BACKGROUND AND IMPLEMENTATION CHALLENGES: Maharashtra being the second most populous state in India with a total population of 11.2 million has about 2.9 million adult tobacco users. India followed a bottom-up approach for the implementation of FCTC Article 5.3 guidelines. Following that the Public Health Department, Government of Maharashtra released a circular numbered Tanika-2017/Chapter number 208/Health-5 dated 4th October 2017 to prevent tobacco industry interference (TII). However, this circular was not comprehensive enough.

INTERVENTION OR RESPONSE: In 2020 and 2021 instances of TII by the Foundation for Smoke-Free World were reported. Thus, Civil Society Organizations (CSOs) played a catalytic role in advocating for Article 5.3 guidelines. During the years 2021 to 2023, CSO-led three state-level consultations were conducted to highlight the significance of Article 5.3. Consequently, the State Tobacco Control Cell organized the State-level Coordination Committee meeting on 30th September 2022 focusing on the adoption of comprehensive Article 5.3 policy. Eventually, multiple consultations between CSOs and a Government of India-funded premier institute Advanced Centre for Treatment, Research and Education in Cancer resulted in submission of the draft of FCTC article 5.3 guidelines on 26th June 2023 to the state. Following a series of administrative policy processes on 12th June 2024 the draft was tabled and finally approved on 3rd October 2024.
RESULTS AND IMPACT: The government of Maharashtra adopted Article 5.3 guidelines through a resolution by the Department of Public Health numbered- Tobacco/Meeting-2024/Chapter Number 66/Health-5 dated 3rd October 2024. These guidelines follow the four guiding principles and seven out of eight recommendations of the 2008 WHO FCTC 5.3 policy. The formation of Empowered Committees with the defined role of each member at the state and in 34 districts has led to the formation of a robust governance structure.
CONCLUSIONS: Maharashtra's approach to adopt WHO FCTC article 5.3 policy guidelines is a result of an unwavering commitment by CSOs-led multistakeholder engagement.