Implementing comprehensive tobacco control polices in medical education institutions and associated teaching hospitals - a case study from a northern state in India

摘要

Background and challenges to implementation: GATS India 2009:10 estimated that, 2.7% of adults are exposed to second hand smoke in health care facilities in Himachal Pradesh state in north India. Department of medical education, Government of Himachal Pradesh provides professional medical education as well as clinical services through a network of 5 medical, 4 dental and 35 nursing schools and associated teaching hospitals. Indian tobacco control legislation (COTPA) bans smoking in public places and sale of tobacco products in and around an educational institution; however the implementation of the law has been sub-optimal for a long time. The present case study enumerates the steps taken by the Department of Medical education to implement tobacco control policies in these institutions. Intervention or response: With an administrative order from the department, high level institutional core committee for tobacco control were constituted in each institutions. Institute wise comprehensive action plan was developed. Nodal officers for enforcement in each institute were notified. A circular was shared to all stakeholders including the staff associations to comply with the law. Specified signages and anti-tobacco messages were displayed at all prominent places. Strict law enforcement was ensured, till date more than 800 violators has been punished and fine amount of near 1.5 lakh INR has been collected. Results and lessons learnt: There is an overwhelmingly positive response from all stakeholders. The smoking has been literally banned. Tobacco products are not available inside and within 100 yards of the premises. Institute authorities are doing regular monitoring of enforcement activities. There is an increase in no. of tobacco users seeking tobacco cessation services. Conclusions and key recommendations: Medical education institutions and associated teaching hospitals in Himachal Pradesh state in India demonstrated successful implementation of tobacco control policies. Following these strategies, other institutions in India or in similar settings in other countries can also be made tobacco free educational institutions to promote public health.