Background

In January 2005, the Rajasthan Cancer Foundation (RCF), Jaipur, began its efforts to extend advocacy for cancer control to the districts of Rajasthan, to achieve its vision of statewide cancer control by working with the community at the micro-level. The need for a collaborating partner was obvious as RCF realized that it would require resources that it could not possibly generate.

The Choice of District Headquarters

It was considered logical to choose the district headquarters as the collaborating partner and nodal centre as this would provide a model that could be replicated in other districts of Rajasthan. This was because the RCF’s attempts to liaison with the state Medical and Health Directorate had not succeeded in making cancer control a priority. According to the system that has been worked out, the district collector must be entirely committed to the goal of cancer control, must agree to take the mantle of leadership upon himself, and should involve the local government and non-government agencies, social groups, the media, and so on, in the effort

The Choice of Jhunjhunu

Out of four districts approached, Jhunjhunu became the ideal partner for the RCF because of the reciprocation the RCF got from the district collector and the fact that his office played a catalytic role in bringing together the local groups and their leaders. Another factor which significantly influenced the choice of Jhunjhunu District as the partner was the possibility of garnering financial resources from the Narottam Seksaria Foundation, Mumbai, and the Seva Jyoti Foundation of the RR Murarka Foundation (Kolkata), as their patrons had their roots in Jhunjhunu. This was followed by empowering sessions separately for the local health workers, NGOs and media agencies to highlight the issues faced by the district and to deliver the possible solutions.

The Road to Tobacco Control

The need for tobacco control advocacy became evident following some holistic steps undertaken for cancer control. It was realized hereafter that focusing on tobacco control should be the priority in the ongoing efforts at Jhunjhunu to match with available resources locally

1. The district celebrated its first World No Tobacco Day, 2006:
   Thus the district of Jhunjunu became the first district in Rajasthan to celebrate World No Tobacco Day.
   
   
2. Empowerment of block-level NGOs for effective tobacco control:
   The RCF collaborated with the Jhunjhunu Cancer Society (JCS) to hold empowerment sessions for the NGOs working on tobacco control in its eight blocks (sub-district units). These sessions were conducted with a special focus on developing tobacco cessation counseling services locally. Five out of the eight blocks began with regular tobacco cessation efforts with a special focus on schools. Of these, Navalgarh block was a model in leadership, team work, collaboration with the sub-divisional office and schools to raise community awareness and vigilance by the civil society in enforcing the ban on the sale of tobacco products within 100 yards of educational institutions.
   
   
3. Partnership with police for enforcement of the notified rules:
   To bring about the effective enforcement of the notified rules of the tobacco control law, a partnership was established with the police department through advocacy sessions with its personnel. These were followed by a specific session to assist them in quitting tobacco, which was also attended by their families. The police was asked to focus on only one rule i.e. the ban on the sale of tobacco products within 100 yards of educational institutions. It responded in the first six months by registering 98 cases of infringement throughout the district. The strategy was to check for retail tobacco outlets, as the teams went for their routine rounds once in a week. Stringent action was taken against defaulters, including the confiscation of tobacco products and the filing of a challan to the magistrate and imposition of fine. Every case was reported in the local media to act as a deterrent for others.
   
   
4. Notification for a smoke-free public place:
   As a result of the campaign, 90% of public places in Jhunjhunu city now display the standard notification on the ban on smoking in public places (at least two boards or wall writings of 60 x 30 cm. displaying the notice “No Smoking Area—Smoking Here is an offence”). The majority of educational institutions have declared themselves tobacco-free zones. Youth groups from these institutions began visiting public places, on a rotational basis, to educate tobacco users, besides holding rallies, demonstrations, plays, and so on, to raise public awareness on the matter. Six of these students represented Rajasthan and RCF in the Global Youth Meet for Health (GYM), 2006, an international health activity organized by Hriday-Shan of Delhi.
   
   
5. Jhunjhunu becomes the first smoke-free district city on WNTD 2007:
   RCF proposed the concept of Smoke-free Jhunjhunu City to the Jhunjhunu district administration in making Jhunjhunu smoke-free by WNTD 2007. The effort involved the district administration, municipal council, Jhunjhunu Cancer Society, local organizations and the media to approve and work for making Jhunjhunu smoke-free by 31 May 2007. Advocacy sessions were held by RCF for all relevant local agencies. Municipal byelaws were passed by the municipal council to facilitate the smokefree effort. Jhunjhunu was declared smoke-free by its Municipal Corporation on World No Tobacco Day 2007. The State Tobacco Control Cell In-Charge presided over the declaration function, attended by over 500 people and well covered by the media. The RCF effort was aided by the Ministry of Health and Family Welfare, Government of India and the WHO India Office.
   
   
6. In recognition of its achievements, Jhunjhunu was recently identified as one of two state districts to run the MOH- aided National District Tobacco Control Programme.

Recommendations:

RCF considers that the model is replicable in other districts countrywide if: (1) a national or state policy can identify the office of the district collector as the government agency, with the district collector as the prime mover of a district tobacco control programme; his undertaking the leadership role is most vital; (2) the principal collaborating agencies are empowered optimally in tobacco control; (3) the collaborating NGOs get an optimal and prompt support by the office of the district collector; and (4) the local NGOs can be optimally funded (through either local or state resources) to be able to coordinate with ‘autonomy’ and sustain tobacco control activities for at least five years.

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