This call for proposals is based on the Centre for Tobacco Control in Africa (CTCA) Research Agenda developed with collaborative support from several partners, to address gaps in tobacco control research. CTCA supports innovative research that generates the critical evidence to drive tobacco control, bridge the knowledge gaps and narrow the space between Policy and implementation. The primary focus of CTCA is to support the implementation of the WHO- Framework Convention on Tobacco Control (FCTC) in Africa, which came into force in 2005.

The WHO Framework Convention on Tobacco Control (FCTC) is an international legally binding treaty that provides an evidence-based comprehensive approach to tobacco control. The FCTC forms a baseline on how countries can begin implementing tobacco control programs. The treaty sets a floor and aims at the ceiling.The WHO FCTC set to; 1) Protect present and future generations from the devastating health, social, environmental, and economic consequences of tobacco consumption and tobacco smoke exposure, and 2) Present a roadmap that leads to comprehensive tobacco control programs and strategies at the international, national, regional, and local levels.

The treaty  has to-date been ratified by 181 parties worldwide. Forty-four (44) out of the 54 Member States of the African Union, have ratified the World Health Organization Framework Convention Tobacco Control (WHO-FCTC). The Conference of Parties (member countries ratifying the treaty) is responsible for evaluating the implementation of the treaty and defining the WHO FCTC Guidelines.  A key element of WHO FCTC success is ensuring that voices of the world’s citizens are present, with the exception of the tobacco industry. Civil society continues to play an important role in the implementation of the WHO FCTC.

The WHO FCTC comprises of demand reduction measures (Articles 6, through 14) and supply reduction measures (Articles 15, to 21) that are legally binding; Parties are encouraged to carry out these minimum standard provisions.

With the WHO FCTC, the tobacco epidemic can be reversed, and millions of tobacco-related deaths prevented. The MPOWER package is one of the interventions that has saved lives and reduced costs from averted healthcare expenditure in many countries. MPOWER is a package of six important and effective tobacco control policy measures in line with the demand reduction provisions contained in the WHO Framework Convention on Tobacco Control. These policies are proven to help countries implement the WHO FCTC and counter the tobacco epidemic. The policies include: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco; Warn about the dangers of tobacco;Enforce bans on tobacco advertising, promotion and sponsorship (TAPS); and Raise taxes on tobacco.

Over 7 million people worldwide die each year due to smoking [1]. Smoking harms almost every organ of the body due to chemicals in tobacco products and the smoke. Tobacco use is recognized as the one risk factor common to four main groups of noncommunicable diseases: cancers, cardiovascular disease, chronic lung disease, and diabetes. Noncommunicable diseases (NCDs) account for 70% of all deaths worldwide [2]. Smoking is associated with mental disorders including schizophrenia, anxiety disorders and depression. People with mental illness have high rates of morbidity and mortality from smoking related illnesses such as cardiovascular disease, respiratory diseases and cancer [6].

Smoking increases the risk of communicable diseases by inhibiting the immune system [3]. This makes it more difficult for a patient to avoid infection when exposed to the pathogen. For example, smoking increases the risk of tuberculosis by two to three times. Twenty percent of deaths from tuberculosis could be avoided if patients did not smoke [4]. Treatments for infectious diseases are more effective if complicating factors such as smoking are also prevented or controled. People living with HIV have higher rates of smoking than the general population and are also vulnerable to the associated adverse health effects [5].

CTCA was established under the WHO/Tobacco Free Initiative (TFI) Service Agreement and entrusted with the responsibility of supporting governments in African countries to meet their obligations under the WHO Framework Convention on Tobacco Control in 2011. CTCA was established as a centre of excellence in tobacco control within the School of Public Health of Makerere University in Uganda. While maintaining the niche of capacity development, CTCA’s face, focus and operational modalities have evolved to match the changing tobacco epidemic and control environment to attain a Tobacco Free Africa. This underpins sustainability with a footprint sprouting from a structured National Tobacco Control Program. The volution path of CTCA is summarized in the next three paragraphs.

 In the initial phase of CTCA, the stakeholders articulated the vision of the Centre as a new, innovative and systematic approach to support Governments in Technical, Institutional and cross-sector areas of Tobacco Control (TC). CTCA support focused on developing policies and legislation to regulate tobacco use, increase tobacco taxation, ban tobacco products advertising, and protecting the public from exposure to tobacco smoke. The Centre had and still has a regional scope. In phase 1 CTCA supported five countries (Angola, Kenya, Mauritania, South Africa and Uganda). The Centre collaborated with WHO in the capacity assessments of the first target countries (Uganda, Mauritania and Angola) to identify needs and opportunities for capacity building in tobacco control.

 In phase two from 2015 to 2018, the Centre received further funding from the Bill and Melinda Gates Foundation through the African Capacity Building Foundation to support the governments of Botswana, Uganda, Ethiopia, Niger, The Gambia and Gabon on attainment of four outcomes including (1) Adoption and implementing policies for farmers transitioning from tobacco farming to alternatives, (2) Increased adoption of policies and laws compliant with FCTC, (3) Increased implementation/enforcement officers of policies and laws compliant with FCTC and (4) development and implementation of national tobacco control programs.

From April 2019, CTCA received phase III funding from the Bill and Melinda Gates Foundation through the Africa Capacity Building Foundation to implement a three-year project to enhance the tobacco control sustainability in Africa. The target countries include Uganda, The Gambia, Benin, Niger, Burkina Faso, Namibia, Zambia and Kenya. The objectives of the project phase include;

1. Improve sustainability of tobacco control in target countries
2. Enhance tobacco control actors knowledge and skills in policy, design, implementation, monitoring and evaluation
3. Foster TC research and alternative livelihood interventions and Strengthen CTCA institutional and human capacity to effectively deliver on its mandate

The WHO FCTC articles; 20 (research, surveillance,evaluation and information exchange), 21 (reporting and exchange of information) and 22 (scientific, technical, legal fields and provision of related expertise) provide inquest for evidence base and tracking of implementation of tobacco control interventions hence the birth of CTCA Tobacco Control Research Agenda for Africa. The central goal of the Tobacco Control Research Agenda for Africa is to set a research base for Africa to roll out the World Health Organization Framework Convention for Tobacco Control implementation in bridging policy relevant gaps and provide comprehensive evidence for informed tobacco control initiatives and dissemination framework as well as provide feedback to stakeholders at all levels.

The research to inform policymaking in the region is either sparse or conducted by international partnerships albeit to answer questions specific to their needs. A number of gaps that exist in tobacco control policy implementation necessitate a harmonised approach to generate critical local evidence to drive the response. These gaps include: (1) Limited local evidence to drive best practices for policy adoption and implementation; (2) Inadequate capacity for tobacco control research especially nonepidemiologic such as economics and policy analysis, ethnography and evaluation both country and cross-country; (3) Disjointed platform for communicating, disseminating and sharing best practices on tobacco control in Africa; and (4) Need to focus research funding towards high priority Tobacco Control areas.

Development of the research agenda was guided by practical field experiences from tobacco control partners in Africa and was premised on; 1) significancy of the out turn to tobacco control, 2) need to bridge the gaps in existing research, 3) feasibility of doing the research, 4) level of WHO FCTC implementation and,  5) desire to link policy to implementation.

2.1. Objectives

The goal of this call for proposals is to identify and support cutting edge innovative research projects to address key knowledge gaps of the priority research themes on tobacco control in Africa as identified in the TCRA.

The findings of the research projects will contribute to building an evidence base that will specifically;

1. Provide decision makers with up to date context specific tobacco burden status to guide development and implementation of tobacco control interventions
2. Promote reduction of tobacco use among key populations such as youths, women, etc
3. Unravel and catalyse uptake of the gains of alternative livelihood approaches over tobacco growing
4. Uncover and reverse the socio-behavioral patterns of tobacco use and dependence

2.2 Themes and Research Priorities

This call for proposal is organized around eight research priorities spanning the various themes such as Health, Agriculture, Economics and Trade, Environment, Education, Policy, and culture. The research priorities were identified according to the following criteria:

• significance in influencing tobacco control implementation in Africa,
• gaps in existing research efforts,
• existing funding sources,
• feasibility of doing the research
• level of WHO FCTC implementation, and
• drive to link policy to implementation.

Applicants submitting projects for different research priorities should provide separate applications for each research priority.

The proposed research project(s) should be able to be implemented within twelve (12) months.

The details of each research priority are presented below

2.2.1 Patterns and trends of tobacco use and exposure for all tobacco products including the new products at country and regional levels

It is important to clearly indicate the types of tobacco products the research project focuses on and highlight differences in use according to gender, age groups and region. Examples of knowledge gaps the research may address include the following:

1. Current prevalence and trends by age, sex, regions; incidence and prevalence of tobacco related diseases
2. Surveillance to understand the tobacco use epidemic and shifting epidemic from High income countries (HIC) to Low-Middle Income countries (LMIC)

• Driving factors of tobacco use in Africa

1. Changing patterns of tobacco use in Africa
2. Mapping new and emerging tobacco products in Africa- patterns, trends, contents, potential effects of the new products, who is the most at risk and the motivation factors for the use of new and emerging tobacco products
3. Link between use of new tobacco products and other substances (e.g. alcohol, cannabis, aviation fuel);

• Marketing strategies and plans, supply chain, of new tobacco products

2.2.2 Effects of tobacco use and exposure on sustainable development

Although some research has been done showing the effects of tobacco use and exposure, there still remains many undiscovered scenarios that endager populations silently. This may be constrained by varying factors such as hard-to-reach communities, minority populations, cost implications, etc. Therefore, there is need for in-depth research that will contribute to attainment of sustainable development goals relating to poverty, education, culture, food security, environment, HIV, TB, reproductive health etc.

The following knowledge gaps to support tobacco control and sustainable development may be considered as examples;

1. Assess the economic, environmental and health impact of tobacco use
2. Assess the effects of tobacco use on poverty, education, culture, environment, HIV, TB, reproductive health, and other industrial products

• Studies on food security in the tobacco growing regions

1. Understand the interaction between tobacco use and communicable diseases such as HIV, TB
2. Linking tobacco use with other substance abuse
3. Assessing the relationship between tobacco use and other industrial products such as alcohol, and sugars

2.2.3 Sociocultural context of tobacco use

The need to comprehend the whole continuum of tobacco use right from onset through utilization to quitting cannot be underestmated. Several factors ranging from personal, peer influence, communal, culture, style, etc come into play and if ignored may reduce the effectiveness of tobacco control interventions. Because tobacco is addictive due to the nicotine chemical delivered in the lungs, heart and brain, it is critical to understand whypeople keep using tobacco products even when they are harmful, what makes it so difficult for people to overcome smoking addiction, and what is needed for people to be able to quit smoking. To this end, research is needed to;

1. Understand and document the cultural values attached to tobacco, tobacco use practice and effects
2. Link between cultural, tobacco growing and the environment

• Behavioural patterns and influence

1. Transcultural considerations and effects of tobacco
2. The balance between social cultural attachments and tobacco economics
3. Effects of culture on tobacco control programming

• Transcendence of tobacco use and dependence

2.2.4 Tobacco control policy research and analysis of cost effectiveness, impact, drivers, enablers, innovation, challenges, communication and advocacy for tobacco control

Fourty four African countries ratified to the FCTC and WHO provides guidelines on implementation of the articles to curb the tobacco epidemic. Given that most countries have mechanisms through which to implement tobacco control initiatives, it is of interest to learn through more research the extent to which country laws, strategies, or plans are implemented so as to realize short, medium and long terms results in reducing tobacco use and exposure. In other words, how have mechanisms such as smoke free environments; graphical health warnings placed on cigarette packs; ban of tobacco advertising, promotion and sponsorship; and helping smokers quit smoking been implemented, the lessons learned and what are the potential impacts at hand.

The following examples provide a guide to research projects to address the knowledge gaps under this research priority;

1. Cost-effectivenees of each tobacco control policy strategy and intervention to form basis for prioritization (SF, TAPS, Taxation, GHWs, communication, advocacy, cessation) at national and regional levels
2. The political economy of tobacco control in Africa and its impact on policy adoption and implementation

• Impact of TC policies, regulations, and interventions in Africa

1. Knowledge, perception, practice and capacity of policy makers to deliver tobacco control programmes in Africa.
2. Understanding public support for the different tobacco control measures in African countries.
3. Tobacco control policy implementation linkages with other development areas such air pollution and overall sustainable development.

• Strategies to increase motivation to use and access to evidence-based treatment interventions such as cessation interventions integrated into the health care system targeting special populations such youth and lower SES smokers.
• Assessment of how socio-cultural determinates of tobacco use impact tobacco control programming to make less effective

2.2.5 Tobacco use and populations at risk

Populations with a common characterization are more likely to have unified attractions for tobacco use and exposure. There is interest in research studying tobacco use in special groups such as youth, young adults, women/gender, elderly, residents of urban areas, military, prisoners, mental health patients, populations in low socio-economic dwellings like slums. Examples of knowledge gaps that require further research include but not limited to;

1. Effectiveness of tobacco control interventions in specific sociodemographic groups in Africa
2. Interventional studies to reduce tobacco and substance use among the youth (cohorts)

• Social-economic and environmental determinates of tobacco use among special populations in Africa.

1. Effective strategies and approaches for enhancing youth participation in tobacco control policy implementation.
2. Model tobacco use and poverty-inequality
3. Epidemiology of tobacco use among special populations in Africa (youth, armed forces, poor, mental health and LGBT) in Africa

• Risk factors for smoking acquisition and cessation among special populations such as the youth

2.2.6 Tobacco industry and tobacco control policy

The tobacco industry fronts deceptive advertisements and marketing depicting smoking as an admirable lifestyle and thus lure many young people to start or continue tobacco use. However, with increased evidence, this trend can be reversed. The research needed to address the knowledge gaps may include;

5. Implementation of the FCTC Article 5.3 in Africa
6. Economic estimation of the cost of TI interference and its implications to the national economies of African countries

• Capacity of African governments to respond effectively to tobacco industry interference

1. Effectiveness of media campaigns on tobacco in reducing industry interference.
2. Interaction of TI and TC policy and impact of TC policies on the tobacco business
3. Impact of TI influence tobacco farming including efforts to understand industry relationships with farmers and ways to incentivize substitution of crops

• Nature, form and type of cooperate social responsibility
• Tobacco industry business practices and tax evasion and avoidance (licensing, sister companies/subsidiaries

1. Drivers and factors of tobacco industry investment decisions
2. Understanding the anti-tobacco marketing; messaging efficacy, innovative communication, and tobacco industry marketing strategies

2.2.7 Tobacco production, alternative livelihoods and environment

Tobacco growing traps many farmers in the vicious cycle of poverty, escalates deforestation, and the disposal of packaging and cigarette butts pollute the environment. There is growing evidence that the farmers who abandoned tobacco and adopted alternative and more profitable crops improved their livelihood and health. It is therefore an urgent need to attract more farmers still stack on tobacco growing, despite its high cost of production, and provide them proof of more viable alternative livelihoods.

Below are some examples of research needed to address the knowledge gaps:

1. Impact of tobacco farming on the environment and soil testing over time, as well as evaluations of soil erosion
2. Behaviour response analysis to alternative livelihood policy interventions;

• Supply chains, Value chains and suitable buyers for viable alternatives and profitability analysis in different regions;

1. Economic and social impact of crop substitution; controlled experiments on input programs, credit programs and market enhancements

2.2.8 The economics of tobacco and tobacco control

Tobacco tax policies is one of the most effective ways to prevent smoking. The increase in taxes directly increases the prices of tobacco products and ultimately reduces the demand for tobacco. On the other hand, raising taxes encourages smuggling of tobacco products, i.e. illicit trade. The smuggled products are cheaper than legal tobacco products because they are produced and sold without paying taxes. The WHO recommends that excise taxes account for at least 70% of the price of tobacco products. However, most countries have a long way to go to reach 70%.

Therefore research projects are needed to address knowledge gaps such as;

1. Adjusted country specific estimates of relative risk and attributable fractions of mortality, health care costs, and disability due to tobacco use
2. Current taxation regimes and systems and their effectiveness and impact

• Effective tax regimes and Sustainable financing of tobacco control extent and impact

1. Link between tobacco taxation and poverty
2. Utilization and expenditures for treatment and disease specific costs
3. Effective tobacco pricing for new and emerging tobacco products

• Contribution of socio-economic transitions on changes in tobacco use
• Market based estimates of productivity costs of death, disability and the interplay of insurance, labour force participation and earnings

1. Tobacco industry influence on the tax structures, prices and market for tobacco products in Africa
2. Price elasticity changes overtime at different levels of tax and price, cross price elasticity
3. Economic cost of tobacco use/disease burden tobacco related illnesses

• Levels of illicit trade of tobacco products in Africa
• Impact of increases in tobacco taxes on illicit trade
• Drivers, nature, magnitude and effects of illicit trade

1. Mitigation strategies for illicit trade

• Impact of track and tracing on the illicit trade and tax administration

CTCA will award student grants of 5000 USD to twelve (12) successful applicants to conduct innovative research in a period of 12 months. The total budget earmarked for this call for proposals is USD 60,000 across all awards. While awards are anticipated as a result of this call for proposals, CTCA reserves the right to fund any or none of the applications submitted.

The research project budget must be submitted in excel format using the template provided. Each line item in the budget must be justified in a brief narrative.

This call for proposals targets  African researchers  interested in having this research contribute to their academic research dissertations. The student should have a supervisor who will guide them in undertaking the research. Although it is not a requirement to be an expert in tobacco control at application stage, it is essential to be equipped with knowledge on tobacco control as you excute the research.

Applicants must submit a declaration of no conflict of interest with the tobacco industry in the research they propose to execute.

Only those applications directly addressing at least one of the eight research priorities described in section two will be considered as eligible.

Applicants will be excluded from participating in the call for proposals procedure if they are (a) subject to conflict of interest; (b) guilty of misrepresentation in supplying the information required by this call for proposals

Two webinars will be organized via the GOTO/Zoom meeting platform to support applicants address any questions during population of their applications. The first and second webinars will take place on 20th April 2020 and 3rd May 2020 at 2pm to 3:30pm respectively. Continuous communication via e-mails will address ongoing concers as they arise.

Applicants attending the webinar are encouraged to test the platform prior to the start of the webinar presentations.

For any concerns to access and use the submission portal, please contact CTCA help desk at radesk@ctc-africa.org

This call for proposals invites full applications detailing the proposed research and how it addresses the gap(s) of the research priority. Full applications shall comply with the following requirements:

1. They must be complete according to the following summary table

2. They should be submitted via the following link https://ctc-africa.org/tc-ra-call-submision​ . All applicants will be required to register to the platform before submitting their applications. The platform allows applicants to work on their applications in steps and save the work done. The platform also allows applicants to upload supporting documents to their application. Once the application is complete, you will submit by clicking the submit button. Once application is submitted, no editing will be possible.
3. They must be sent no later than the deadline of 29 May 2020 at 5 pm EAT. Late and incomplete applications will not be reviewed. CTCA is not responsible for late or incomplete submissions.
4. The submission languages are English and French.
5. Applicants submitting projects for different research priorities should provide separate applications for each priority.
6. All applicants will be informed in writing about the results of the selection process.

Eligible applications will be reviewed by judges with expertise in the various themes. The evaluation will be conducted within two months after the submission deadline.  The final decision will take into account the institutional review board approval of the research.

The project proposals will be assessed based on the following criteria:

10.1 Application form template

Cover Page

Project title:

Research Priority Addressed: 

Country where project will take place:

Research Project length (months):

Total budget requested (USD):

Researcher: names, course of study, email address, phone number, and institution

Contact information for student Supervisor(s) : Names, areas of specialty, email addresses, phone numbers, and institutions

Abstract

Research Plan

• Introduction and background

2.0 Justification for the research

3.0 Goal, objectives and research question (s)

4.0 Methodology and approaches

5.0 Partnerships involved

6.0 Dissemination Plan

10.2 Budget template

10.3 Workplan template

10.4 Declaration of interest template

Declaration of Interest statement

I certify that I am not involved and neither plan to be involved with the tobacco industry (those persons and companies engaged in the growth, preparation for sale, shipment, advertisement, lobbying, and distribution of tobacco and tobacco-related products) in any way with regard to the proposed research project. I acknowledge that any engagement with the tobacco industry will result in termination of the proposed research from the whole process of this call for proposals. If I have any question as to what constitutes conflict of interest with the tobacco industry I will consult the Centre for Tobacco Control in Africa (CTCA) for guidance.

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PRINTED NAME

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SIGNATURE

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DATE