Institutionalization of Indian Tobacco Control Programme at Grassroot level - experiences from state of Jharkhand in India. (Enabling institutional structure is key to sustained results)

摘要

Background and challenges to implementation: In Jharkhand, prevalence of tobacco is a serious concern as its 50.01% (n=19.5 million) of adults are edicted to tobacco as against national average of 34.6% as per GATS 2010. Government of India launched National Tobacco Control Programme (NTCP) IN 2010-11 in two districts of Jharkhand i.e. Dhanbad & East Singhbhum as pilot basis. Enforcement of Indian tobacco control law, capacity building, awareness generation, school health programs and cessation are main components of NTCP. Currently Jharkhand State Tobacco Control Cell in technical collaboration with SEEDS and The Union is implementing a project on tobacco control in 6 districts of state. Intervention or response: Several effective strategic interventions were undertaken. All primarily revolved around institutionalization of efforts, value systems, management practices and administrative structures. Institutional framework was developed through four pronged strategies i.e. intense advocacy, capacity building & follow up with government officials, effective monitoring at state and district level and consistent media mobilization without losing out to capture even a smaller event related to tobacco control issues. Collaborative and systematic efforts were made. Meetings / workshops / trainings and brainstorming sessions were conducted in collaboration with the District Administration. Results and lessons learnt: These resultes in sensitisation of program managers, law enforcers and media resulting in noticablely high commitment to the cause. Innovatively, formation of anti-tobacco squads, inter-departmental State and Districts Tobacco Control Coordination Committees′ meetings, enforcement reviews in monthly crime review meetings were conducted. This provided distinctive outcomes: - Appointment of nodal officers at- state level - Appointment of three nodal officers in each district, - Synergy between efforts of health, police and general administration, - Review by Deputy Commissioners in their monthly meetings of all departments Conclusions and key recommendations: It is established that successful enforcement and implementation is achieved only through well-established institutionalization of tobacco control within existing system. Enabling Institutional Structure is indeed Key to Sustained Results.