Blazing a new trail in tobacco control
The DDC Model
A trendsetting strategy is taking on the tobacco menace aggressively and yielding results in the state of Kerala, where nearly a quarter of the population is still under the influence of the scourge.
While, globally, tobacco control is largely a public health issue, MD Niche Media Consultants has propelled Kerala to see it as a developmental issue to be counted in the governance agenda.
“If you can't measure it, you can't manage it and you can't fix it,” Mike Bloomberg, American philanthropist, entrepreneur and politician, has famously said. That was the underlying philosophy when Bloomberg Philanthropies-backed Campaign for Tobacco Free Kids assigned MD Niche to create ‘measurable’ and ‘sustainable’ tobacco control systems in all the 14 districts of Kerala.
We are proud to have successfully pioneered inclusion of tobacco control in the agenda of the District Development Council (DDC) — one of the most important structures of the state’s administration — where it is reviewed alongside key development issues every month.
It took us just nine months and a well-crafted strategy to boot, besides sensitisation at all levels of governance and coordinated efforts to help create this permanent and sustainable mechanism that monitors and records compliance as well as violations of The Cigarettes and Other Tobacco Products Act (COTPA), 2003 — India’s tobacco control law.
Moreover, all information relating to COTPA implementation is made available monthly for each of the 14 districts of Kerala on their official websites, besides the high-visibility portal of the state Public Relations Department. The information includes the number of -- government offices that have gone smoke-free and put up signage; inspections conducted to detect illegal sales of tobacco products; and people who were booked selling tobacco products to minors or near schools.
Anyone who has ever worked in public health, governance, law enforcement, or any branch of statistics and public reporting will realise what a wealth of measurable data the websites provide for policymakers. They also enable the state administration to identify non-performers, put in place remedial measures, and boost implementation.
Kerala is so far the only state in India to have this mechanism; it is an initiative that bears not only the stamp of uniqueness but also comes out as a replicable model for governments across the world. Here is briefly how the MD Niche tackled the daunting task, the processes we devised, and the challenges we encountered in implementing this project:
- High levels of literacy in Kerala translate into good record-keeping processes in government systems. However, creating regular reporting structures for tobacco control – a non-priority area – was a hard call;
- The first step was to identify a suitable platform for tobacco control reporting and reviews. The answer came in the form of the meetings of the District Development Council (DDCs), which have been functioning in Kerala since 1957. These are chaired by the District Collectors with magisterial powers and are a democratic forum for decision-making attended by officials from all government departments and people’s representatives – MPs and MLAs – to discuss the developmental issues;
- Our team took a top-down approach to reach to the district level. We first met with the Revenue Minister and the Revenue Secretary who gave the initial directive to District Collectors to take up COTPA, 2003 as an agenda item for review in the monthly DDC meetings;
- The District Collectors were the next target for sensitisation. Our team held at least two-three rounds of personal meetings with them and supporting officials across all 14 districts over the period. We went armed with a resource kit we put together with the latest figures on tobacco use and tobacco-induced disease trends in Kerala and wheedled and begged our way for appointments with the super-busy officials;
- We designed reporting templates in Malayalam for easy administrative use and questions were simple and basic to elicit ‘Yes’ or ‘No’ responses. The inputting formats were designed to get answers in less than 5 minutes; the idea being not to burden the participating departments;
- We identified pilot districts for the process and wrote letters and opened channels of communication with the Collectors urging them to put the reviewed reports up on official websites and get citizens to join in the battle;
- We created feedback channels so that district functionaries could tell us what they wanted to be included in the system. It helped build a sense of ownership among them and many now see them as their personal contribution to public health;
- The next major step was to meet the District Planning Officers (DPOs), who convene the DDC meetings and are critical agents in the whole activity, explain the process, answer their queries and constantly encourage the most enthusiastic among them;
- In districts that were hard to crack, we played our own videos made in-house containing the heart-breaking stories of tobacco victims struggling with the health and economic burdens of the habit;
- We got help from our friends in the media whom we encouraged to write about the best and worst performing districts in COTPA implementation, triggering a bit of competition;
- We held a group sensitisation programme for DPOs led by none other than the Vice-Chairman, Kerala State Planning Board, which is the planning brain of the state. The District Planning Officers are attached to the Kerala State Planning Board;
- By early November 2016, all 14 districts had a dedicated COTPA section up on their website. Now all districts use a standard template for review and reporting, but it is designed for customisation;
- Having put things in a proper structure in all districts, we felt the need for a state-level review mechanism. Working accordingly, we identified the website of the State Public Relations Department – the mouthpiece of any democratic Government and the official information dissemination authority – for the integration of all the 14 district websites. It took us some effort to convince the Director of Public Relations (DPR) to give us dedicated space for COTPA in the home page of the website.
The DDC model of tobacco control is a major step forward in seeing tobacco control not just as a public health issue but also a part of the development agenda, as envisaged by the United Nations Sustainable Development Goals 2015-2030. Tobacco control has been included as one of the targets in “Goal 3 - Ensure healthy lives and promote well-being for all at all ages” as a key tool to fight non-communicable diseases.
It was undoubtedly a great recognition for our work when the World Health Organisation proclaimed ‘Tobacco: A Threat to Development’ as a theme for the World No Tobacco Day on 31 May 2017.