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Awareness to action through multi-channel advocacy for effective tobacco control in five Indian states

This project was implemented in collaboration with the Gramin Shikshan Charity Foundation (an NGO based in Hubli, Karnataka) across seven districts – three northern and four southern Karnataka districts. Project aim was to study effect of district level capacity building of law enforcement officials and tobacco control advocacy on implementation of selected provisions of national tobacco control legislation. Five districts, namely, Tumkur, Ramanagaram, Mysore, Dharwad & Gadag, were taken as intervention districts while two districts – Bengaluru rural and Haveri – were taken as control districts. In the course of one year, state and district level need assessment surveys as well as pre-compliance monitoring exercises were conducted in all seven districts highlighting the needs of district level law enforcement officials as well as the status of implementation of tobacco control law in these districts.

Youth and on-screen tobacco use

Exposure to on-screen (portrayal of tobacco use in media) tobacco use has been shown to be one of the factors influencing initiation of tobacco use by youth. Media rating system is one of the tool to reduce exposure of youth to on-screen tobacco use. There was a proposal by Central Board for Film Certification (film certification authority in India) to possibly rate films with portrayal of tobacco use as ‘A’ (only for adult viewing) films, in order to reduce its exposure to youth.

IPH carried out a study among youth in Karnataka (including students from metropolitan city, towns and villages) to assess awareness and enforcement of current media rating system. Study findings suggested poor re of viewership restrictions as prescribed by prevailing media rating system. Study also provided data on various aspects of tobacco use and its association with exposure to on-screen tobacco use among youth. This study was funded by the World Health Organisation (India). Publications from the study are in progress.

Youth and tobacco use in Bangalore city

Youth and tobacco use in Bangalore city


Following an initial exploratory and small study by IPH on tobacco use among pre-university students, a large-scale cross sectional study using a random sample of 19 pre-university colleges across the Bangalore city was planned for better and representative assessment.

Various aspects related to tobacco use including, prevalence of tobacco use, social perceptions of tobacco use/user, factors influencing initiation/continuation of  tobacco use, implemettaion of relevant policies etc. were studied. This study was carried out under ISEC-SRTT visiting fellowship programme by Institute for Social & Economic Change, Bangalore. Publications from this study are in progress. A research brief was produced summatising the study findings and was distributed among city based pre-university colleges. Study findings were reported in several news reports.


Youth and tobacco use in Bangalore city

Tobacco use and its correlates among college students in Bangalore

Most studies on youth and tobacco use in India (including Global Youth Tobacco Surveys) focsues on high-school students (grades 8, 9 and 10). In Karnataka, pre-university education (grades 11, 12) is imparted through a seperate governmanet department and often in different settings than high-schools. This phase of life represents a transition of student from relatively more restricted school setting to liberal university setting. In order to understand tobacco use and related factors among pre-university students, IPH carried out an exploratory cross sectional study among 500 students of a purposely selected pre-university college in Bangalore city.  Study provided findings on tobacco use prevalence, reasons for (non) use of tobacco by students, awareness on tobacco harms, information sources for such awareness etc.

Study findings were published in the National Medical Journal of India and were subsequently disseminated through mass media reports. For more details, please see relevant publications and news reports.

Youth and tobacco use in Bangalore city

Tobacco Control

Health promotion tobacco control

Awareness to Action through Multi-Channel Advocacy for Effective Tobacco Control” in Karnataka. This project is funded through Bloomberg Initiative for tobacco control project of HRIDAY (Health Related Information and Dissemination Among Youth) and is simultaneously done in other four Indian states by different agencies.

In Karnataka, IPH is working in collaboration with Gramin Shikshan Charity Foundation to implement the project in five intervention and two control districts. Project aims to advocate for and build capacity of district level law enforcement officers and NGOs for effective tobacco control.

Various activities including state and district level need assessment (of govt officers and NGOs) and pre-compliance monitoring exercises have been undertaken. There will be district level training workshops and various advocacy activities before we do post-compliance monitoring exercises.


Shortage of General Duty Medical Officers in Tumkur: a crisis unfolding

Shortage of General duty medical officers (GDMO) affects the effective management of government health facilities and thus, affects the quality of health care across Tumkur district in southern Karnataka. The Community Health Centres (CHC) and Primary Health Centres (PHC) are the worst hit facilities while the problem is doubled by creating more centres with limited available resources. As a result of this, patients with minor illnesses are also going directly to First Referral Units (FRU) such as CHCs, Taluka hospitals or District hospital where the hospitals are already overloaded with patients.

A GDMO in India is a MBBS graduate. At the primary and secondary level of health services, he/she is mainly responsible for the preventive and promotive work under the national programmes such as Reproductive and Child Health programme, Immunization programme,  Revised National Tuberculosis Programme, etc. He/she needs to attend to patients in the outpatient department, inpatient wards and casualty. In the PHC, he/she is additionally responsible for the administration of the PHC and management of the periphery like supervising the staff, monitoring the reporting systems of services provided, financial performance, etc. In Taluka hospitals and the District hospital, the presence of GDMOs allows specialists to attend to cases and conduct operations/procedures within their speciality.

From the above mentioned role and responsibilities, we can therefore understand the importance of having adequate number of GDMOs at the various levels. Now we can see how shortage of GDMOs badly affects not only the functioning of facilities but also the quality of health care available to the community. This is the scenario in Tumkur today but is similar across other districts in Karnataka also.

According to the district records, in 2011, there are 147 total sanctioned posts out of which 133 are filled while 14 are vacant. According to Indian Public Health Standards, there should be at least 407 GDMOs in Tumkur  across all facilities(not including AYUSH doctors).This means that the State health department needs to create 260 more posts for GDMOs and recruit at least 274 more doctors. The State health department is trying to bridge this gap through appointment of contractual AYUSH doctors instead. However, the AYUSH doctors are not provided with adequate orientation on their job responsibilities and in some cases, nil. As a result of this, even if they are available at the facilities, they are unable to take an active part in managing these centres. At the end of the day, only the poor patients suffer either by going to private practitioners if they have some money or by staying at home and worsening if they do not.

Thus, there is an urgent need to develop strategies to address this issue. The strategy may be to: i) rethink creation of new PHCs or CHCs, ii) reorganise the PHCs depending on needs of the population rather than numbers, iii) recruit GDMOs on contractual basis to fill in gaps for short term, iv) address the issue of fresh MBBS graduates joining the private sector, or v) address the friction rate of doctors leaving government service to join the private hospitals.

Arupa & Tanya