A new report released by the Centre for Integrative Public Health Management (CIPHM) has raised concerns over the long-term sustainability of tobacco control programmes in low- and middle-income countries (LMICs), despite nearly two decades of international funding and policy support.
The report, titled “Sustainability of Programmes to Reduce Tobacco Use in Low- and Middle-Income Countries,” assessed six countries — Pakistan, Bangladesh, Philippines, Vietnam, Mexico and Brazil — using the “Index of Tobacco Control Sustainability” (ITCS), a framework published in the journal BMJ Tobacco Control.
The findings show that none of the six countries achieved the threshold required to classify their tobacco control systems as “fully sustainable,” although performance varied widely between nations. According to the report, Brazil emerged as the strongest performer with a score of 118 out of 130, reflecting robust institutions, strong enforcement mechanisms, dedicated budgets, and comprehensive implementation of tobacco control measures. Mexico and the Philippines followed with moderate scores, while Vietnam and Bangladesh demonstrated partial institutional progress.
Pakistan ranked lowest among the countries assessed, scoring only 35 out of 130. The report attributed Pakistan’s weak performance to limited institutional capacity, inconsistent taxation policies, inadequate dedicated funding, weak coordination mechanisms, and high dependence on tobacco-related revenues.
The study argues that tobacco control sustainability should not be viewed merely as a health policy issue, but rather as a broader “political economy” challenge. Researchers noted that countries heavily reliant on tobacco taxation often face a “revenue trap,” where governments struggle to aggressively reduce tobacco consumption because of fiscal dependence on tobacco income.
The report also reviewed the impact of the Bloomberg Initiative to Reduce Tobacco Use, launched in 2005 by Bloomberg Philanthropies. Since its inception, the initiative has committed more than US$1.5 billion globally to support smoke-free laws, graphic warning labels, taxation reforms, advertising bans, and public awareness campaigns in developing countries.
In Pakistan, Bloomberg-supported projects contributed to strengthening the National Tobacco Control Cell, promoting smoke-free city initiatives, introducing graphic health warnings, and supporting tobacco taxation reforms between 2008 and 2011. Similar support was extended to other countries through collaboration with organizations such as the World Health Organization, The Union, and the Campaign for Tobacco-Free Kids.
However, the CIPHM report concludes that external donor funding alone has not been sufficient to create durable, self-sustaining tobacco control systems in LMICs. The study identified major gaps in national budgeting, research capacity, governance structures, monitoring systems, and inter-ministerial coordination.
Researchers stressed that many countries still lack dedicated budgets for tobacco control, long-term institutional planning, and trained personnel capable of sustaining programmes independently once international funding declines.
The report recommends a multi-dimensional strategy to strengthen sustainability, including improving institutional governance, diversifying government revenue sources, enhancing collaboration with civil society and the private sector, and gradually transitioning from donor dependence toward nationally financed programmes.
The report encourages open discussions with all stakeholders to achieve effective and sustainable tobacco control. CIPHM noted that existing sustainability frameworks do not adequately account for safer nicotine alternatives and called for broader stakeholder discussions on updating international assessment tools.
The organization further recommended comprehensive policy evaluations in all six countries to assess implementation gaps, resource allocation challenges, and alignment with evolving global approaches to reducing tobacco use.
