Clamping down

Home ministry blocks foreign funds for NGO that supported health ministry's anti-tobacco drive

The Public Health Foundation of India had been working on government programmes since 2010.

The Ministry of Home Affairs has barred the Public Health Foundation of India from receiving foreign funding by revoking its registration under the Foreign Contributions (Regulation) Act. The ministry cited the organisation’s lobbying against tobacco use as one of the reasons for the move. However, as the foundation’s officials have pointed out, it has been working with the Ministry of Health and Family Welfare on anti-tobacco programmes since 2010.

The Public Health Foundation of India is a public-private initiative established to provide technical support to the health ministry on a range of issues concerning public health, including tobacco control. The foundation has worked on several research projects and organised training workshops for health workers on how to counter tobacco consumption. It took on many of these initiatives at the ministry’s request.

In July 2015, experts from the foundation were asked to present evidence before a Parliamentary Committee on Subordinate Legislation that was reviewing pictorial health warnings on tobacco packets.

Health activists working on tobacco control have said that the home ministry’s position is appalling. “We have to interact with the government on any issue related to social development, not just tobacco control,” said Sanjay Seth from Voice of Tobacco Victims, a campaign that is putting tobacco victims at the forefront of the tobacco control movement in India. “How can they officially raise [anti-tobacco lobbying] as an issue?”

Other reasons cited by the home ministry’s for cancelling the foundation’s licence include alleged violations in the use of funds for HIV/AIDS projects, remittances to foreign countries from its Foreign Contribution Regulation Act account and failure to declare all its bank accounts to the government.

In October, the government cancelled the Foreign Contribution Regulation Act licence of the Institute of Public Health in Bengaluru and Voluntary Health Association of Assam, both which have done considerable work on tobacco control. However, the reasons for their licences being cancelled were not specifically stated.

Tobacco is one of the leading causes of cancer and non-communicable diseases around the world. Every year 9.8 lakh people in India die of a tobacco-caused disease. Research done by the Public Health Foundation of India under the directives of the government estimates that the health costs attributable to tobacco use in the year 2011 for people between the ages of 35 and 69 amounted to Rs 1,04,500 crores.

“Tobacco control activity is not a criminal activity,” said Dr Pankaj Chaturvedi, cancer surgeon at Tata Memorial Hospital. “We are furthering the cause of government of India and augmenting the National Tobacco Control Programme.”

Health ministry not consulted

The home ministry does not seem to have consulted the health ministry before barring the foundation’s foreign funding. Three health ministry officials told Scroll.in that they had not been informed about the order and only learned about it only from newspaper articles. They said they were surprised by the home ministry’s decision.

The health ministry runs the National Tobacco Control Programme to enforce the Cigarettes and Other Tobacco Products Act and spread awareness about the harms of tobacco. The government has allocated a budget of about Rs 40 lakhs per state and Rs 47 lakhs for each of the 400 districts under the programme this financial year.

“Our stance is very clear on tobacco control,” said Dr Arun Panda, additional secretary with the health ministry, who said that the ministry will continue its work to curb tobacco consumption.

Only last year, the government made encouraging moves to curb tobacco use in the country when it mandated that pictorial warnings must cover 85% of boxes containing tobacco products, as against 40% previously. This means that after Nepal and Vanuatu, India has some of the largest pictorial warnings on tobacco packets in the world.

In November, India hosted the seventh Conference of Parties of the Framework Convention on Tobacco Control, which takes decisions necessary to promote effective tobacco control implementation. The convention encourages countries to take measures such as outlawing smoking in public and restricting advertising and sponsorship of tobacco products. Health Minister JP Nadda made a commitment at the inaugural speech of the conference to continue efforts to regulate the use of tobacco products in the country.

However, even as the conference was underway, advertisements appeared on hoarding and even on the backs of autorickshaws alleging that anti-tobacco activists has “hidden agendas” that hurt the interests of tobacco farmers and paan wallahs.

Campaign against anti-tobacco movements portraying a tobacco farmer. Photo credit: Shoaib Daniyal.
Campaign against anti-tobacco movements portraying a tobacco farmer. Photo credit: Shoaib Daniyal.

The action against the Public Health Foundation of India comes at a time when anti-tobacco movements in India are showing some signs of success. The National Family Health Survey showed that the percentage of men and women who use tobacco has dropped in the past decade. In 2005-’06, 57% of men used tobacco, which has dipped to 44.5% in 2015-’16. In 2005-’06, 10.8% of women used tobacco which has dipped to 6.8% in 2015-’16.

Most organisations in India that work on tobacco control rely on foreign funds with much of their money coming from the Bloomberg Initiative to Reduce Tobacco Use, which funds anti-tobacco programmes around the world. The home ministry’s crackdown on the Public Health Foundation of India has alarmed many activists working with these organisation. Seth of Voice of Tobacco Victims said that the home ministry’s move blatantly favours the tobacco industry. A faculty member of the Institute of Public Health alleged that might have been targeted because they were working effectively against tobacco control.

Claimed cancer surgeon Chaturvedi: “This move is conspiracy of the tobacco lobby to malign non-governmental organisations working on tobacco control.”

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.