How to monitor WHO-MPOWER policies implementation at sub national level in low resource settings? Experience from the state of Himachal Pradesh in India

Background and challenges to implementation MPOWER are the WHO recommended policies for reducing demand and supply of tobacco under Framework Convention (FCTC). Tobacco surveillance is important for policy development and action but due to huge cost it is difficult to use MPOWER toolkit in poor resource settings. The state of Himachal Pradesh in India have successfully demonstrated an effective mechanism for tobacco surveillance by customising MPOWER toolkit since 2010. Intervention or response Key indicators have been developed to monitor the MPOWER compliance on monthly basis as a part of routine reporting mechanism as M - a) Number of the tobacco related violations observed b) Number of violators panelised P - a) Number of public places where active smoking observed b) Number of violators panelised O - a) Percentage of health institutions having tobacco cessation facilities b) Percentage of tobacco users utilising the cessation services W - a) Number of violations reported for selling tobacco without pack warnings b) Number of prosecutions launched in the courts E - a) Number of violations reported related to tobacco advertisement and promotion b) Number of prosecutions launched in the courts. Results and lessons learnt The monthly progress review is leading to a healthy competition among the districts to perform better. The validation of the progress is done by academic institutes also. Himachal has successfully sustained smoke free status since 2013. The community based tobacco cessation services have been started in addition to indoor facilities. The compliance of specified pack warnings on tobacco products is quit high and most of the places do not have any outdoor advertisement of tobacco. There is a constant rise in tobacco taxes since 2010. Conclusions and key recommendations Cost effective tools to monitor MPOWER compliance is the way forward for optimum allocation and utilisation of resources in low income settings