National Tobacco Control Programme (NTCP)

Background

Background

The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 8 million people a year around the world. More than million of those deaths are the result of direct tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke. Around 80% of the 1.1 billion smokers worldwide live in low- and middle income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco use contributes to poverty by diverting household spending from basic needs such as food and shelter to tobacco.

Tobacco burden in India

Tobacco is one of the greatest threats to the health and wellbeing of all citizens in India. It is a common risk factor for the development of most of non communicable diseases including cardiovascular diseases, respiratory disorders and cancer. The GATS-II conducted in 2016-17 showed that in India, lO.7% of all adults smoke while 21.4o/o of all adults use smokeless tobacco. Tobacco not only has adverse effects on the individual who is using it but also affects the people around through second hand smoke.

Health Burden of Tobacco

Cancer of oral cavity, tongue, larynx and pharynx, esophagus, stomach, gall bladder, urinary bladder, uterine cervix and lungs.
Cardio-vascular Diseases and Chronic Obstructive Pulmonary Diseases [COPDs] linked with the Tuberculosis.
40% of TB and other related diseases are attributed to tobacco consumption.
Oral diseases
Low-birth weight babies
Reduced fertility and sexual impotence among men.
Early ageing and wrinkling of skin.
Pre-mature deaths
Cancers: 50% of cancers in males and 20% cancers in females are attributed to tobacco use
Majority of cardio-vascular and lung disorders

Burden of Second Hand Smoke

Second-hand smoke is the smoke that fills restaurants, offices or other enclosed spaces when people bum tobacco products such as cigarettes, bidis and hookah. There are more than 7000 chemicals in tobacco smoke, of which at least 25% are known to be harmful and at least 69 are known to cause cancer. As per the WHO Report-

In adults, second-hand smoke causes serious cardiovascular and respiratory diseases, including coronary heart disease and lung cancer. In infants, it raises the risk of sudden infant death syndrome. In pregnant women, it causes pregnancy complications and low birth weight.
Almost half of children regularly breathe air polluted by tobacco smoke in public places.
Second-hand smoke causes more than 1.2 million premature deaths per year.
65,000 children die each year from smoke.

Attributable to second-hand To curb this menace Urban Development Department has issued a declaration to keep all the restaurants smoke free. Further, to protect the interest of nonsmokers a provision of “Designated Smoking Area” has to be established in the restaurants with seating capacity of 30 or more. These DSAs have to comply with the necessary and mandatory provisions as mentioned in the COTPA Act 2003. The DTCC shall have the right of inspecting and providing the necessary support in establishment of DSAs at district level.

About NTCP

About National Tobacco Control Programme

Government of India launched the National Tobacco Control Programme (NTCP) in the year 2007-08 during the 11th Five-Year-Plan, with the aim to (i) create awareness about the harmful effects of tobacco consumption, (ii) reduce the production and supply of tobacco products, (iii) ensure effective implementation of the provisions under “The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003” (COTPA) (iv) help the people quit tobacco use, and (v) facilitate implementation of strategies for prevention and control of tobacco advocated by WHO Framework Convention of Tobacco Control.

During the 11th Five Year Plan, NTCP was implemented in 21 states covering 42 districts. To carry forward the momentum generated by the NTCP during the 11th Five Year Plan and baseline data generated through the Global Adult Tobacco Survey (GATS) India 2009-2010, indicating high level of prevalence of tobacco use, it was up scaled in the 12th Five Year Plan with a goal to reduce the prevalence of tobacco use by 5% by the end of the 12th FYP. As per the second round of GATS, the prevalence of tobacco use has reduced by six percentage points from 34.6% to 28.6% during the period from 2009-10 to 2016-17. The number of tobacco users has reduced by about 81 lakh (8.1 million).

The main thrust areas for the NTCP are as under:

Training of health and social workers, NGOs, school teachers, and enforcement officers;
Information, education, and communication (IEC) activities;
School programmes;
Monitoring of tobacco control laws;
Coordination with Panchayat Raj Institutions for village level activities;
Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at district level.

Objectives

Objectives of National Tobacco Control Program

To build capacity of the State / Districts to effectively implement the tobacco control initiatives; To train the health and social workers;
To undertake appropriate IEC activities and mass awareness campaigns, including at schools, workplaces; public place etc;
To set up a regulatory mechanism to monitor.
Implement the Tobacco Control Laws;
To establish a system of tobacco product regulation.
Provide facilities for treatment of tobacco dependence To conduct Adult Tobacco Survey/Youth Survey for surveillance, etc.
Integration with other programs under NHM: manpower, IEC, funding, strategies / Augmenting Tobacco Cessation: NPCDCS, NOIIP, Tb-Tobacco collaboration.
Action Plan to meet the 2030 target of 3% Reduction in tobacco cultivation.
Coalition with all stakeholders, academic institutions and professional bodies.

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NTCP Structure

Structure of NTCP

NTCP is implemented through a three-tier structure, i.e.

National Tobacco Control Cell (NTCC) at Central level.
State Tobacco Control Cell (STCC) at State level &
District Tobacco Control Cell (DTCC) at District level. There is also a provision of setting up Tobacco Cessation Services at District level.

Currently, the Programme is being implemented in all 36 States/Union Territories covering over 600 districts across the country.

National Tobacco Control Cell (NTCC)

The National Tobacco Control Cell (NTCC) at the Ministry of Health and Family Welfare (Mo HFW) is responsible for overall policy formulation, planning, implementation, monitoring and evaluation of the different activities envisaged under the National Tobacco Control Programme (NTCP). The National Cell functions under the direct guidance and supervision of the programme in-charge from the MoHFW i.e. Joint Secretary. The technical assistance is provided by the identified officers in the Directorate General of Health Services.
The programme broadly envisages;

National level

Public awareness/mass media campaigns for awareness building and behavioural change
Establishment of tobacco product testing laboratories.
Mainstreaming research and training on alternative crops and livelihood with other nodal Ministries.
Monitoring and evaluation including surveillance
Integrating NTCP as a part of health-care delivery mechanism under the National Health Mission framework.

State Level

Dedicated State Tobacco Control Cells for effective implementation and monitoring of tobacco control initiatives. The Key activities include;

State Level Advocacy Workshop
Training of Trainers Programme for staff appointed at DTCC under NTCP.
Refresher training of the DTCC staff.
Training on tobacco cessation for Health care providers.
Law enforcers training / sensitization Programme.

District Level

Dedicated District Tobacco Control Cells for effective implementation and monitoring of tobacco control initiatives. The key activities include:

Training of Key stakeholders: health and social workers, NGOs, school teachers, enforcement officers etc.
Information, Education and Communication (IEC) activities.
School Programmes.
Monitoring tobacco control laws.
Setting-up and strengthening of cessation facilities including provision of pharmacological treatment facilities at the district level.
Co-ordination with Panchayati Raj Institutions for inculcating concept of tobacco control at the grassroots.

Structure of NTCP

TCC

Tobacco Cessation Centre (TCC)

Focus Group Discussion involves gathering people from similar backgrounds or experiences, to bring them together to discuss a specific topic of interest. It is a form of qualitative research; here questions are asked about their perceptions attitudes, beliefs, opinion ideas, habits etc. In National Tobacco Control Program, FGD is conducted with identified tobacco users in a village; taluk and district level. and motivate them to quit tobacco consumption. It can be done with Self Help Group Meeting, Colleges, Youth Clubs, Parents Meeting at School and Colleges, Health Camps, Rotary club/Lions club, NGOs etc. Those who quit tobacco completely can share his/ her experience to motivate others. Tobacco victims and cancer patients can be invited to talk on tobacco ill effects and benefits so quitting tobacco. It can be done by using tobacco ill effects flipchart, posters and showing anti tobacco videos. Discussion should not only highlight the health hazards of tobacco, but it should also showcase the economic consequences on “how tobacco ruins a household”, “Economic Burden of tobacco”, “Social burden of tobacco” etc. The psychologist has to show them a different angle about their cultivated habit, how quitting will be beneficial to him/her in different was. At end of the FGD, psychologist should explain services available in Tobacco Cessation Centre and refer him to Psychiatrist working under DMIIP Program for any higher treatment, to those who are willing to seek tobacco cessation service. Educative materials, flipcharts, reading materials are given to FGD participants. Ideally, one FGD group consists of 1015 people. NTCP Psychologist has to be actively involved along with other NTCP team members. Counselor Psychologist under NTCP has to organize 4 such FGD’s in a month.

Telephonic Counseling/Phone Therapy

Considering the current situations we encourage our Counselors/Psychologist to undertake “Telephonic Counseling” also called “Tele-therapy” or “Phone Therapy”. Phone Therapy or Phone Counseling is the process of talking to a client via telephone/Skype to resolve mental health issues. Telephone Therapy can be found effective in adolescents can be done through telephone or even Skype calls. Recent studies show that telephone therapy has much therapeutic value as Face to Face to therapy. It also can be used to supplement Online therapy sessions, send reminder SMS for follow up appointments etc,

Considering current scenario, TCC is a way of helping people who do not have means or opportunity to attend face toface sessions, and to receive the help that they want to receive.

DTCC

District Tobacco Control Cell (DTCC) Key Objectives/Activities

Training of Key Stakeholders – Advocacy, Cessation, Enforcement officer Training
IEC activities
School Program
Monitoring of Tobacco Control Laws
Setting up and Strengthening Tobacco Cessation facilities.
Coordination with Panchayath Raj Institutions to implement the Tobacco Control Program at grass roots.

DLCC Members

District Tobacco Control Cell,

District Level Co-Ordination committee.

Sl.No	Designation	Post
1	Deputy Commissioner-Revenue	President
2	Additional Deputy Commissioner-Revenue	District Nodal Officer
3	Superintendent of Police- Dept of Police	Vice President
4	District Health & Welfare Department Officer.	Member Secretary
5	District Surgeon, Chigateri District Hospital	Members
6	Secretary of district legal service thirty	Members
7	Deputy Secretary, Zilla Panchayath	Members
8	Deputy Commissioner, Excise department	Members
9	Deputy Director-Public Instructions	Members
10	Deputy Director Pre-university education	Members
11	Deputy Director Social Welfare department.	Members
12	Join Director- Dept of Agree	Members
13	Division controller – K.S.R.T.C	Members
14	Regional Transport Officer R.T.O Office.	Members
15	Labour Officers – Department of Labour.	Members
16	National Child Labour Officer	Members
17	Environmental Officers, Karnataka state Environmental Pollution control Board.	Members
18	Superintendent – Dept of Prison	Members
19	District Surveillance Officer, Davangere	Programme Officer.
20	Designated Officer – Food Safety & Standard Authority India	Members
21	Project Director – Urban Development Cell	Members

Taluk Tobacco Control Team

Sl.No	Designation	Post
1	Tahsildars	President
2	Circle Police Inspector	Vice President
3	Taluk Health Officers	Member Secretary
4	Executive Officers – Taluk Panchayat	Members
5	Block Education Officers – Department of Education	Members
6	Excise Inspector-Dept of Excise	Members
7	Assistant Director -Department of Social Welfare	Members
8	Civic authorities, Council, Municipal, Town Panchayat	Members
9	Assistant Director, Department of Agriculture	Members
10	Child Development Project Office- Department of Women & Child	Members
11	Food Saftey Officer Food Safety Standard Authority Officers.	Members
12	Labour Inspector	Members