Towards Smoke Free Mizoram
Dr. Jane R. Ralte
State Nodal Officer cum Project Officer
Smoke Free Mizoram
Mizoram State Tobacco Control Society
Grantee of Bloomberg Initiative to Reduce Tobacco Use
Introduction
Health and Family Welfare Department under the Government of Mizoram was one out of about twenty grantees to receive funding from Bloomberg Initiative to Reduce Tobacco Use during Round Four. In order to effectively implement this project “Advocacy and mobilization for smoke free Mizoram and effective tobacco control implementation in the state” the Mizoram State Tobacco Control Society (MSTCS) was constituted under the Health & Family Welfare Department, Government of Mizoram on 9th April 2009. The Society also looks after the National Tobacco Control Programme (NTCP) under the MoHFW, GoI and the Tobacco Cessation Clinic funded by WHO. The society has undertaken various initiatives in the fight against tobacco within the state and has already achieved several noteworthy milestones though there is still much more to cover along the way. The society functions under the chairmanship of Mr. Van Hela Pachuau, Chief Secretary, Government of Mizoram and Dr. Jane R. Ralte, State Focal Point, MSTCS, Mizoram.
Interventions
The following are some of the different levels of interventions done so far towards Smoke Free Mizoram:
- Smoke Free Initiatives
- An important milestone towards Smoke Free Mizoram was when the Civil Hospital, Aizawl organized an official programme on 30th Sept. 2008 to inform the public about the COTPA-smoke free rules 2008 and that it was going to be a Smoke Free area from the 2nd October 2008. When the rule was enforced by the hospital there was a lot of resistance and objection from the public as well as the workers.
- In order to commemorate the 1st anniversary of the COTPA-smoke free rules 2008 a programme was organized on 30th September 2009 where it was reiterated that more stringent enforcement will be done in order to move towards 100% Smoke Free hospital campus. Ms. Lal Riliani, President, ISTH (M) was the chief guest on this occasion. The event generated a lot of earned media and achieved much in terms of educating the public.
The details of offenders are as follows-
Aizawl
PENALIZED OFFENDERS
AIZAWL DISTRICT
1. CIVIL HOSPITAL
Sl.No
Month
Year
No of Offenders
Amount Collected
Millenium Centre
2
` 60/-
Kulikawn Hospital Aizawl
96
` 1450
1.
October
2008
351
` 11,065/-
2.
November
2008
473
` 16,785/-
3.
December
2008
166
` 1,315/-
4.
January
2009
198
` 2,630/-
5.
February
2009
120
` 1260/-
6.
March
2009
28
` 240/-
7.
April
2009
11
Nil
8.
May
2009
109
` 930/-
9.
June
2009
74
` 630/-
10.
July
2009
40
` 40/-
11.
August
2009
Record not found
Record not found
12.
September
2009
5
` 60/-
13.
October
2009
66
` 130/-
14.
November
2009
78
` 220/-
15.
December
2009
44
` 140/-
16.
January
2010
15
` 160/-
17.
February
2010
9
` 90/-
18.
March
2010
17
` 150/-
19.
April
2010
26
` 250/-
20.
May
2010
62
` 250/-
21.
June
2010
5
` 450/-
22.
July
2010
25
` 320/-
23.
August
2010
10
` 100/-
24.
September
2010
33
` 290/-
25
October
2010
27
` 310
26
November
2010
17
` 610
27
December
2010
24
` 300
28
January
2011
16
` 190
29
February
2011
23
` 370
30
March
2011
10
` 100
31
April
2011
14
` 140
32
May
2011
12
` 120
33
June
TOTAL
2170
` 41, 155/-
2. KULIKAWN HOSPITAL
Sl. No
Month
Year
No. of Offenders
Amount Collected
1
March
2011
Nil
Nil
2
April
2011
Nil
Nil
3
May
2011
Nil
Nil
3. MILLENIUM CENTER
Sl. No
Month
Year
No. of Offenders
Amount Collected
1
March
2011
13
` 1070
2
April
2011
3
May
2011
4. OTHER DISTRICTS:
a) (COTPA Section 4)
Sl No
District
No Of Offenders
Amount Collected
1.
Lunglei
38
` 1540/-
2.
Mamit
112
` 5380/-
3.
Champhai
194
` 6549/-
4.
Kolasib
25
` 1620/-
5.
Saiha
27
` 970
6.
Serchhip
51
` 1240/-
7.
Lawngtlai
29
`1260/-
Total
345
` 18,559/-
b) COTPA Section 6(b)
Sl No
District
No Of Offenders
Amount Collected/Material Confiscated
1
Aizawl
1
59 Packets of Gutkha were seized
2.
Lunglei
Nil
Nil
3.
Mamit
Nil
Nil
4.
Champhai
13
` 260/-
5.
Kolasib
Nil
Nil
6.
Saiha
7
Smoke form – 224 Packets and Smokeless form – 63 Packets were seized
7.
Serchhip
Nil
Nil
8.
Lawngtlai
Nil
Nil
Total
21
` 260/-
c) COTPA Section 7
Sl No
District
No Of Offenders
Amount Collected/Material Confiscated
1
Aizawl
Nil
Nil
2.
Lunglei
Nil
Nil
3.
Mamit
Nil
Nil
4.
Champhai
21
` 1020/- and 57 Cigarettes were confiscated
5.
Kolasib
Nil
Nil
6.
Saiha
Nil
Nil
7.
Serchhip
Nil
Nil
8.
Lawngtlai
Nil
Nil
Total
21
` 1,020/-
ANTI- TOBACCO SQUAD:
Sl No
Month
Year
No Of Offenders
Amount Collected
1
October
2010
01
Nil
2.
November
2010
05
290
3.
December
2010
64
2470
4.
March
2011
03
600
5.
April
2011
15
1300
6.
May
2011
03
300
7.
8.
Total
91
` 4960/-
OVERALL TOTAL
Cumulative Report
Section
No. of Offenders
Amount Collected/ Material Confiscated
4
2619
` 65, 744/-
6(b)
21
` 260/-
224 packets of smoke form and 113 packets of smokeless form were seized. 59 packets of Guthkha were also seized.
7
21
` 1020.
57 cigarettes were confiscated.
Overall Total
2557
` 67, 024/.
281 cigarettes confiscated and 172 packets of smokeless form confiscated.
- Sensitization Programmes
- Air Quality Monitoring (AQM)
- Mapping of Public Places
- Focussed Group Discussion
- Training of Trainers
- Awareness Campaigns
- Liquid Tobacco "TUIBUR" Factory
- Sensitization Workshop For Local Tobacco Manufacturers
- IEC Materials
- Opinion Poll
- Involvement of Village Council (PRI)
- Participation of Media
- Political Commitment
- Strong NGO Presence
- Future Plans
- Mapping of Public Places
- AQM
- District Transport Authority
- Village Council Members
- Hotels & Restaurant Owners
- Focused Group Discussion
- Champhai
- AQM
- Mapping of Public Places
- Sensitization Programs for Stakeholders
- District Transport Authority Programme
- Village Council Members Programme
- Focused Group Discussion
- Hotels & Restaurant Owners Programme
- Seminar for different groups
- Opinion Poll
- Mamit
- AQM
- Mapping of Public Places
- Lawngtlai
- Saiha
- Hotels & Restaurant Owners Programme
- Aizawl
- State Transport Authority Programme
- Aizawl
- AQM
- Mapping of Public Places
- Sensitization Programs for Stakeholders
- District Transport Authority Programme
- Village Council Members Programme
- Focused Group Discussion
- Hotels & Restaurant Owners Programme
- Seminar for different groups
- Opinion Poll
- Kolasib
- AQM
- Mapping of Public Places
- Sensitization Programs for Stakeholders
- District Transport Authority Programme
- Village Council Members Programme
- Focused Group Discussion
- Hotels & Restaurant Owners Programme
- Seminar for different groups
- Opinion Poll
- Serchhip
- The total absence of any taboo associated with the use of different forms of tobacco has proven to be an uphill task and the process of “de-normalization” of tobacco is very slow and sometimes seems a herculean task. There is still low awareness amongst the public about tobacco and its control.
- Health professionals and enforcement officials who consume tobacco are many in number and they are very good at slowing down the process of enforcement. The file put up approval of challan form, receipt form etc and for identification of budget head is still not out, with Law Department repeatedly returning file on the pretext of asking for various clarifications.
- Low priority given to tobacco control by most departments.
Sensitization programs have been conducted for different target groups such as enforcement officials, stakeholders and health professionals within Mizoram. Awareness regarding general information on tobacco, second hand smoke and COTPA are usually given. Issues regarding details on how to go about creating a smoke free workplace, practical issues related to enforcement of various provisions of the law, other important topics are also discussed. As a result of such programmes there is visible change in the compliance to smoke free rules by various government offices, e.g. the number of signages put up has gone up dramatically, number of people smoking in public is gradually going down.
Air Quality Monitoring (AQM) data collection was conducted in Aizawl from 8th to 14th September 2009. Several locations such as government and private buildings, schools, public places and offices were covered. A total number of 20 such places were covered in Aizawl. The report of data collected during this period was sent to Ms. Hema S.Khanchandani, International Research Associate Campaign for Tobacco Free Kids on 15th September 2009 for data analysis
A press meet was conducted on 10th Sept 2009 to inform members of the press about the AQM survey conducted in Aizawl and the process followed. During this meeting it was declared that, based on the AQM findings, the most polluted public place will be given the “Dirty Ashtray” award while the least polluted public place will be given the “Zamzo Award” named after one of the most beautiful flowers of Mizoram. A press meet was also conducted with Mizoram Journalist Association (MJA) with matters relating to similar issues mentioned above.
Mapping of Public Building/Places with regards to putting up of signages in various government offices was undertaken in Aizawl and Lunglei. 27 Public Building/Places in Aizawl and 30 public building/places in Lunglei, Mizoram were covered.
In Aizawl, 27 public places/buildings were investigated, out of which 14 places/buildings were found to have put up signages. These 14 public places comprised of office buildings and hospitals. However, it was found that in most of these 14 public places, even though signages were put up, people who were found smoking were not penalized. . The other 13 public places which were found without signage were not aware of the COTPA smoke free rules, in spite of the fact that Notification to this effect had been issued by the Chief Secretary. Necessary instructions and guidelines regarding the rules were again given to the Head of these public places. Following this signages have been put up in quite a number of institutions.
In Lunglei, 30 public buildings and educational institutions were investigated and it was found that each one has put up signages in their respective buildings.
It was observed during the process of carrying out mapping of public places that many people were found smoking inside the office buildings, including those with signages. Hence, compliance to the rules is very poor. In order to address this problem/gap, notification has been issued to all Secretaries and Heads of Departments by the Chief Secretary for strict compliance. It is felt that this initiative should start from government offices and then pressure can be applied to the private sector for creating healthier and smoke free public places in Mizoram.
MSTCS has organized focused group discussions in three different districts of Mizoram, namely Aizawl, Champhai and Lunglei covering groups such as Mizoram Journalist Association, Mizoram Kohhran Hruaitu Committee (church leaders), Information and Public Relations and Mizoram Hmeichhe Insuihkhawm Pawl (women’s association). Discussions cover topics like COTPA and how to bring about collaborative and collective effort to work towards Smoke Free Mizoram, not only public places as notified under COTPA but also other places where there is mass gathering of people due to some event, e.g. funeral service, social event etc.
MSTCS carried out training of trainers and leaders of YMA (Young Mizo Association) and different church Youth Organizations covering all denominations. This training was carried out to these leaders with a view to pass on the message to the youth and members of their respective communities. Besides these it is felt that the Young Mizo Association (YMA) can play a very important role in “de-normalization” of tobacco use in the community. This can be seen by the fact that smoking is now considered abnormal when youth gather in houses of bereaved families, which is a normal community activity. The role played by the Indian Society on Tobacco and Health (Mizoram chapter) in the process of de-normalization of tobacco use in public is also acknowledged. This initiative was spearheaded by the President of ISTH(M), Mrs Lal Riliani, who is also the wife of the current Chief Minister of Mizoram since 1989.
Various awareness campaigns have been conducted regularly in several educational institutions, churches and communities within several districts in Mizoram, and is an ongoing process. These campaigns are conducted by trained staff under various tobacco programmes, with stress given not only to the health effects of tobacco but also effects of second hand smoke and COTPA smoke free rules. To this end signages have been given out to several institutions and public places.
The team from MSTCS arranged a visit of the press to the liquid tobacco “tuibur” factory on 13th July 2009. The main purpose behind this visit was to investigate the process of manufacture of tuibur, how the factory is set up and how it functions and present this objectively to the public through the media. It was found that the location of the factory was not very ideal; moreover, the running of the factory was extremely unhygienic. It was observed that the process of making ‘tuibur’ (liquid tobacco) releases huge quantity of tobacco smoke which can be considered second hand smoke. It also causes pollution of the stream/rivulet near the factory. This was because of the solid waste products generated in the manufacturing process which also leads to pollution of the nearby environment, therefore affecting our eco system.
A state level program on sensitization Workshop for Local Tobacco Manufacturers was organized on 12th June 2009. In this program, a good number of participants from the two associations of local tobacco manufacturers i.e.Vaihlo Zuar Association (Local Tobacco Leaves Seller) and Tuibur Zuar Association (Local Tobacco-Water Seller) participated. Presentations on the general information on tobacco, second hand smoke and COTPA were given and key issues were brought to their attention and issues like alternate occupation was also discussed with them.
MSTCS has developed different kinds of IEC materials, which are utilized in various ways as a means for a Smoke Free Mizoram. These materials include Pamphlets, Fact sheet, Posters, TV Spots and Radio Jingles. We had applied for funding under World Lung Foundation for the media component but were unable to get the funding due to resource constraints.
Opinion poll is in the process of being conducted in all 8 districts of the state and has been conducted in 3 districts till date, i.e. a total of 1975 questionnaires only (750 in Lunglei, 300 in Champhai and 925 in Aizawl districts). We are aiming to complete the process of data collection within this year and finish data entry and analysis by March 2010.The total sample size is 2500 for the state.
Notification letters were sent out to all Village Councils within the entire state on matters relating to COTPA and its enforcement within their respective jurisdiction. We have called them for sensitization workshops in two districts and given them necessary information and materials to aid them in their work. We will be conducting this programme in all district headquarters of the state.
We attribute the success of our media blitz to the active involvement of members of the press. We have taken every effort to inform them of all development in the area of tobacco control from time to time and to gain the attention of the press regularly so that we are able to generate earned media. We have found that a consultative approach with certain journalists and some local cables have paid good dividend.
The present Chief Minister, Health Minister and Chief Secretary are very strong anti-tobacco proponents and this strong anti-tobacco leadership has been very important in moving our Smoke-free policies and its implementation to a higher level.
The Indian Society on Tobacco and Health (Mizoram Chapter) has played a key role in filling the gap in enforcement and applying pressure on civil society as well as on the government. ISTH(M) has been asserting pressure for the last 20 years, particularly towards smoke-free environments. The Society is stronger than ever since the present Chief Ministers wife, Mrs Lal Riliani is the president of ISTH(M).
The following are the future plans of MSTCS
| Sl.No | Date of Activity | Name of Activity | Venue |
| 1 | 13/10/09 to 16/10/09 |
|
|
| 2 | 21/10/09 to 24/10/09 |
|
|
| 3 | 26/10/09 to 31/10/09 |
|
|
| 4 | Nov 1st week | ||
| 5 | Nov 2nd Week | ||
| 6 | 17/10/09 to 20/10/09 |
|
|
| 7 | 1st Week of December |
|
CHALLENGES
Numerous challenges have been faced in different areas while enforcing various provisions of the COTPA. In Mizoram we have a very pro-tobacco mindset and societal acceptance of tobacco use by the community, which is reflected in the high consumption of various forms of tobacco by the state as highlighted by NFHS 2 and also 3.
| I. SMOKED FORM | II. ALL TYPES | ||
| NFHS - 2 | NFHS - 2 | ||
| Male: 59.4% | Female: 22.1% | Male: 60% | Female: 60.7% |
| (29.4%) | (2.5%) | (28.3%) | (12.4%) |
| NFHS - 3 | NFHS - 3 | ||
| Male: 73.6% | Female: 16.1% | Male: 83.1% | Female: 60.8% |
| (32.7%) | (1.4%) | (57%) | (10.8%) |
Some of the problems and challenges maybe enumerated as follows:-
STRENGTHS
In Mizoram the main strength has been the strong political commitment, starting from the state Chief Minister, Mr. Lal Thanhawla and Health Minister, Mr Lalrinliana Sailo. At the same time, the strong participation of the Indian Society on Tobacco and Health (Mizoram Chapter) whose President is the wife of the Chief Minister, Mrs Lal Riliani has crucial in carrying this anti-tobacco drive to higher level. The strong support and leadership of the state Chief Secretary who is also the Health Secretary, Mr. Van Hela Pachuau has been one of the key elements in implementing the various tobacco control initiatives successfully and effectively in the state.