BACKGROUND: As tobacco control policies have seen significant global uptake over the past two decades, understanding their implementation processes is critical to ensuring policy effectiveness. Low- and middle-income countries (LMICs) bear a disproportionate burden of tobacco-related harm, and progress in tobacco control often lags behind that of high-income countries. This study, part of a larger research project on tobacco control policy implementation in LMICs, focuses on the role of civil society organisations (CSOs), exploring their implementation activities and examining the facilitators and barriers that influence their efforts.
METHODS: Six LMICs, one from each WHO region, were selected based on their adoption of smoke-free policies, health warnings, or tobacco advertising, promotion, and sponsorship (TAPS) restrictions—three key MPOWER measures—between 2012 and 2020. In each country, semi-structured interviews were conducted with advocates, public officials, and staff from international organisations. Data were analysed thematically.
RESULTS: Participants from all six countries reported that CSOs engaged in several implementation activities, including: (1) raising public awareness, (2) training implementers, (3) monitoring compliance and exposing violations, and (4) supporting public bodies, for example, in developing regulations and enforcing policy. Key facilitators of these activities included public and political support, while barriers encompassed tobacco industry interference, regulatory gaps, and limited resources. A critical challenge was the lack of or reduction in funding following policy adoption, with small, short-term projects proving insufficient to sustain efforts. Variations by policy type were noted; for instance, industry interference was less prominent for smoke-free policies, while public support was less essential for health warnings than for other measures.
CONCLUSIONS: This study shows that CSOs are essential actors in tobacco control policy implementation in resource-limited settings, addressing gaps in awareness, capacity-building, and monitoring. It also highlights the need to explore strategies that can better support CSOs and ensure the long-term effectiveness of tobacco control policies in LMICs.