Innovative approaches to implement MPOWER policies in low-resource settings: A significant reduction in tobacco use (21.2%–16.1%) since Global Adult Tobacco Survey-1 in Himachal Pradesh, India

MPOWER is the evidence-based toolkit for effective tobacco control under the WHO-framework convention on tobacco control (FCTC). Indian Tobacco Control Law (COTPA, 2003) and National Tobacco Control Program (NTCP, 2006) are not fully compliant to FCTC. Himachal Pradesh a northern hilly state in India with a population of about 7 million was not included under NTCP till 2014 whereas as per the Global Adult Tobacco Survey (GATS) 2009–2010 the prevalence of smoking among males (33.4%) was much higher than the national average (24.3%) with high exposure of passive smoking (82.5%) at homes. Implementing MPOWER without technical and financial support was a huge challenge. The multisectoral engagement especially the partnership between the local NGO (HPVHA) and the State Health Department under the guidance of the International Union against TB and Lung Diseases New Delhi helped in bridging the policy gaps through advocacy and capacity building. Building partnerships, sharing the responsibilities, and empowering the key stakeholders to utilize the funds collected as fine for tobacco control helped in policy implementation effectively. MPOWER implementation has achieved substantial progress in all six demand and supply reduction strategies of tobacco in the state of Himachal Pradesh. GATS, 2016–2017 shows a significant decline (21.2%–16.1%) in tobacco use and passive smoking at homes (82.5%–32.9%) in the state. Innovative approaches of implementing MPOWER policies are the way forward for effective tobacco control in low resource settings.