Programs: Tobacco control:the bloomberg initiative to reduce tobacco use is working to implement proven tobacco control policies around the world. It aims to reduce the global demand for tobacco through a comprehensive, proven approach that combines policy change with increased public awareness. In 2017, vital strategies advanced critical tobacco control policies across 10 countries and significantly influenced standards and practice globally. As a result, hundreds of millions more people are protected by new or strengthened mpower policies; millions have quit smoking as a direct result of our campaigns; we know more about how to gain traction on tax campaigns and expose tobacco industry tactics; and we have built stronger public support on- and offline for new interventions. In 2017, vital strategies supported 38 best-practice media campaigns in 10 countries while garnering significant government investment. Government partners provided funds or in-kind donations totaling more than $4 million and contributed in every country where we did a campaign. Synergized with other advocacy partner activities, these campaigns helped to achieved critical policy wins. We're also leveraging communities and relationships with key local organizations such as the women's union in vietnam to advance smoke-free policy and demonstrate both high-level and vocal public support for tax increases. To guide our campaigns, we engaged in 2017 in data-driven research with government officials, key stakeholders and the general public in countries to learn what types of messages are most likely to grow support of tax policies and expose the tobacco industry's nefarious behavior. Vital strategies gave sub grants to organizations to contribute towards building the movement for global tobacco control through its focus legislative and policy outcomes across mpower measures, industry interference and tobacco control sustainability. There were major strides made by our partner organization the union in the promotion and adoption of who fctc compliant legislation at both national and subnational levels. Tax: the union help with building the capacity of officials at the ministry of health, ministry of finance, other ministries, and parliamentarians on tobacco tax in both vietnam and indonesia. Policy recommendations were developed for the moh in indonesia. A draft tax bill was developed with the union's help for the mof in vietnam. The union also worked closely with bloomberg partners in developing tax models for the mof in vietnam. In india, the union works with grantees in monitoring the price and tax changes for tobacco products incurred by the introduction of gst. In pakistan, the union engaged moh in tax discussion through hiring a tax consultant for moh and coordinated with moh and bi partners and ensured that the recommendations from both sides align with each othersmoke-free: smoke-free remains a priority policy area for the union in 2017. In china, the national smoke-free law was fiercely opposed by the tobacco industry and the legislative process came to a halt in 2017. Another major policy focus in 2017 for china is the national health promotion law, which is a general public health law and includes tobacco control provisions, particularly smoke-free. The union helped china cdc in drafting the tobacco control provisions in the health promotion law. The review and debate around the law will continue into 2018. Considerable progress in smoke-free has been made at the sub-national level in china. Two cities shenzhen and lanzhou, with a combined population of 16 million, became 100% smoke-free in 2017. Hangzhou and guangzhou, with a combined population of 24 million, have made impressive progress in building political momentum and the amendments of both smoke-free laws are expected to be passed in 2018. Seven jurisdictions in india with a total population of 15 million were declared smoke-free in 2017. Five subnational jurisdictions in indonesia with a total population of 7 million adopted a smoke-free policy in 2017. In pakistan, the union launched a project to replicate the successful smoke-free islamabad model in 5 districts in punjab. With the help of the union grantee ash philippines, the executive order on smoke-free environment was issued by the president and an administrative order was released by the moh in 2017. Georgia and benin became 100% smoke-free countries after the comprehensive tobacco control law was passed in 2017. Phw and plain packaging: the momentum in implementing phw in countries we work in has been strong in 2017. Nepal became one of the international best practices in phw when it adopted the policy for 90% phw in early 2017. Other countries that passed laws requiring phw in 2017 include myanmar (75%), cambodia (55%), georgia (65%), and benin (50%). The bangladesh ministry of health issued an order to require pictorial health warnings to be placed on the upper part of the pack rather than the lower part as according to the 2016 interim order. The pakistan federal cabinet decided to implement a 50% pictorial health warning starting from june 2018 and then 60% from june 2019. Progress has been made in the push for plain packaging in brazil and uruguay. Inca in brazil built legal and technical foundation for the proposed plain packaging bill by producing an expert opinion on the constitutionality of the policy before the congress. The uruguay government submitted a plain packaging proposal to the congress, which is expected to be approved in the first half of 2018. Once passed, uruguay will have the world's most comprehensive set of restrictions on tobacco branding with its existing single presentation regulation. Positive development took place in chile that the comprehensive reform to the general law for tobacco control with a plain packaging component has already been approved by the senate and is pending at the house of representatives. Taps ban: in indonesia, an amendment of the national broadcasting law that includes a ban on tobacco advertising and promotion is being discussed by the parliamentary legislative committee. Jakarta achieved more than 95% compliance in banning tobacco advertising and promotion in 2017. Bogor city became the first city in indonesia to have implemented a local ban on display of cigarette packs at point of sale. Georgia and benin banned all taps in the country through the national tobacco control laws passed in 2017. Tobacco industry interference: tobacco industry interference continues to be the main challenge for tobacco control policy making across all the countries the union works in. To address this, 5 states in india have passed 5. 3 policies with the union's support. The union has also helped the mohs in india, bangladesh, and mexico develop draft 5. 3 policies. Thanks to the effort to sensitize government officials by the union's ngo grantees in bangladesh, the cabinet, the mayor of dhaka south city corporation, and a university have all distanced themselves from a major csr event organized by bat in 2017. The union has helped establish three tobacco industry observatories in brazil, south africa, and sri lanka. These observatories provide intelligence on industry activities to regional and country tobacco control advocates. An emerging challenge in 2017 is the launch of the foundation for a smoke-free world by philip morris international. The union has been working closely with bi and partners in discussing joint communications strategy. A letter to all past, present, and future grantees of the union and tfk was sent advising on the position we take toward this foundation. As the secretariat of the wctoh, we developed a position statement in collaboration with partners for the conference on this foundation. Country leads have actively collected information on the outreach and activities of the foundation and advised the union's collaborators and grantees not to work with the foundation. Notably, the mohs in indonesia and vietnam both issued notices to other ministries, agencies, and subnational jurisdictions advising not to collaborate with the foundation.
resolve:global cardiovascular health and public health infrastructure initiatives, also known as resolve to save 100 million lives and resolve to prevent epidemicsproject goals for these initiatives include:- cardiovascular health initiative: catalyze progress reducing the burden of cardiovascular disease in low- and middle- income countries. - preventing epidemics (public health infrastructure) initiative: reduce risk of epidemics by strengthening capacity of low- and middle-income countries to detect, respond to, and prevent health threats. The following summarizes progress, including building a great team and launching key partnerships. Of particular note regarding progress in the first year:- rapid progress improving global recommendations and policy for hypertension treatment and increasing the accountability of treatment programs, with patients being treated in 3 states of india under the new strategy - global launch of replace, an action package to eliminate artificial trans-fats from the global food supply by 2023, with new commitments made by thailand (2019 target date) and india (2022 target date). - progress increasing accountability for preventing epidemics, advancing understanding of the need to step up preparedness in specific capacities and launch of a website to help accelerate progress doing so. Project outcomeskey organizational and programmatic goals were reached that demonstrate the progress of resolve to save lives and its initiatives, as summarized below. 1. Staffinga. Onboard core staff (at least team leads or one other for the three key components of operations, cardiovascular health, and public health infrastructure, and team leads for india and china). Target date: end of first quarter of grant - achievedb. Nodal staff from vs placed at sub-grant entities. Target date: end of second quarter of grant - achieved2. Contractual arrangements - sub-agreements signed with at least two major partners. Target date: end of second quarter of grant - achieved3. Surveillancea. Initiation of surveillance for trans-fat consumption in india. Target date: end of first quarter of grant - achievedb. Establishment of standards for surveillance of sodium and trans-fat consumption. Target date: end of third quarter of grant - achieved (4th quarter)c. Establishment of standards for clinical and community surveillance of blood pressure control. Target date: end of third quarter grant - achieved (4th quarter)4. Policy - establishment of guidelines and protocols for management of hypertension in primary care. Target date: end of third quarter grant - achieved5. Advocacy for public health infrastructure strengthening - launch of website with clear presentation of independent evaluations of country preparedness. Target date: end of third quarter of grant (march 31, 2018) - achieved (4th quarter)building an exceptional team (staffing)launched in mid-2017, resolve to save lives led a successful recruitment effort and fully staffed its core teams for the cardiovascular health and prevent epidemics initiatives within the first six months. Three of the four lead positions were filled by september 30, with the remaining senior team lead (prevent epidemics) filled in february 2018. Both teams, which currently include 19 core personnel, are staffed with subject matter experts who possess noteworthy expertise in their areas of specialization. Key partnerships (contractual agreements)resolve to save lives entered into partnerships with leading global organizations across the two initiatives to take on roles related to technical assistance, advocacy, surveillance, training, and implementation science. Key partners include the world health organization, the world bank, campaign for tobacco free kids/global health advocacy incubator, the cdc foundation, and johns hopkins bloomberg school of public health. Contracts were executed close to anticipated timeframes (figure 1), allowing for a rapid start of activities. We have experienced challenges with two partners. The global health advocacy incubator (ghai) has had a slow start, and we will monitor their performance closely in the coming months and may adjust their budget accordingly. We are also exploring alternatives for fulfilling the functions we had envisioned for ghai if necessary. In addition, cdc has undergone significant organizational change, and their ability to deliver anticipated services is unclear. Their sub-grant agreement has been modified accordingly, and future funding will depend on their performance in this year. Cardiovascular health initiativethe global cardiovascular health initiative launched on september 12, 2017, with a focus on three components: trans-fat elimination, sodium reduction, and improved hypertension control. In this first year, resolve to save lives is supporting cardiovascular health efforts that have been launched in our two highest priority countries, india and china, as well as in thailand. Initial activities are underway in ethiopia, turkey, vietnam, with programs under consideration in bangladesh and nigeria. The india hypertension management initiative officially launched on november 28, 2017, in collaboration with the ministry of health and family welfare, state governments in india, the indian council of medical research, and who india. The program is now active in three states (punjab, madhya pradesh, and kerala) and will expand to 2 additional states (maharashtra and telangana) in july/august 2018. In china, resolve to save lives, through partnerships with the beijing lisheng cardiovascular health foundation and project hope, is providing technical assistance on a $600 million world bank loan that has been matched by a $3. 5 billion investment from china to improve primary care in anhui and fujian provinces with a focus on hypertension treatment. Along with programs in shandong and henan provinces, improved treatment programs could potentially be available to a population of more than 300 million in 2018. We learned that an electronic health information system will be extremely important to the success of treatment of hypertension more important than previously been recognized. In november 2017, we convened 40 of the world's leading digital health and hypertension treatment experts with the goal of identifying a simple, usable, free, open-source, and scalable it tool that can be widely and rapidly deployed to improve hypertension management. This was followed by the recruitment and hiring of an exceptional digital team tasked with building a digital platform. A prototype platform for hypertension management has been developed and will be tested in india in summer 2018. Trans-fatin partnership with the world health organization, on may 14, 2018, resolve to save lives launched replace, a 6-component technical package for global elimination of artificial trans-fat from food. The launch received heavy coverage in media worldwide, with more than 36 unique stories in top-tier publications during the first 24 hours, including the new york times, the financial times, associated press, reuters and le monde. In the area of artificial trans-fat elimination in india, we conducted preliminary testing of samples of human serum and began technology transfer to india for future testing of stored samples, and worked with india's regulatory authority, which has now committed to the elimination of artificial trans-fat by 2023. Policythe cardiovascular health initiative made surprisingly rapid progress advancing key policy and protocols. On september 29, 2017, who and resolve to save lives produced the first-ever practical, precise algorithms for treatment of hypertension as well as a new accountability framework. In january 2018, the world health organization executive board approved targets to eliminate artificial trans-fat from food, increase treatment of hypertension by 230 million people, and reduce dietary sodium by 25% by 2023. In may 2018, the government of thailand announced a commitment to eliminate artificial trans-fat from food by 2019. The government also convened manufacturers of various food products including noodles (a major contributor to dietary sodium in thailand), which committed to reducing sodium by 5% in the first year and more in following years. Advocacy for public health infrastructure strengthening on june 22, 2018, we launched a communications platform to increase transparency, accountability, and progress in reducing the risk of epidemics. The prevent epidemics website (www. Preventepidemics. Org) features a unique readyscore that relays, on a scale from 0 to 100, how prepared each country is for an epidemic. Country-specific pages provide users information on what a country is doing well, and what needs to improve, as well as tailored advocacy packages to motivate leaders to make health security a priority.
data for health:the bloomberg data for health initiative aims to, in four years; improve health data for policy making for over 1 billion people in 20 low- and middle income countries and cities. As part of the initiative, bloomberg philanthropies issued a grant to vital strategies, an usa-based affiliate of the international union for tuberculosis and lung disease, on march 30, 2015. The goal of the grant is to help countries: (i) improve birth and death certificate systems; (ii) conduct efficient public health surveys to monitor major risk factors for early death and (iii) support governments to strategically use public health data to inform policy priorities. Under the grant vital strategies is required to (i) coordinate the selection process for 20 countries and cities in the initiative; (ii) lead implementation management for the strengthening of birth, death, and cause-of-death data in the civil registration and vital statistics (crvs) component of the program; (iii) lead design and implementation of a special, rural crvs project in malawi that builds on successful work previously supported by bloomberg philanthropies and (iv) lead design and implementation of the data use component of the program. In 2017, across the components of the data for health initiative, vital strategies successfully (i) completed enrollment of 20 countries and cities by mid-2017; (ii) successfully completed phase ii work plans for all enrolled countries and cities; (ii) trained more than 14,000 doctors, nurses, community health workers, government officials and journalists on topics ranging from medical coding for cause of death certification, verbal autopsy, using data to inform policy and data-led journalism. Specific examples of key achievements across the 20 enrolled countries are as follows:- bangladesh: d4h helped initiate verbal autopsy for the first time in bangladesh to determine cause of death in the community where there is no health facility. More than 7,600 verbal autopsies have been conducted in six sub-districts in 2017. - peru: sistema infomatico national de defunciones (sinadef), an online death notification system, received the highest level of support from the minister of health as a critical system to improving the quality of birth and death statistics in peru. Sinadef has effectively been integrated in to the peruvian crvs system and has achieved near national-level scale. 100% of expected deaths are now being reported from hospitals that use the sinadef online cause of death certification system, compared to a national average of 78% at baseline. - rwanda: international medical certificate of cause of death adopted by ministry of health and rolled out nationwide to all public and private health facilities for the first time. 100% (700 physicians) in-service physicians have been trained on how to correctly complete a medical certificate of cause of death (mccod). Additionally, vital strategies continued to work to maintain a focused, innovative approach to rural death registration in malawi. In 2017 302 births and 80 deaths were recorded using electronic village registration (evr) from a total population of 48,654 in the traditional authority mtema. Renovations of the national registration bureau office space started in early 2017 were completed by year end, allowing the government entity to better serve its constituents. Vital strategies also provided nrb with a vehicle to support the reporting of births in-country. Lastly, in 2017, vital strategies continued to work with countries to strengthen practices, structures and policies to institutionalize consistent, widespread, high-quality data use in ministries of health and health departments. During the year tools and procedures to deliver data to health ministry leaders to help them make more informed decisions were developed in eight countries, with an additional two countries creating units expressly responsible for maintaining high data use standards and/or for providing advanced analytic support and another two countries drafting standards and policies that promote the release, sharing, timeliness, and confidentiality of public health data. Work was also completed in the development of data-driven products to help ten countries enhance their data-driven health reports and three countries are being aided in the development of online data portals to make data accessible to the public.
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