Synthesis of major common factors that affect FCTC implementation in the Cook Islands, Vanuatu, Nauru and Palau
| Common facilitators | Common barriers | |
|---|---|---|
| Content | ▸ The goals, causal theory and methods of FCTC and resultant tobacco control legislation as a whole were seen as appropriate, achievable and effective, especially in the case of cost-effective provisions | ▸ Some FCTC provisions were seen as somewhat ambitious and/or difficult to achieve in light of limited capacity |
| Context | ▸ Institutional networks among staff and departments within the ministry of health departments, and networks with external agencies, were supportive in all cases | ▸ Institutional networks between the key actors in the ministries of health and the government departments outside of health tended to be weak ▸ Institutional networks between the ministries of health and NGOs were not evident in countries where antitobacco NGOs did not exist (Vanuatu/Nauru) |
| Commitment | ▸ Ministry of health commitment tended to be favourable, although competing health issues was a limiting factor | ▸ Commitment at the ground level was hindered by competing issues (Cook Islands/Nauru), and rurality/remoteness (Vanuatu and to some extent the Cook Islands) ▸ Whole-of-government commitment is challenged in departments outside of health. Commitment from the ministry of finance or equivalent, police authorities, legal departments to FCTC provisions from all countries tended to be weaker |
| Capacity | ▸ Mandated authority for staff within the Ministry of Health to enforce FCTC provisions facilitated implementation in the Cook Islands, Vanuatu and Nauru ▸ External agencies, including the WHO, Secretariat of the Pacific Community, Australian Agency for International Development, New Zealand Aid Programme and the CDC, provided assistance towards FCTC implementation | ▸ A lack of staff and funding/resources were major barriers in the Cook Islands, Vanuatu and Nauru, and to a lesser extent in Palau. The tobacco control focal point typically consisted of one person ▸ Sustainable funding mechanisms for tobacco control (ie, earmarking taxes to health promotion/tobacco control) have not been achieved in any of the four countries examined |
| Clients & Coalitions | ▸ Very limited public pro-tobacco coalition activity existed, which can partially be attributed to limited tobacco manufacturing presence ▸ The public has generally supported tobacco control regulation, as indicated in each of the countries examined. There has been no public protest or attempts to disrupt FCTC implementation | ▸ Antitobacco NGOs did not exist in Vanuatu or Nauru, and a coalition group was inactive for some time in the Cook Islands. In situations where NGOs did exist, there was limited funding and a strong reliance on volunteers |
CDC, Centers for Disease Control; FCTC, Framework Convention on Tobacco Control; NGO, non-government organisation.