platform for sharing knowledge and lessons learned from
experts on developing innovative financing mechanisms to
secure sustainable funding for health promotion and NCD
prevention.
Earmarked taxes: A global view
More than 40 countries earmark tobacco tax revenues for health purposes
- Tobacco control programmes
- Health coverage expansion (e.g. through health insurance coverage)
- NCD prevention and control programmes
- Other, more general or unspecified health programmes
| Tobacco Control Programmes | Health Coverage Expansion | NCD Prevention and Control Programmes | Other, More General or Unspecified Health Programmes |
|---|---|---|---|
| Yemen | Colombia | Panama (National Institute of Oncology) | Colombia (sports) |
| Lao PDR | Congo | Costa Rica | Paraguay (sports) |
| Vietnam | Egypt | Paraguay | Costa Rica (sports) |
| Madagascar | Azerbaijan | Mauritania (anti-cancer research) | Côte d'Ivoire (AIDS programme) |
| Côte d'Ivoire | Philippines | Botswana | |
| Gabon | Palau | Madagascar (sports) | |
| Bulgaria | Indonesia | ||
| Switzerland | Thailand | ||
| Panama (tobacco cessation and fighting illicit trade) | Nepal | ||
| Costa Rica | India (emergency response) | ||
| Palau (NCD prevention only) | Bangladesh | ||
| Comoros (sports, hospital emergencies) | Mongolia | ||
| Estonia (sports) | |||
| Lithuania (sports) | |||
| Ireland | |||
| Tunisia | |||
| Algeria | |||
| Morocco | |||
| United States of America | |||
| Argentina | |||
| Kenya | |||
| Guatemala | |||
| Nicaragua (sports) | |||
| El Salvador | |||
| Jamaica |
*Country names appear more than once when their tax revenues are earmarked for more than one specific health programme.
More than 20 countries earmark alcohol tax revenues for health purposes
- Alcohol control programmes
- Health coverage expansion (e.g. through health insurance coverage)
- NCD prevention and control programmes
- Promotion of physical activity
- Other, more general or unspecified health programmes
| Health Coverage Expansion | NCD Prevention and Control Programmes | Promotion of physical activity | Other, More General or Unspecified Health Programmes |
|---|---|---|---|
| Chad | Mongolia | Bulgaria | Venezuela |
| Azerbaijan | Lithuania | Switzerland | Colombia |
| Philippines | Ireland | Nicaragua | Costa Rica |
| El Salvador | Paraguay | Bolivia | Panama |
| Gabon | Guatemala | ||
| Madagascar | |||
| Thailand | |||
| France | |||
| Morocco |
Nine countries earmark sugar-sweetened beverage tax revenues for health purposes
- Health coverage expansion (e.g. through health insurance coverage)
- NCD prevention and control programmes
- Promotion of physical activity
- Other, more general or unspecified health programmes
| Health Coverage Expansion | NCD Prevention and Control Programmes | Promotion of physical activity | Other, More General or Unspecified Health Programmes |
|---|---|---|---|
| France (through social security) | Panama (cancer and diabetes) | Nicaragua | Portugal |
| Hungary | Zimbabwe | Poland | |
| Azerbaijan | |||
| Philippines |
Funding for tobacco control is low - received only 0.3% of total
development assistance for health
(DAH) between 2018 and 2021.
An annual funding of USD 9.6 billion is needed for comprehensive
implementation of WHO
FCTC worldwide. However, the current funding available for tobacco control programmes is about
USD 1.2 billion (equivalent of 12% of
the amount required for comprehensive tobacco control
implementation) with an annual funding gap of USD 8.4 billion.
Innovative funding mechanisms in ASEAN
| Budget Allocations (USD) | |||||
|---|---|---|---|---|---|
| Ministry of Health Budget | Health Promotion Centre (operational budget), Ministry of Health, Brunei (2008)* |
408,606 (BND 550,000) (2023-2024) 408,606 (BND 550,000) (2022-2023) 185,730 (BND 250,000) (2021-2022) |
189,107 (BND 250,000) (2019-2020) 115,942 (BND 160,000) (2017-2018) 115,942 (BND 160,000) (2016-2017) |
||
| Singapore Health Promotion Board (2001)** |
435 million (SGD 591 million) (2022) 358 million (SGD 486 million) (2021) 241 million (SGD 328 million) (2020) |
261.71 million (SGD 352 million) (2019) 185.61 million (SGD 245 million) (2018) 183.33 million (SGD 253 million) (2017) |
|||
|
Philippine Department of Health Philippine Health Insurance Corporation |
Republic Act 10351 (2012) 85% of incremental tobacco and alcohol tax revenue earmarked for health
|
||||
|
Republic Act 11467 (2020) I. Sugar-sweetened beverages (SSBs) 50% of the total excise taxes collected from sugar-sweetened beverages shall be allocated in the following manner:
|
|||||
|
II. Alcohol products 100% of the total revenues collected from excise taxes on alcohol products shall be allocated in the following manner:
|
|||||
|
III. Heated tobacco and vapor products 100% of the total revenues collected from excise taxes on heated tobacco and vapor products shall be allocated in the following manner:
|
|||||
| Earmarked Surcharge Tax | Lao PDR Tobacco Control Fund (2013)*** |
2% profit tax plus LAK 200 per pack 40,933 (LAK 779,128,800) (2022) 117,740 (LAK 1,004,912,730) (2018) 116,700 (LAK 945,266,000) (2017) |
|||
| Thai Health Promotion Foundation (ThaiHealth) (2001) |
121.43 million (THB 4.17 billion) (2023) 118.24 million (THB 4.08 billion) (2022) 122.63 million (THB 4.09 billion) (2021) 136.88 million (THB 4.09 billion) (2020) |
140.07 million (THB 4.17 billion) (2019) 124.87 million (THB 4.03 billion) (2018) 135.04 million (THB 4.4 billion) (2017) 119.80 million (THB 4.28 billion) (2016) |
|||
| Vietnam Tobacco Control Fund (2013) |
1% excise tax, effective 1 May 2013; 1.5% from 1 May 2016; 2% from 1 May 2019 17.15 million (VND 405 billion) (2022) 16.26 million (VND 375 billion) (2020) 11.26 million (VND 261 billion) (2019) |
||||
| National Treasury Allocation | Malaysian Health Promotion Board (MySihat) (2006)**** |
1.91 million (MYR 7.5 million) (2018) 1.65 million (MYR 7.1 million) (2017) |
|||
| Indonesia Local Cigarette Tax (2014) |
Distribution of 10% local cigarette tax revenue to provinces for health***** 1.52 billion (IDR 22.79 trillion) (2023) 1.27 billion (IDR 18.96 trillion) (2022) |
||||
* The budget also covers other NCD prevention programmes (healthy eating, physical activity, school health, and community programmes), in both children and adults.
** Budget for all health programmes under HPB and not solely for tobacco control.
*** This excludes the tax uncollected from imported brands as the tobacco industry refused to pay the 2% profit tax and LAK 200 per pack.
**** In June 2018, the Cabinet decided to abolish MySihat as part of the government’s rationalisation plan.
***** 10% local tobacco tax surcharged for social development (50% of the amount is for health - 75% of the 50% allocation for health is to be used for the National Health Insurance (Jaminan Kesehatan Nasional (JKN)) programme, 25% for maintenance of health facilities).
Thailand: Annual budget for health (2010-2022)
| 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ThaiHealth budget as percentage of combined MoPH budget + Fund for National Health Security (%) | 1.93 | 1.80 | 1.78 | 1.83 | 1.84 | 1.83 | 1.49 | 1.49 | 1.30 | 1.32 | 1.25 | 1.68 | 1.45 |
Thaihealth funding for selected major NCDs risk reduction programmes (2017-2022)
Implementation of FCTC Article 5.3 in ASEAN
- Code of conduct, guidelines, or other policy >
- Limited to issuing authority
- Apply to the whole bureaucracy
| COUNTRY | Policy |
|---|---|
| Myanmar | Directive No. 91/2020 Guidelines on contact with cigar and tobacco product manufacturers, distributors, sellers, or related persons apply to the Ministry of Health only. |
| Philippines | Civil Service Commission - Department of Health Joint Memorandum Circular 2010-01 (JMC) applies to the whole government. |
| Lao PDR | Tobacco Control Law (Amended) 2021 - prohibition of involvement with the tobacco industry in protecting public health policies applies to all government agencies. |
| Cambodia |
The circular of the Ministry of Education, Youth, and Sport bans all forms of partnerships with the tobacco industry among educational facilities. The sub-decree on the establishment and functioning of the Committee for Tobacco Control (CFTC) has incorporated principles of Article 5.3. |
| Brunei Darussalam | Prime Minister Circular (code of conduct) on prohibition of involvement with the tobacco industry applies to all government agencies. |
| Singapore | Implementation of internal code of conduct is enforced by the whole government. |
| Indonesia |
The ministerial regulation (code of conduct) or guidelines only apply to the Ministry of Health. The Ministry of Education and Culture guidelines reject any form of advertising offers, promotions, sponsorship, and/or cooperation with the tobacco industry and support tobacco-free school premises. |
| Vietnam | No policy. |
| Malaysia | No policy. |
* In 2017, the Vietnam Ministry of Health (MOH) issued an official letter advising all ministries and local government offices on non-cooperation with the PMI-funded Foundation for a Smoke-free World (FSFW), and in 2019, MOH also issued a circular to safeguard the drafting process for policies and legal documents to reduce interference from other units with conflicts of interests.
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