29 July 2016

1. Implementation of tobacco control legislation in Republic of Moldova - Expected challenges and additional support requiredIon Salaru, Deputy director on noncommunicable diseases prevention and health promotion, National Center of Public Health 29 July 2016

2. Implementation of Tobacco Control Law provisions – new experience for Republic of Moldova • After entering into force on 17 September 2015 of the majority of the provisions of the amended Law 278 on tobacco control, starts a new phase of FCTC implementation in Republic of Moldova, • Ministry of Health assumed a leadership role on Law implementation, • For better coordination of activities, by Ministry of Health Decision # 39-d of 01.02.16 established an intersectorial Working Group and adopted working plan for first 6 months of 2016, which meets 3-4 times per month.

3. Strengthening capacities – trainings of public health specialists • Performed 3 Training workshops with specialists of Public Health Service on implementation of tobacco control legislation (on 04.12.2015, 26.02.2016 and 14-15.04.2016). • By Internal Orders of NCPH and most PHC were approved internal policies of protection from tobacco smoke and established responsibilities of the organization in conducting surveillance on implementation of the tobacco smoke protecting measures in accordance with the Instruction on control measures on protection from exposure to tobacco smoke approved by joint order of the Ministry of Health and Ministry of Interior no. 390/157 of 30 May 2016. • In plans of works were included concrete measures of management and supervision on the fulfillment of legislation on protection from exposure to tobacco smoke.

4. Trainings of managers and other categories • 1) explanatory meeting on 11 December 2015 with representatives of networks of supermarkets from Chişinău in connection with entering into force on January 1, 2016 the provisions of Article 21 of Law 278/2007 and amendments to the Article 19 of Law no. 1227-XIII of 27 June 1997 on advertising on total ban on advertising, promotion and sponsorship of tobacco products, • 2) training of managers and representatives of hotels and restaurants on May 12, 2016 at NCPH, • 3) Round Table on May 13, 2016 in Chisinau PHC with public servants and representatives of municipal services, businesses from mun. Chisinau, • 4) training for different categories of employees, including about 500 policemen, 300 medical workers, 30 of employees of the hotels on the provisions and application of Law 278, • 5) on daily base are offered consultations for managers in hospitality sector and those responsible for managing public buildings.

5. Normative framework development 1) approved by the Chief State Sanitary Doctor of the Republic of Moldova Decision no. 12/23/2015 6 “Methodical recommendations on applying administrative measures for non-complying the legislation on tobacco control", 2) approved by Chief State Sanitary Doctor of Republic of Moldova Decisions no. 1 of 02.10.2016 – Evaluation Sheets of compliance with the provisions of Law 278 on the ban on advertising and promotion of tobacco products in commercial units and of smoking ban in enclosed spaces 3) already mentioned adopted Instructions on state inspection on the implementation of legal provisions relating to protection against exposure to tobacco smoke, 4) approved guide for implementation of legal provisions related to protection from exposure to tobacco smoke for managers

6. Preventing access of minors to tobacco products • According to the decision of the Ministry of Health no. 06d of 12.01.2016, Public Health Centers were requested to check tobacco trade units in order to verify compliance with provisions of article 21 of Law no. 278 and apply administrative measures if necessary in accordance with Article 3641 of the Code of Administrative Offences of the Republic of Moldova no. 218-XVI • As a result were checked over 50% of tobacco sales units from 11413 units registered. In order to eliminate and prevent registered noncompliance's were submitted sanitary requirements regarding the obligation to comply with the warning in fulfilling the law provisions, • On 20 June 2016 a meeting was organized at Ministry of Health with managers of State Enterprise "Moldpressa“, addressing issues concerning compliance with the law 278.

7. Preventing access of minors to tobacco products • By the Chief State Sanitary Doctor of Moldova addressed a Letter to Local public authorities on the enforcement of Law no. 278-XVI from 14.12.2007 on tobacco control, with proposal to conduct mapping of all tobacco products trade points located nearby educational institutions and medical institutions. • Process is currently ongoing. Territorial Public health Centers are not issuing anymore or prolonging sanitary authorizations for units selling tobacco products located at a distance less than 200m from the mentioned institutions, currently about 15 kiosks were displaced or reprofiled.

8. Counseling and cessation of tobacco addiction • In order to provide specialized treatment and counseling for smokers who want to quit smoking, by the Ministry of Health Order No. 139 of 03.04.2016 was established the Cessation Service for counseling and treatment of tobacco addiction. • The national coordinating institution was nominated Republican Clinic of Narcology, which provides basic actions. Brief advice is offered by primary healthcare institutions, counseling and treatment services are offered in specialized offices of narcology and at Republican Clinic of Narcology, • established national free quit-line (0800 10001), where smokers can receive an advice how to quit.

9. Health promotion and communication • As of 7 May 2016 was initiated a new communication campaign on promoting smoke free environments, • The second stage of campaign with other video spots was conducted between 15-30.06.2016 on national TV Channels. With the support of WHO is finalizing a new spot on implementing of enclosed smoke-free environments. • Were published and distributed three types of conventional international signs on smoking banning in public institutions and hospitality sector and informational materials in more than 20 thousand copies each type of material, in total over 150 thousand unit were distributed. • It was widely marked World No Tobacco Day on May 31, 2016 through multiple actions - press conference, flash mob, distributing materials in institutions, lessons, visits of most popular restaurants, etc..

10. Health promotion and communication The main webpage of NCPH www.cnsp.md was developed, which includes a banner "tobacco control“, where while accessed are available all important news, normative and informational materials that can be downloaded directly from the mentioned website. It was established at NCPH hotline 0800 123 00, available 24/24 and 7/7 for addressing requests for information or complains regarding Law 278 implementation starting from 30 May 2016, which can be accessed also from mobile phones.

11. To implement the provisions of Law no.278 / 2007, Directive 2014/40 / EU of the European Parliament and of the Council of April 3, 2014 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale tobacco and related products and repealing Directive 2001/37 / EC, developed the draft Government Decision for approval of three sanitary regulations: • on ingredients in tobacco products and related products (Art.11), - on reporting on tobacco and related products (Article 13), and • Trade of tobacco products and related products (Article 24), which is currently in the Government for approval. • Should be mentioned that the approval process is hampered by the interference of the tobacco industry, which exerts a powerful lobby through some central authorities (ME, MF) and some associations (EBA, AmCham, lawer ass.). Development of Sanitary regulations

12. - There were organized two meetings of the National Council on Tobacco Control Coordinator - on 5 April and 24 May 2016 at which they reviewed the activities conducted by various authorities to implement Law 278, preparing to implement bans on indoor workplaces , the events, including marking World no Tobacco Day 31 May, with adopting of appropriate decisions.- By the Ministry of Health sent official letters to all relevant public authorities and major companies with request to enforce implementation of smoke free environments, - By the National FCTC Focal Point (NCPH) presented biannual National report on FCTC implementation for 2014-2015, with relevant information. Coordination of implementation

13. For the next period we consider as priority the following actions for which we request a support from our development partners:1) Continuing public information, by distributing information materials and conduct further developed video spots. It will be simultaneously presented the implementation process and the first results of implementing the law, including compliance by economic operators, public institutions and the public for counteracting tobacco industry interference;2) Develop and submit draft of the new National program on tobacco control for the years 2017-2021 produced by the Working Group set by the Ministry of Health for coordination with all relevant authorities –3rd quarter 2016; Conclusions and proposals It is generally seen a positive impact of the Law 278, which is respected in most cases - visible change is recorded primarily in institutions from hospitality sector. Most companies comply with the law. Further actions are needed to inform, explain and train all relevant actors also PH specialists to achieve complete compliance with the provisions of art. 26 and 27 of Law 278.

14. Conclusions and proposals 3) To draft Sanitary Regulation on labeling of tobacco products and health warnings (for the application of the law art.16,17,18 278) – 4th quarter 2016-1st quarter 2017.4) Approval by Government Decision developed three sanitary regulations on tobacco and related products - urgent.5) Strengthen Public Health Service in the area of tobacco control, including: the tobacco control division at NCPH and Tobacco Control units in other territorial PHC, with development of specific institutional regulations and job descriptions, with appropriate modification of the existing ones – 3rd quarter 20166) organization of specific trainings for PHC specialists regarding enforcement of the law on tobacco control- 3rd -4th quarters 2016.

15. Conclusions and proposals 7) To carry Surveys on law 278 enforcement for further development of evidence based proposals to improve policies and amend legislation, on :a) advertising and promotion of tobacco products in retail trade units close to educational institutions – Sept.-October 2016,b) implementing legislation on smoking ban in enclosed spaces (assessing the level of compliance, customer satisfaction, economic indicators after 31 May - July -August 2016c) on specific taxes for tobacco and related products and impact on smoking prevalence in Moldova - August-September 2016,8) Organize a national adult tobacco survey on the prevalence of smoking in adults - GATS, 2017;9) Needs assessment and evaluation for improvement of Cessation Service;10) Strengthening partnerships with local government authorities, businesses and civil society to implement Law 278.