Innovative and Sustainable Financing Mechanism for Health Promotion and Tobacco Control

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3.6 Health promotion model: A unit within the government structure

Introduction

Let's learn about the unit within the government structure and its relevant case studies.

Model 3: Unit Within the Government Structure

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Public health and health promotion traditionally reside in the ministry of health.

However, it can be:

Set up and managed by any government department but should be accountable and responsible to the Prime Minister or the Ministry of Health
May result in less flexibility for innovative and more controversial programmes, if some government members are unsupportive

The main goal is supporting the implementation of government public health policies and strategies in close collaboration with other government sectors
Easier access to other government departments
Foster greater coordination, and reduce the potential for duplication of resources, funding, or efforts
May inhibit its ability to collaborate with civil society and non-government agencies as well as some parts of the private sector
Likely to be exposed to administrative and government influence, particularly in policy making and priority setting for health promotion
Decision-making process for the disbursement of grants/scholarships may be more readily influenced compared to an autonomous entity

The sources of funding can be the same as for an autonomous entity. However, if collection of funds is handled within the government system in the absence of an independent board to oversee the distribution of funds, there is a high potential for ministerial and legislative redirection of funds to other priorities

Advantages

Fully support and implement government public health policies, priorities, and strategies because of the close working relationship with other areas within the department
Gain direct access to government through the Minister and Departmental Head to better influence policy and direction for health promotion
Reduce potential for duplication of funding or effort
Access resources and expertise from a range of other departmental units

Disadvantages

Reduced independence because of direct ministerial control; limited flexibility to undertake innovative and perhaps controversial programmes and activities
Possibility of political influence in grants and sponsorship disbursement decisions
Potential competition from within the department for resources
Capacity may be limited by the bureaucratic requirements of a government department, thus affecting the ability of the unit to collaborate with other ministries and especially with other sectors outside of the government to respond quickly to emerging health issues or to provide grants in a timely manner

Case Study of Singapore Health Promotion Board (HPB), 2001

Governance structure

Semi-autonomous agency and a unit in MOH

Governed and chaired by

Board of Governance and independent chair

Report to

Minister of Health

Funding source

Ministry of Health budget

Estimate total annual budget (USD)

183.33 million (SGD 253 million) (2017)

185.61 million (SGD 245 million) (2018)

261.71 million (SGD 352 million) (2019)

241 million* (SGD 328 milion) (2020)

358 million* (SGD 486 million) (2021)

435 million (SGD 591 million) (2022)

*Annual total budgets were increase significantly as HPB was one of the primary agencies dealing the COVID situation in Singapore.

Purpose of the fund

Being a centre of excellence for health promotion, disease prevention and patient education.
Establishing, engaging and supporting local and international partnerships.

Expand to read more about the Singapore Health Promotion Board

Introduction

Singaporeans have one of the longest life expectancy at birth in the world.¹ In part, this is contributed by Singaporeans enjoying good access to quality and affordable healthcare. However, with a rapidly ageing population and the shift towards a fast-moving, knowledge-based economy with more sedentary jobs, non-communicable diseases have been on the upward trend and drove 80% of Singapore’s burden of diseases in 2017.²

One major thrust in Singapore’s approach in its design of the health system is the emphasis on preventive efforts to keep Singaporeans healthy. The Health Promotion Board (HPB)³ was set up by Singapore’s Ministry of Health (MOH) in 2001 as a statutory board to drive Singapore’s national health promotion and disease prevention programmes. In line with the MOH’s twin philosophies of individual responsibility and affordable healthcare for all, HPB’s approach to health promotion is to drive behaviour changes for healthier lifestyles in the population through awareness, adoption, and sustaining of healthy behaviours using public education, intervention programmes and digital engagement, as well as influencing the environment to support healthier choices.

Governance Structure and Funding

A Board of Directors is appointed for corporate governance and oversight. This Board comprises independent members from a variety of sectors including academia, audit, finance, healthcare, and the public and private sectors. The Board reviews and approves HPB’s strategies, plans and financial budgets to ensure that activities and resources allocated are optimised to meet HPB’s objectives and key priorities as well as the MOH’s mandate.

HPB operates on a 5-year block budget from the MOH, on a predetermined set of deliverables (performance indicators) with MOH. HPB has the operational flexibility to reallocate resources within the budget based on operating conditions. In Financial Years 2018, 2019, and 2020⁴ , HPB operated on an approximate budget of SGD282 million, SGD328 million, and SGD486 million, respectively. Yearly reports are provided to the MOH to apprise funders on the health of key performance indicators. By law, HPB is also required to report to the Parliament annually. In addition, a mid-term review is also conducted during the 5-year funding cycle to ensure that the board is on track to achieve the strategic goals.

Approach to Health Promotion

HPB takes a life-course approach in influencing common modifiable lifestyle risk factors, including eating well, being physically active, not smoking and having good mental health. This is complemented by secondary prevention efforts such as early detection of diseases through evidence-based health screening for adults, children/ youth. In addition, HPB also promotes communicable disease education and prevention.

Outreach efforts are focused on three key settings – Schools, Workplaces, and Community - as well as digital engagement to ensure that the preventive programmes are of sufficient scale and reach the mass population. This is supplemented by targeted efforts to reach out to hard-to-reach segments such as the families of lower socio-economic status and ethnic minorities. HPB also works closely with public sector agencies, the industry, and grassroot organisations using a combination of approaches including programmes, policy and regulatory levers, and grants to change the environmental context and influence social norms to make healthy living more accessible and acceptable for the larger population.

Physical Activity
For example, we encourage Singaporeans to be physically active through a wide range of physical activity programmes, which are available at community spaces across the island, such as neighbourhood parks and shopping malls. This normalises the concept of having people come together in shared spaces, exercising anywhere and everywhere.

To influence a shift away from a sedentary lifestyle and physical inactivity, HPB also initiated a nationwide physical activity steps movement, more commonly known as the National Steps Challenge (NSC) in 2015. Leveraging the concept of gamification and technology, the programme empowers Singaporeans to take responsibility for their health and wellbeing and by tracking their progress towards their personal physical activity goals with the aid of a steps fitness tracker and HPB’s Healthy 365 mobile application. Participants are encouraged to clock steps and engage in moderate to vigorous intensity physical activities and are rewarded with Healthpoints when they achieve certain physical activity milestones. The Healthpoints can be used to redeem rewards such as grocery vouchers and transport credits. The programme has reached 1.7 million unique participants, spanning from youth to working adults and seniors, across 5 seasons from October 2015 till March 2020⁵ .

Diet Quality and Nutrition
To improve diet quality and reduce excessive calorie intake among the population, HPB is working across the whole-of-government and with various stakeholders across the value chain to increase the accessibility of healthier food options and increase demand through education and ground promotion efforts. This involves reformulating key staples and ingredients available in the food supply by providing grants for activities such as new product research and development, marketing and publicity, trade promotion, etc. Year-round consumer promotions and public education campaigns complement the upstream efforts in the food chain.

High sugar levels are linked to increased risk of obesity and diabetes. More than half of Singaporeans’ daily sugar intake comes from beverages, of which prepacked beverages contribute 64 percent. To help consumers 1) identify beverages that are higher in sugar and make more informed, healthier choices, 2) reduce the influence of advertising on consumer preferences, and 3) spur industry reformulation, MOH and HPB announced mandatory nutrition labels and advertising prohibitions for pre-packaged beverages in 2019, which will take effect in December 2022. The policy has persuaded major beverage manufacturers to reformulate their higher-sugar drinks to lower-sugar alternatives, ahead of the effective date of the measures. MOH and HPB will be expanding the policy to include freshly prepared beverages, such as local coffee/tea, bubble tea and juices/smoothies.

Tobacco Control
Singapore has one of the world’s toughest policies on smoking control. To complement the policies, HPB adopted a multi-pronged approach which includes a comprehensive mix of strategies including public education, provision of smoking cessation services (e.g I Quit Programme), partnerships with businesses and grassroots communities, legislation controlling tobacco advertising, sales of cigarettes to minors and tobacco taxation. Agencies such as the Health Sciences Authority (HSA) and the National Environment Agency (NEA) are also undertaking efforts in the tobacco control programme. HSA administers and enforces the Tobacco (Control of Advertisements and Sale) Act while NEA is progressively extending the Smoking (Prohibition in Certain Places) Regulations to more public places where the public are more likely to be exposed every day to second-hand tobacco smoke. Efforts such as the above have driven a downward trend in smoking prevalence in Singapore over the years and maintained at a low prevalence of 10.1% as of year 2020.

World Health Organisation Collaborating Centre
HPB’s contribution in public health extends beyond Singapore’s shores. As a World Health Organisation Collaborating Centre for Health Promotion and Disease Prevention, HPB collaborates with health promotion institutions around the world. The collaborations have facilitated many valuable exchanges and discourse around the prevention of non-communicable diseases (NCD), contributed to the building of health promotion capabilities in the region, strengthened the ties with international counterparts and affirmed Singapore as a leading player in health promotion globally.

The Future of Health Promotion in Singapore

With an increasingly complex health landscape, it is pertinent to ensure that health promotion efforts continue to evolve to be relevant to individuals and maintain their mindshare on healthy living. Developments in technology and data analytics provide new tools and approaches to do so. To this end, HPB is making its foray into precision public health to leverage technology and data-driven approaches to deliver more tailored health interventions to individuals in a timely manner at scale, with the aim of deepening engagement with Singaporeans and sustaining their healthy living journey throughout the life-course and drive greater impact for NCD prevention and control.

For example, Health Insights Singapore (hiSG) is a study undertaken by HPB to understand the health behaviours and lifestyles of Singapore residents through wearable technology. Through that study, HPB is able to monitor participants for at least two years and collect lifestyle and behavioural data across various health topics such as physical activity, nutrition and mental wellbeing. This will in turn contribute to the development of health promotion policies and programmes.

With a growing population of digital natives, HPB will continue to build our capabilities to harness technology and data to enhance our programmes. Going forward, accelerating shifts in lifestyle behaviours through technology-enabled insights, evidence-based research and programmes and innovative engagement and partnership models will be HPB’s key strategic priorities to sustain health promoting environments and empower Singaporeans with the knowledge and skills to make healthy living within reach for everyone.

For more information on HPB, please visit https://hpb.gov.sg/

Reference

¹ WHO Health Statistics 2021. https://cdn.who.int/media/docs/default-source/gho-documents/world-health-statistic- reports/2021/whs2021_annex2_20210519.xlsx?sfvrsn=7f635c31_5

² MOH/IHME 2017

³ HPB is to perform the functions, objects and duties set out in the Health Promotion Board Act (Chapter 122B) (the Act). It was also registered as a charity (Registration no: 01810) under the Charities Act (Chapter 37) since 17 September 2004.

⁴ The financial year starts on 1 Apr and ends on 31 March the next year. (e.g FY20 is from 1 Apr 2020 to 31 Mar 2021)

⁵ Data is accurate as at 18 April 2022 for 5 seasons of the National Steps Challenge. Season 6 ended on 31 March 2022.

Related Reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth).

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

Case Study of Taiwan Health Promotion Administration (HPA), 2001

Governance structure

Unit in Ministry of Health and Welfare, Taiwan (MOHW)

Governed and chaired by

Director General, HPA

Report to

Ministry of Health and Welfare (MOHW)

Funding source

Tobacco Health and Welfare Surcharge
2002: USD 0.17(NTD 5) per pack of cigarette.
2006: USD 0.33(NTD 10) per pack of cigarette.
2009: USD 0.67(NTD 20) per pack of cigarette
2021: USD 0.67(NTD 20) per pack of cigarette

Estimate total annual budget (USD)

USD 243 million (NTD 7 billion 285 million)
(2021)

USD 247 million (NTD 7 billion 421 million)
(2020)

USD 250 million (NTD 7 billion 515 million)
(2019)

Purpose of the fund

To support development of national health policy and health promotion model.
To promote healthy birth and growth.
To promote healthy lifestyles in terms of NCD risk factors (tobacco, unhealthy diet, physical inactivity and alcohol), prevention control, and community development.
To promote healthy aging.
To promote health care for the underprivileged.
To support life-course approach to NCD surveillance and research.

Expand to read more about the Taiwan Health Promotion Administration

The Health Promotion Administration (HPA) of the Ministry of Health and Welfare (MOHW) is the health promotion authority that promotes comprehensive health services to all residents of Taiwan. HPA upholds the spirit of “Prevention is better than cure.” HPA reinforces preventive medicine and community health, intimately integrates social welfare and cross-functional resources, implements the concept of the womb to tomb, citizen health promotion from family to the community. With the director-general in overall charge of the HPA, the administration is also supported by two deputy director-generals and one secretary-general. There are seven operational divisions and four administrative offices responsible for the planning and implementation of health promotion policies.

HPA’s mission includes the promotion of public health, maternal and child health, and primary preventive health services. The ultimate goal of the Administration is to prolong healthy life expectancy for all.

The goal of HPA is to extend the longevity of citizens’ health, reduce health inequality, and achieve “Health for all.” The HPA gives priority to four major initiatives: (1) enhancing health literacy and promoting healthy lifestyles; (2) promoting preventive healthcare, effective prevention, and screening; (3) upgrading the quality of healthcare and improving chronic disease control and prognosis; (4) creating a friendly and supportive environment and bolstering healthy options and equality. It plans and implements measures to promote reproductive health, maternal and child health, adolescent health, and the health of middle-aged and elderly people as well as to advance the prevention and control of health hazards such as smoking and betel-quid use, cancers, cardiovascular diseases, and other major non-communicable diseases. It is also responsible for conducting public health surveillance and related research about other special health topics. Moreover, the HPA joins forces with all the public health agencies in the country’s counties and cities, hospitals, and other medical institutions. It also works with private groups to implement health policies and build a healthy environment for the entire population.

The HPA programmes include:

healthy birth and growth;
healthy lifestyles and community development (tobacco control, obesity prevention and control, and a healthy environment including creating healthy cities and communities, advancing health-promoting schools, hospitals, workplaces, and building a network of safe communities and promoting safe schools);
healthy aging (active aging, chronic disease prevention, and control, cancer prevention and control);
healthcare for the underprivileged; and
a life-course approach to NCD surveillance, research, and health education.

The main funding source for HPA is derived from tobacco health and welfare surcharges. This was in response to a strong campaign by numerous NGOs to push for levying tobacco health and welfare surcharges specifically for tobacco hazards prevention and control, social welfare, and health preventive services. The Tobacco and Alcohol Tax Act 2000 came into force in 2002. Prior to this, there was a Tobacco Hazards Prevention Act passed in 1997. In 2007, Tobacco Hazards Prevention Act was mandated to be the source of law for levying tobacco health and welfare surcharge. About USD 0.67 per pack of tobacco health and welfare surcharge has been collected since 2009. The tobacco health and welfare surcharge is allocated for national health insurance reserves and health promotion activities to provide health equality to all citizens.

Tobacco health and welfare surcharge distribution and utilization including

50% for National Health Insurance reserves;
2% for the Ministry of Health and Welfare to support medical subsidies for rare diseases and for cancer prevention and tobacco control and health promotion;
8% for improving medical affairs such as
4% for the Ministry of Health and Welfare to subsidize medical shortage areas and upgrade the quality of clinical care;
3% for the Centers of Disease Control (CDC) to upgrade the quality of vaccines;
1% for the MOHW to promote public health and social welfare;
1% for the Ministry of Finance to support the investigation of smuggled or inferior tobacco products and prevent tax evasion of tobacco products;
less than 1% for the Ministry of Agriculture to provide assistance to tobacco farmers and workers of related industries.

Based on the budget distribution, the HPA received 27.2% of the total tobacco health and welfare surcharge with an estimated budget of USD 250 million (NTD 7 billion 515 million) in 2019; USD 247 million (NTD 7 billion 421 million) in 2020; and USD 243 million (NTD 7 billion 285 million) in 2021. The funding is used for medical subsidies for rare diseases and for cancer prevention and tobacco control and health promotion at the national and local levels.

The Tobacco Hazards Prevention and Health Protection Funds are controlled by MOHW, and HPA is the managing and implementing unit. To ensure the transparency and accountability of the tobacco health and welfare surcharge distribution and utilization, a council of the fund was established to review and evaluate the activities of the fund. It comprises a convener represented by the Deputy Minister of the Ministry of Health and Welfare, the executive secretary held by the Director-General of HPA, and 13 to 17 experts or scholars to support them.

With the greater proportion of tobacco health and welfare surcharges allocated to national health insurance, subsidization, and investigation of smuggled or inferior tobacco products, not all health promotion activities can be funded adequately. An evaluation system is being developed to measure outcomes to support any changes in the tobacco health and welfare surcharges distribution and utilization. In addition, to gain more financial resources, HPA works to strengthen its partnerships with other agencies or organizations that have similar goals and tasks.

References

Organization Act of the Health Promotion Administration, Ministry of Health and Welfare 2013. (Taiwanese, English)

Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Taiwan Health Promotion Administration Annual Report 2021, Taiwan.

Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Taiwan Tobacco Control Annual Report 2020, Taiwan.

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth).

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

Case Study of Korea Health Promotion Institute (KHEPi), 2011

Governance structure

Autonomous agency under Ministry of Health

Governed and chaired by

Board of Directors and chaired by a president

Report to

Minister of Health and Welfare

Funding source

Treasury budget and donations

Estimate total annual budget (USD)

10 million (2013)

Purpose of the fund

To develop and support of national health promotion policies.
To plan and implement national health promotion projects.
To develop technique and consult of national health promotion programs.
To develop evaluation system, research & analysis, providing information associated with health promotion and community health services.
To collaborate with specialized agencies which are related to health promotion and community health.

Expand to read more about Korean Health Promotion Institute (KHEPi)

Korea Health Promotion Institute (KHEPi)

Korea Health Promotion Foundation was established in 2011. The foundation is governed by a president and a board of directors, which consists of 13 members including the president.

It aims to increase public awareness of health promotion, enhance quality of life and thus extend life expectancy, and attain health equity for the people besides developing an effective management system for health promotion programmes and services.

Generally, the budget sources of Korea Health Promotion Foundation are the National Health Promotion Fund and donations. Most of the funding is derived from the Ministry of Health and Welfare budget. Donations contributed by SamSung Life Insurance Incorporation were used to support suicide prevention and cervical cancer prevention programmes.

The Korea Health Promotion Foundation’s budget is used to support policy development and the implementation of tobacco control programmes, nutrition and oral health programmes. However, this type of funding mechanism provides insufficient and unpredictable financial resources to support health promotion initiatives. This funding limitation is a major challenge for the Foundation. In order to provide sustainability of health promotion programmes, the Korea Health Promotion Foundation would like to be established under National Health Promotion Law.

The priority areas for funding also include research and policy development of health promotion programmes and evaluation, educational programmes for health promotion, developing new model of health promotion and community health care system, and building knowledge and skills in health promotion among professionals.

To ensure the effective implementation of its programmes, Korea Health Promotion Foundation built a network and collaborated with various sectors including public and private agencies as well as the international partners.

References

International Network of Health Promotion Foundations (INHPF). Legislation for Health Promotion Foundations. Available at: http://www.hpfoundations.net/about-hp-foundations/legislation-for-hpf

International Network of Health Promotion Foundations (INHPF). Governance of Health Promotion Foundations. Available at: http://www.hpfoundations.net/about-hp-foundations/governance-of-hpf

Choi J-M. Korea Health Promotion Foundation. Presented at International Seminar on Health Promotion Foundations and 12th Annual Meeting of the INHPF, 25- 27 June 2012, Seoul, South Korea.

So YJ. Korea Health Promotion Foundation. Presented at Presented at International Seminar on Health Promotion Foundations and 12th Annual Meeting of the INHPF, 25- 27 June 2012, Seoul, South Korea.

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth).

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

Case Study of Vietnam Tobacco Control Fund, 2013

Governance structure

Semi-autonomous agency and a unit in MOH

Governed and chaired by

Inter-sectoral Management Board and chaired by Minister of Health

Report to

Government and National Assembly

Funding source

A compulsory contribution equal to 1% of factory price of all cigarette packs consumed in Viet Nam, effective May 1, 2013; increase to 1.5% from May 1, 2016; and 2% from May 1, 2019

Estimate total annual budget (USD)

11.263 million (VND 260,970 million) (2019)

16.256 million (VND 375,030 million) (2020)

17.15 million (VND 405 billion) (2022)

Purpose of the fund

To support communication and community-based campaigns on the harmful effects of tobacco and initiatives on prevention and control of tobacco harms.
To support development of pilot models of smoke-free community, agencies and organizations as well as community-based smoking cessation services.
To generate evidence through research.
To build capacity among the network of collaborators.
To support development of teaching materials and integration of teaching on tobacco harms and tobacco control in the educational programs.
To support the implementation of measures for alternative occupation for tobacco growers, tobacco raw material processing, and tobacco manufacturing workers.

Expand to read more about the Vietnam Tobacco Control Fund

Vietnam Tobacco Control Fund (VNTCF)

Vietnam Tobacco Control Fund (VNTCF) was established under the Tobacco Control Law passed by the National Assembly of Vietnam on 18 June 2012 and effective on 1 May 2013. The fund is for the prevention and control of tobacco harms. The Prime Minister is responsible for organizational regulations and the operation of the fund.

It is managed and administered by an Inter-sectored Management Board, under which there are other supporting boards including: Board of Profession Consultants; Board of Controller; and Board of Executive.

The inter-sectoral Management Board is chaired by Minister of Health and supported by a representative from Ministry of Finance as vice chair as well as member representatives from Ministry of Industry and Trade, Ministry of Education and Training, Ministry of Information and Communication and other relevant agencies.

VNTCF is a national fund under the arm of the Ministry of Health (MOH) and subjected to state financial management by Ministry of Finance (MOF). The MOH is also responsible for reporting to the government on performance management and the use of funds annually, and reporting to the National Assembly on the results of operations and the management of the fund biannually.

Existing within a government structure, VNTCF functions as a semi-autonomous entity.

The funding source for VNTCF is derived from a compulsory contribution, which is calculated as a percentage of the excise tax-based prices (factory price) imposed on tobacco manufacturers and importers. They are required to contribute one percent (1%) of factory prices of all cigarette packs produced locally or imported to be consumed in the country, beginning from 1 May 2013. This tax will be increased to 1.5% from 1 May 2016 and 2% from 1 May 2019. The fund is also open for voluntary contribution from national and international organizations and individuals as well as other legal sources. All the collections received are directed to the Fund and used for prevention and control of tobacco harms. In 2019, VNTCF has collected USD 11.263 million (VND 260,970 million) and USD 16.256 million (VND 375,030 million) in 2020.

Based on a not-for-profit principle and subject to approval by the Fund's Management Board, the fund aims to support a wide range of short-, medium- and long-term strategies and activities. These include communication and community-based campaigns about the harmful effects of tobacco use and other prevention and control strategies; development of pilot models of smoke-free community, agencies and organizations; community-based smoking cessation services; evidence generation through research and building capacity among the network of collaborators; content development on the harms of tobacco and on tobacco control for educational programmes; and support for the implementation of measures for alternative occupations for tobacco growers, tobacco raw material processing and tobacco manufacturing workers.

Between 2019 and 2020, 100 grantees were funded by VNTCF with a total funding of USD 27.568 million (VND 636,000 million) distributed among 23 ministries, mass organization agencies, 63 provinces/cities agencies, 4 tourism cities and 10 hospitals. The projects supported mainly on communication campaigns related to tobacco prevention and control, smoke-free development, and capacity building for law enforcement.

References

Socialist Republic of Vietnam. Law on Prevention and Control of Tobacco Harms. Law No.:09/2012/QH13. 18 June 2012.

Law on Prevention and Control of Tobacco Harms 2012.

Department of Tax Policy, Ministry of Finance. Establishing Governance and mechanism of Vietnam Tobacco Control Fund (VNTCF). Presented at ProLEAD E: Establishing Health Promotion Foundations, ProLEAD Module II for Lao PDR and Viet Nam, Vientiane, Lao PDR, 3-4 April 2013.

Vietnam Tobacco Control Fund (VNTCF). (2020). Performance, management and use fund for tobacco control for the period of 2019-2020.

Related reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth).

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.

Case Study of Lao PDR Tobacco Control Fund, 2013

Governance structure

Unit in MOH

Governed and chaired by

Tobacco Control Fund Council (The National Committee on Tobacco Control)

Report to

Government

Funding source

Government budget:
- 2% of profit tax from tobacco business operators
- 200 kip per cigarette package from all local tobacco manufacturers producers and imported the manufactured tobacco products

Estimate total annual budget (USD)

116,700 (LAK 945,266,000) (2017)

117,740 (LAK 1,004,912,730) (2018)

Purpose of the fund

To support implementation of tobacco control law and Framework Convention on Tobacco Control (FCTC).
To improve and strengthen health care service quality.
To support National Health Insurance scheme for the public.
To support the cost of a administration and necessary performance for the National Committee on Tobacco Control.

Expand to read more about the Lao PDR Tobacco Control Fund

Lao PDR is establishing a tobacco control (TC) fund as stipulated in the tobacco control law passed in November 2009. A Prime Ministerial Decree for the TC fund was adopted by the government in January 2013 and became effective in May 2013. The fund is placed under the Ministry of Health and operates as a semi-autonomous entity.

It is governed by the Tobacco Control Fund Council which reports to the National Committee on Tobacco Control, which is chaired by the Minister of Health and supported by two vice-chairs from the Vice Ministers of the Ministry of Finance and the Ministry of Industry and Commerce. The other members are the Vice Minister of the Ministry of Education and Sport; Media Department (Ministry of Culture Information and Tourism); Police Environment Department (Ministry of Security); and Hygiene and Health Promotion Department (Ministry of Health). The Prime Minister appoints Council members. The Council is supported by a secretariat team comprising a manager, vice manager, and technical staff to carry out the management and implementation of the Fund. They are from the Tobacco Control Fund Office (TCFO) located in the Finance Department, Ministry of Health.

The funding sources of the tobacco control fund are obtained from two mains sources: 1) two percent (2%) additional profit tax from tobacco business operators, and 2) 200 kip per cigarette package of locally produced tobacco and/or imported the manufactured tobacco.

The fund is equally distributed across the different objectives. About 37% of the total budget is allocated for tobacco control and health promotion activities including health education; production of tobacco control Information, Education and Communication (IEC) materials; cessation programmes for smokers who want to quit smoking and those who have been affected by tobacco smoke; the expansion of smoke-free areas; support for research on the health, economic and social impacts of tobacco smoking; smuggling control activities, and an awards programme that recognizes individuals and organizations who have achieved and contributed to the implementation of tobacco control.

A further 25% is used for improving and strengthening health care service quality such as building, renovation, and medical supplies and equipment for public hospitals, particularly for the diagnosis and treatment of tobacco-related diseases. Another 32% is for a National Health Insurance scheme for the public. The remaining six percent (6%) is for supporting the cost of administration and performance for the National Committee on Tobacco Control.

References

¹ Law on Tobacco Control. Vientiane, 26 November 2009.

² Decree on Tobacco Control Fund. Vientiane, 24 May 2013.

³ Pholsena S. Establishing Governance and mechanism of Tobacco Control Fund in Lao PDR. Presented at ProLEAD E: Establishing Health Promotion Foundations, ProLEAD Module II for Lao PDR and Viet Nam, Vientiane, Lao PDR, 3-4 April 2013.

Related Reports

World Health Organization. (2004). The establishment and use of dedicated taxes for health. World Health Organization Regional Office for the Western Pacific.

Vathesatogkit P, Yen Lian T, Ritthipakdee B. (2013). Health Promotion: Sustainable Financing and Governance. Bangkok, Thai Health Promotion Foundation (ThaiHealth).

World Health Organization. (2016). Earmarked tobacco taxes: lessons learnt from nine countries. Geneva, World Health Organization.