Funding and sustainability

Unlike many public health interventions in LMICs, THR does not require large, ongoing public expenditure to deliver population-level benefit. The core mechanism of THR, encouraging and enabling people who smoke to shift from combustible tobacco to non-combustible alternatives, is largely consumer-driven once appropriate regulatory and market conditions are in place. This makes THR fundamentally different from programmes such as vaccination, HIV treatment, or TB control, which depend on sustained public financing, clinical infrastructure, and intensive service delivery.

In practice, THR can be implemented at minimal cost to health budgets. The primary public-sector role is enabling rather than providing: clarifying legal status, setting proportionate product standards, correcting misinformation, and ensuring that safer alternatives are more accessible and affordable than cigarettes. Once these conditions exist, people who smoke can switch with little or no ongoing supervision, allowing harm reduction benefits to accrue without placing sustained demands on healthcare staff or facilities.

Sustainability therefore depends less on securing new funding streams and more on avoiding unnecessary cost burdens. Integrating THR into existing tobacco control frameworks, rather than creating stand-alone programmes, prevents duplication and keeps implementation lean. In many settings, modest regulatory reform or tax restructuring may have greater impact than large programme investments. Where funding is required, such as for initial policy development, communication, or limited capacity-building, this can often be supported through existing tobacco control budgets or small, time-limited grants.

Transparent governance and basic monitoring remain important, but they need not be resource-intensive. Demonstrating that THR reduces smoking-related harm at low cost strengthens the case for political support and long-term sustainability. By recognising THR as a low-cost, high-impact complement to traditional tobacco control, LMICs can advance harm reduction without diverting scarce resources from other essential health priorities.