. 2020 Sep 11;13(2):110–121. doi: 10.1093/inthealth/ihaa055

Table 1.

Existing tobacco regulation and control policies and their implementation challenges

MPOWER strategies	Tobacco products (prevention and control) laws	Tobacco control plan and strategies	Implementation challenges
Monitor tobacco use and prevention policies	•Provision of inspectors and their role in policy compliance^57,58•Establishing a monitoring committee at central level to formulate and implement policies^57,58•Delineating the roles and responsibilities of inspectors and the committee^57,58•Using health tax fund in research and investigation of tobacco-related diseases⁵⁸	•Developing toolkits for planning, monitoring and evaluation of and training for desk officers^60,61•Developing tobacco control manual in line with tobacco control law^60,61•Conducting BCC at national and subnational level^60,61•Advocacy with concerned stakeholders•Regulation by establishing standard testing facilities⁶¹•Conducting compliance studies⁶¹•Review and amendment of legislation including violation penalty⁶¹	•Weak implementation of planning, monitoring and evaluation framework•Weak inspection resulting poor policy compliance•No distinct appointment criteria for inspectors (any government officers can be appointed, who has several roles beside tobacco control)•Weak stakeholder coordination mechanism•Inadequate role of the committee and their ineffective implementation•Inadequate BCC interventions at national and subnational level•Limited research conducted•Low priority of research and prevention activities from the health tax fund
Protect people from tobacco smoke	•Delineation of public places^57,58•Designated area for tobacco consumption and its criteria^57,58•Noticeboard targeting public, pregnant and children aged <18 y^57,58	•Protecting from second-hand smoke•Expanding non-smoking areas^60,61•Notifying smoke-free locations^60,61•Awareness activities^60,61•Conducting BCC campaigns^60,61•Compliance monitoring by police⁶¹	•Poor compliance of designated roles for effective implementation•Limited smoking designated zones (only in standard hotels and some airports)•Weak regulating authorities to ensure effective implementation
Offer help to quit tobacco use	•Organize training and capacity building programs for concerned stakeholders⁵⁷•Encourage people to quit smoking⁵⁷	•Development of national cessation guidelines and manuals^60,61•Establishment of tobacco cessation centers and community cessation clinics^60,61•Establishment of quit-lines and telephone helplines^60,61•Integration of tobacco cessation in health and education program^60,61	•Very few health personnel have been trained on cessation•Limited numbers of counselling clinics and their low priority in tobacco cessation activities•Very few quit-line services•Integrating basic health care services with tobacco prevention and control
Warn about the dangers of tobacco	•The package and wrapper require the facts about the contains of tobacco products⁵⁸•Warning message, symbols and graphics are to be changed regularly^57,58•PHWs must contain at least 90% of total outer portion⁵⁹	•Assessment of PHWs compliance•Frequent development of PHWs and its regular monitoring⁶⁰•Coordinate with line ministries for effective legal enforcement^60,61•Production and dissemination of BCC materials	•Handmade products have not been covered with PHWs•Covering the health warning intentionally by tobacco industries through VAT stickers⁷•Tobacco industries suiting writs and demanding judicial stay orders to procrastinate implementation•Poor coordination among concerned stakeholders
Enforce bans on TAPS	•Restriction to advertisements or promotion^57,58•Vendors obligation to put notice board to restrict purchase/sales by pregnant and minors^57,58•Restriction to include free or binding product sales^57,58•Prohibition on single unit or retail sales⁵⁷ and minimum 20 sticks cigarettes packet⁵⁸•No government subsidies for tobacco industries	•Mobilization of local bodies, administration, civil societies and NGOs for banning TAPS^60,61•Monitoring through coordination with other line ministries^60,61•Conduct compliance survey and routine inspection of industries^60,61•Development of monitoring guidelines to prohibit sales^60,61•Ban smoking and tobacco use in public places^60,61•Control illicit trade of tobacco products^60,61•Registering and monitoring the tobacco shops⁶⁰•Develop crop substitution strategy through replacement of tobacco crops⁶⁰	•TAPS through sports by tobacco industries⁵⁶•Ambiguity among the concerned authorities in their respective roles and responsibilities•No licensing provision to sell tobacco products•No proof is required while purchasing tobacco items to verify age or pregnancy status•Fragile implementing institutions with poor compliance•Inadequate legal provisions for registering tobacco shops•Tobacco industries violating the packaging provision by mini-packing (10 sticks in a pack)•Governmental announcement to lure the investors to revive Janakpur Cigarette Factory
Raise taxes on tobacco products	•At least 25% of excise tax has to be deposited in health fund⁵⁸•Health fund to be used, tobacco-related research, treatment and health awareness activities⁵⁸	•Increase resource allocation through health tax fund ^60,61•Establish health tax fund for controlling consumption^60,61•Assess tax structure and increase excise and tax on tobacco products regularly^60,61	•Low excise tax without annual increment•Objection by tobacco industries/pressure groups after increasing taxation•Major portion of health tax fund is used in treatment subsidies rather that prevention, control and research activities

Abbreviations: BCC, behavioral change communication; NGOs, Non-governmental Organizations; TAPS, tobacco advertising, promotion and sponsorship; VAT, value-added tax.