6.2 Analysis of recent major reforms This section highlights key health-care reforms from 2006 to date, which are considered to have a significant impact on the health of the population and on the health system.
6.2.1 National Authority on Tobacco and Alcohol (NATA) The requirement for a national-level coordinated response to address the harms from tobacco and alcohol in Sri Lanka was building up since the late 1990s. A vibrant nongovernment sector, professional bodies and some sections of the government apparatus saw the need for such a response and strongly advocated for it for over a decade. Initial steps consisted of banning advertising of tobacco in the media, inclusive of the national press and billboards through the amendments to the Consumer Protection Act in 1999. The restriction at that time was enforced partly through legislation and partly through voluntary actions by the tobacco industry. The Global Youth Tobacco Survey (GYTS) of 2003 revealed that 8.7% of schoolchildren were current users of tobacco products and 79.1% and 78.5% had seen pro-smoking messages on billboards and newspapers, respectively. The almost-parallel process of negotiation and finalization of the WHO FCTC in 2003 added impetus to this process, although there were many obstacles placed by the alcohol and tobacco industries. The findings of the GYTS reinforced the need for a national authority for the effective implementation of the FCTC and this resulted in the National Authority on Tobacco and Alcohol Act, No. 27 of 2006. The role of the NATA was defined as “Identifying the policy on protecting public health for the elimination of tobacco- and alcohol-related harm through the assessment and monitoring of the production, marketing and consumption of tobacco products and alcohol products; to make provision for discouraging persons, especially children, from smoking or consuming alcohol, by curtailing their access to tobacco products and alcohol products” (Parliament of the Democratic Socialist Republic of Sri Lanka, 2006). The implementation of a strict anti-tobacco and alcohol policy by NATA, in collaboration with strong non-state stakeholders such as the Alcohol and Drug Information Centre (ADIC) saw the use of tobacco products among youth decreasing from 8.7% in the GYTS of 2003 to 3.7% in the GYTS of 2015. Vigorous health promotion activities directed at target groups starting from the preschool age upwards, the persistent vigilance against direct and indirect advertising, and advocating for an increase in taxes on tobacco and alcohol products have paid dividends. Statistics from the Sri Lanka Customs show that cigarette production fell from 4800 million in 2006 to 2600 million, which is a substantial drop of 45% (World Bank, 2017). According
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