Background:

Tobacco use is the leading preventable cause of death in the world. The increased use of tobacco is one of the greatest public health threats. WHO has estimated that about 4.9 million die due to tobacco annually & that by 2020, it will be the leading cause of death & disability. The total number of premature deaths caused by tobacco during the twentieth century has been estimated at about 100 million & if current trends of tobacco use continue during the twenty-first century, the death toll is projected to go up to 1 billion.

The variety of forms of tobacco use is unique to India. Apart from the smoked forms that include cigarettes, bidis & cigars, a plethora of smokeless forms of consumption exist & they account for about 35% of the total tobacco consumption. India’s tobacco problem is more complex than probably that of any other country in the world, with a large consequential burden of tobacco related disease & death. In India, the tobacco attributable deaths currently range between 8 lakh to 9 lakh per year. India has played a leading role in the development of framework convention on tobacco control (FCTC). India was one among the first few contries to sign & ratify the FCTC. India was also among the first countries to enact a strong national law for tobacco control in April 2003. The early ratification of FCTC & enactment of the Cigarettes & other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 exhibits a strong commitment to tobacco control, more so in light of the fact that India is a major tobacco producing nation.

Justification for National Tobacco Control Progremme:

Since the problem of tobacco in India is complex, in view of the varied nature of tobacco use, it is clear that the control of tobacco can effectively be carried out only with a multisectoral approach, involving the various concerned sectors. Strategies for different sectors are being identified for effective tobacco control in the community, which would help in planning the national strategy for tobacco control in India.

Therefore, there is a great need for establishment of a comprehensive national tobacco control programme to undertake effective tobacco control measures across the country. The compelling need to save many of these lives from falling prey to tobacco use addiction and the urgent imperatives of avoiding the huge health, economic, social and environmental burdens thet would be imposed by tobacco on a nation, form the basis of the need to institute a National Tobacco Control Program.

The National Tobacco Control Programme would help to sensitize all the stakeholders on the harmful effects of tobacco consumption and associated mortality / morbidity. The concomitant increase in awareness would lead to farming of policies that would facilitate reduction of tobacco consumption. Further, in order to ensure long term sustainability for the program and enforcement of the legislation / FCTC, a National Tobacco Control Program needs to be established. The National Programme would also build an appropriate strategy, institute a regulatory mechanism including laboratory network for effective implementation and develop infrastructure at state level for enforcement of the anti-tobacco laws.

The framework for the National Tobacco Control Programme has been categorized into pilot phase; phase I and phase II.

PILOT PHASE:

In the Pilot Phase (2006-07), it is proposed to utilize 2006-07 for developing the strategies for formulating the National Programme on Tobacco Control. The specific steps proposed include :

Setting up State Tobacco Control Cells.

The Anti Tobacco Act was legislated in 2003. In the Pilot Phase (2006-07) it is proposed to set up State Tobacco Coordination Committee is expected to facilitate / drive the process as also to monitor the proposed District Tobacco Control Programme.

(Budgetary estimates are at Appendix ‘A’)

The District Tobacco Control Programme :
There is a need to put in place an effective Community level tobacco control programme in the districts for bringing about public awareness against ill effects due to consumption of tobacco; Also, for monitoring / enforcement of Anti tobacco provisions.

For initializing the District Tobacco Control Programme high prevalent state like Ease, North-Eastern and Central parts of the country will be covered. In addition, it is proposed that urban Slums and re-settlement colonies will also be covered. This is for the reason that there is a huge population cluster residing in these places, with little or no access to health facilities.

It is proposed that District Tobacco Control Units will be set up in Government Medical Colleges / RCC’s / District Govt. Hospitals. For the Pilot Phase (2006-07), it is proposed to take up 2 districts in each State where State Tobacco Control Cells are proposed. (Budgetary estimates are at Appendix B)

The Medical Superintendent of Govt. Medical College / Hospital selected will be authorized to nominate the focal point for tobacco control in the Department of Oncology / Pulmonary Medicine / Community Medicine. The focal point will coordinate all activities including setting of Tobacco Cessation Centers in the hospital. The focal point will also conduct tobacco control activities with support from TCC staff and in collaboration with local NGO’s. Staff will be hired on contractual basis to carry out tobacco control activities.

The following activities would be carried out :
· Tobacco Cessation Center
· Training
· IEC
· School programmes
· Monitoring the tobacco control laws

Tobacco Cessation Centre:
Tobacco Cessation will be established in District Tobacco Control Unit to carry out tobacco cessation activities. These centers would provide counseling and pharmacotherapy to tobacco users for quitting the tobacco addiction. These TCC’s would also develop community outreach programs and conduct training and awareness programs at school and colleges.

Training :
Training workshops would be held in each District Tobacco Control Unit. The target audience would be School Teachers, Health Workers, law enforcers, Women Self Help Groups, other civil society organizations etc. Training on tobacco control will be provided by identified GOI institutions / TCC on tobacco epidemic, tobacco control laws and implementation of the same.

IEC:
District level campaigns would be carried out through local Cables TV channels, Nukkad / Street corner Shows, Exhibitions, Melas, etc. in the regional language. Awareness programs on tobacco control would be carried out by the trained Women SHG / NGO’s in community, villages, slums etc. IEC materials would be developed and disseminated in local languages.

School Programs :
School Programme would cover all Government schools at district level . The School Health programme is proposed to be carried out with the help of NGOs. In the Pilot Plan, it is proposed to take up at least 50 Schools per District. The estimated expenditure proposed is Rs. 8000 per School (8000 * 50 = Rs. 4 Lakh / Dist.).

Monitoring tobacco control laws :
Monitoring of tobacco control laws would be done to ensure that laws related to ban on smoking in public places; ban on sale of tobacco products to minors; are properly implemented. Small teams of trained School Teachers, Health Workers, law enforcers, Women Self Help Groups, other civil society organizations would be formed to coiver small areas of each district. These groups with local NGOs would report biolations back to the focal point for ensuring proper implementation of tobacco control law.