Background and challenges to implementation:
According to GATS 2009-10 prevalence of tobacco use in Bihar among adults is 53.5% (n=30.8 million) much higher than the national average i.e. 34.6%.
In 2008-09, Indian government rolled-out National Tobacco Control Programme (NTCP) including 02 districts of Bihar. With inclusion of another 06 and 11 districts in 2014 and 2015 respectively, currently 19 out of 38 districts of Bihar are covered under NTCP. Main key activities under NTCP are India's tobacco control law's enforcement, training, awareness generation, school health programs and cessation.

Intervention or response:
To establish and initiate tobacco control programme in all 38 districts, Government of Bihar in collaboration with SEEDS-Bihar (an NGO) and The Union implemented a Bloomberg Initiative project on tobacco control.
Through planned interventions, NTCP has been rolled-out in entire states as an institutional framework. Broadly three pronged strategies were adopted i.e. establishing NTCP implementation mechanism, intensive capacity building of government officials, robust reporting and monitoring from districts. Systematic efforts were made at both state and district level to engage for other stakeholder especially media. Additionally nodal officers were identified in all concerned department at state level and three district nodal officers in Health, Police and General Administration were appointed to develop synergy through better coordinated efforts.

Results and lessons learnt:
Awareness and commitment of program managers, law-enforcers and media have noticeably increased for tobacco control. Following were the distinctive outcomes:

• Enforcement mechanism was established in all 38 districts (both NTCP and non-NTCP)
• Periodic programme review by top bureaucrats of concerned departments quarterly at state level and monthly at district level
• Enforcement status review in monthly crime review meeting by police department

Conclusions and key recommendations:
Through intensive advocacy, capacity building and robust monitoring mechanism an efficient model for implementation of National Tobacco Control Programme can be institutionalised within existing system. Multi-stakeholder engagement especially media is very important for better monitoring and sustainability.