Friday, June 3, 2016

Role of HPVHA in Tobacco Control Campaign in Himachal Pradesh

Tobacco Scenario in Himachal Pradesh

The Development Indicators in Himachal Pradesh is higher the national average that does not mean the manifestation of tobacco related health problems in any way. If a state is high on developmental indices it does not necessarily indicate that the need for specific interventions on preventive, curative and enforcement aspects of tobacco control are not required. It is with this raison HPVHA initiated tobacco control activities and implementation of COTPA, 2003 in May, 2007, through a signature campaign and memorandum submitted to then Governor Sh. V. S. Kokje and Chief Minister Sh. Virbhadra Singh and  the project to stop cigarette/ bidi smoking in public places through Smoke Free Shimla.

According to World Health Organization, tobacco is one of the major causes of deaths in India. It accounts for over 8 lakhs death every year. Other than cigarettes, bidis and cigars, a plethora of smokeless forms of consumption exists which accounts for 35 % of total tobacco consumption. According to National Household Survey of Drug and Alcohol Abuse in India, 2002 in which the sample size was 20,000 population in 25 states of India, revealed that there is an increase of tobacco use amongst 41 – 50 years age group (72 %). There was 55.8 % prevalence in the age group of 12- 18 years. The estimated number of tobacco users in India among 10 years of age and above is around 250 million. According to NFHS II, the number of males who currently smoke are 29.2 % and females are 16.2 %. 

Out of 6 million population in Himachal Pradesh 60.5% male and 28.1% females smoke in rural areas. In Vision 2020 of the Department of Health and Family Welfare, HP it is stated that there will be upswing in the lifestyle disease like cardiovascular diseases, cancer, and psychiatric problem in HP. Empirical evidence suggests that the response system with regard to this particular problem in HP is not effective and there is an immediate need for taking up consistent measures to deal with the preventive aspect of Tobacco among the target group. There are no cessation clinics in HP to assist the habitual population and prioritize curative aspect. No consistent Tobacco control programmes are run by health department or other institutions in HP. Occasional sensitization is planned by NGO’s or programmes taken up in schools but this is not the solution. The morbidity profile to ten major diseases in Himachal Pradesh includes acute bronchitis (17.18%), Chronic bronchitis ( 11.86%) that is alarming. ( IGMC , Shimla). With regard to, prevalence of tobacco use by men - HP falls in the 35-49.99% states( Source : NHFS 3). In 2008 the cases of lung cancer patients were highest among cancer patients. (Source: Regional cancer Hospital IGMC Shimla). As per GYTS -2004, 19.6% smokers of HP want to do away with smoking. 8.49% actually tried but after a lapse adopted it again. As per sample study by IGMC – 29.3% school going students smoke (private/public schools 31%, government schools 28.6%). About 83% (with regard to a sample population) people observed sale of tobacco products to minors before 2nd Oct 2008 and 78% people informed that tobacco is being sold around educational institutions (Source: Study conducted by HPVHA). 80% men are aware of tobacco control program and ill effects of tobacco in-spite they yet are continuing smoking (Source: Study conducted by HPVHA).

Keeping HPVHA’s mission in mind we have concentrated our research and advocacy on ill effects of tobacco and effective implementation of Tobacco Control Act. 2003. In an empirical study by HPVHA in Shimla town, the facts revealed that awareness on Tobacco Control is high but there is extreme indifference towards its implementation.

It is in this regard, HPVHA has widened the stakeholders and focused not only on Department of Health and Family Welfare because while working out the advocacy strategies we realized that an integrated amalgamation of crucial stakeholders and departments would speed up the project and the ultimate outcome would be achieved. Similarly we concentrated not only on the issues related to tobacco consumption but also on effective implementation of COTPA, 2003. We oriented our objective by focusing that COTPA, 2003 and Smoke free Shimla is a good social legislation and it is necessary to aware the community on this regard.

With the objective of creating awareness amongst the common people with regard to Tobacco Control Act, 2003, HPVHA did an intensive signature campaign in May 2007 with regard to voicing our views on implementation of TCA 2003. There were radio talks, workshops with allied departments, rally and common march involving school children. In the month of December 2007, HPVHA organized a press conference and rallies to support pictorial health warnings on tobacco product packages. The bottom line of HPVHA advocacy was that if 60% of a pack surface area in Australia and 50% in Thailand could be adopted, the same may be accepted in India too.

In the month of June 2007, HPVHA submitted a memorandum to His Excellency Governor of HP and the Honourable Chief Minister for effective implementation and enforcement of TCA 2003.
India is one among the front runners to sign and ratify the WHO framework convention on tobacco control (FCTC). The Act of 2003 encompasses most of the FCTC provisions. Under the TCA 2003, the Central Government has promulgated the Prohibition of Smoking in Public Places Rules, 2008 to be implemented from the 2nd of October, 2008. In view of this, the HPVHA started a campaign to make people aware of the provisions of the rules. It is in this regard, the first phase of the campaign started from the HPU on 30th September 2008. Our programme coordinator with his team did intensive campaigning to inform about the ban on smoking in public places from 2nd October 2008. HPVHA’s initiative to campaign among the students of the University, schools and colleges is to catch them young and keep them away from the ill effects of tobacco consumption.

A documentary highlighting the current scenario in Shimla town was shown. A Nukkar Natak focusing on the various articles of TCA 2003 was staged. Mr. Shriniwas Joshi, a social activist, addressed the gathering in University auditorium about TCA 2003. Dr. Hardyal Chauhan, the State Programme Officer for Tobacco control in HP spoke on the Govt. policies and strategies on the implementation of national Tobacco Control Programme. Mr. B S Thakur Security, Incharge HPU appealed to the students to follow the provisions of the Act in coming times. The Central Students Association Vice President Mr. Dinesh Negi appealed to the students to stop smoking in the University Campus. The Executive Director of HPVHA appealed the university authorities to support the HPVHA in the activities of implementing the TCA 2003.

The Vice Chancellor of HP University Dr. Sunil Gupta, congratulated HPVHA on its effort on making teachers and students aware of the provisions of TCA 2003. He assured that efforts to make the University smoke-free would continue within the complex. The programme was followed by a silent march in HPU campus and surrounding market. 
HPVHA has worked on concerted approach to make Shimla Smoke Free since 2007. The compliance study had done by The Union South East Asia in May, 2010 showed 90% adherence to section 4 of COTPA, 2003. This has been achieved by HPVHA without any constant flow of funds. 
Activities: 2007
·    HPVHA started campaign against tobacco control in 2007 with a signature campaign for smoke free public places in Shimla city.
·         In June, submitted  a memorandum to then His Excellency, Governor and  Honourable Chief Minister
·      Conducted a base line study on tobacco in Shimla city and published  “Sajhedari” “Tobacco Epidemic”
·         Rallies and Press Conference on 11th   December 2007 in Shimla city
·         Sensitization workshops and meetings with school children and teachers in Shimla city
Activities: 2008
·         May 2008, Press conference on pictorial health warnings in Shimla city
·         September 30th , Silent March in HPU for pictorial health warnings on tobacco products
·         Regular policy advocacy focusing on  authorising  police personnel for Section 4 of COTPA,2003
·         State level workshop for government officials and NGO officials on COTPA, 2003 in Shimla city on 14th November, 2008
·         The national level resource persons from VHAI, Hriday Shan, VOICE etc
Activities: 2009
·        State Level Workshop for Effective Implementation of COTPA, 2003 and Smoke Free Shimla on September 5th 
·         Workshop  presided over by worthy Chief Secretary Govt of HP Mrs. Asha Swroop
·   Workshop  attended by Principal Secretaries, Secretaries and Directors from different departments
·       Strategy was made to make Shimla a Smoke Free City and implementation of COTPA,2003 in whole state
·     Meeting Indira Gandhi Medical College officials, students and press on 30th  May, 2009 to make IGMC smoke free
·     Involvement in state level rally by Department of Health and Family Welfare, HP on 31st  May, 2009
·         Press release on Smoke Free public places and pictorial health warnings
·         Distribution of IEC material for generation awareness on 31st  May, 2009
·    Advertisement on pictorial health warnings and section 4, 5 and 6 in  local newspapers, channels
·         Nukkar Natak on COTPA. 2003 highlighting sections 4, 5 and 6
·         Video Shows in HPU campus
·       Sensitization meetings with university students and college students for creating demand for smoke free public places and educational institutions
·    1st  October 2008, rally of school children and people in Shimla city to High court to implement  COTPA, 2003
·         Press conference on pictorial health warnings and media sensitization
·         Sensitization Workshop on COTPA, 2003 to make HP University a Smoke Free Campus
·       Workshop for Smoke Free  University campus for  department heads of  HP University on 1st  September, 2009
·    Workshop for enforcement officials for implementation of COTPA, 2003 in Shimla city to make Smoke Free.
Activities :2010
·     1st district level workshop for enforcement officials at Solan on 17th January, 2010. Dr. Rajeev Bindal Minister for Health & Family Welfare &Ayurveda presided over the workshop and directed to make Solan a Smoke Free district
·   2nd district level workshop on 20th March 2010 for district level workshop at Mandi. Workshop presided over by Sh. Gulab Singh Thakur Minster for Revenue and PWD govt. of HP.
·         Training workshop for enforcement officials on 22nd and 25th March 2010  for enforcement officials and stakeholders of Shimla city at Bachat Bhawan DC Office Shimla. Workshops  presided over by Mrs. Madu Sood Honourable Mayor MC Shimla and Mr. Suresh Bhardwaj, Honourable MLA and former MP Shimla
·         Follow up meetings with different  stake holders and officials
·      Data collection and FGD for Strengthening Indian CSO for tobacco control. In four district Shimla, Mandi, Bailasur and Kangra districts in association with Hariday Shan.
·      Created intensive awareness in all 52 high & secondary schools of Shimla town to sensitize the heads of educational institutions for implementation of section 6 (a) and (b) of COTPA, 2003 in their surroundings.
·   Distribution of 6000 Smoke free signage to government offices, educational institutions, private institutions, tobacco vendors etc.
·   Constant policy advocacy with Chief Secretary, Principal Secy, Health , school functionaries for implementation of Section 6 of COTPA, 2003
·         Initiated the need for tax advocacy on tobacco products
·         Organized media workshop on sustainability of Smoke Free Shimla in July 2010
·  Organized workshop for educational heads in September, 2010 for making educational institutions a Smoke Free place under section 4 of COTPA
World No Tobacco Day, 2010
·      State Level World No Tobacco Day was celebrated in collaboration of Department of Health & Family Welfare focusing on Women and Tobacco
·        Event   Presided over by Dr. Rajeev Bindal Honourable Minister for Health & Family Welfare & Ayurveda, Sh. Suresh Bahrdwaj, MLA Shimla and Mayor Smt. Madhu Sood.
·         Smoke Free caps  distributed  by HPVHA
·     Shimla Smoke Free Shimla balloons released by Dr. Rajeev Bindal Honourable Minister for Health & Family Welfare & Ayurveda
·         Signature campaign for Tobacco Free Himachal was  started to cover all HH of the state
Smoke Free Himachal Pradesh (2011-2013):
  • Organised 12 District and 40 Block level workshops in all 12 districts.
  • Organized state level inception and networking workshops 
  • Organized Media Sensitization and Training Workshops.
  • Conducted Base Line and End Line Survey on Section 4 of COTPA, 2003
  • Trained district/ block and panchayat level enforcement officials through more than 625 cluster trainings
  • Declared 11 district head quarter Smoke Free by respective Deputy Commissioners 
  • Declared state Smoke Free by Health Minister Sh. Kaul Singh Thakur on 2nd July, 2013 
Campaign for Tobacco Free Himachal (2013-2015)
  • Conducted Base Line Survey on the implementation status of Section 5, 6 and 7 of COTPA, 2003
  • Organized 12 district and 11 Block level workshops and trainings 
  • Organized 12 training of Flying Squad members at respective district head quarter 
  • Conducted End Line Survey on Section 4, 5, 6 and 7 of COTPA, 2003