If Bhutan can effectively implement the ban on smoking, what has prevented Nepal from enforcing the law it has endorsed?
Nepal's parliament endorsed the Tobacco Products (Control and Regulatory) Act-2011 to impose a ban on smoking and chewing tobacco in public places to reduce its harmful effects on public health. With the Act coming into force since August 8, 2011, no one is allowed to smoke or chew tobacco products in public places, such as hospitals, childcare centres, orphanages and elderly homes, government offices, corporations, educational institutions, libraries, airports, hotels, restaurants, girl's and boy's hostels, children's parks and eateries. As per the law, those who smoke or chew, sell and distribute tobacco-related products in public places may be fined from Rs 100 to Rs 100,000. It was a huge stride towards curbing smoking in public places and controlling the unscrupulous sale of tobacco products.
Nepal was the first country after Bhutan in South Asia to impose the ban on smoking in public places.
As per the WHO report, Nepal has the highest rate of smoking with 35.5 per cent male and 15 per cent female smoking or chewing tobacco products. It has also been revealed that the prevalence of smoking among adult females in Nepal is one of the highest in the region. The world health body has also revealed that around 16,000 people die of tobacco-related diseases, such cancer and heart diseases every year. Tobacco is the leading cause of heart attack and cancer, which is prevalent in all age groups and regions.
Even though the law was brought into force with strong commitments from the government, its effectiveness is in question. For a few days, the police fined those who smoked in public places, mainly in the Kathmandu Valley.
Even a lawmaker was caught on camera smoking on the parliament premises. But no action was taken against him.
Due to the slackness of the law enforcing agencies, people are seen smoking in public places, parks and restaurants, and the street vendors are seen openly selling tobacco-related products in the busy streets under the very nose of the police. The major challenge for the government is to control its sales in public places as defined by the law.
Nepal enacted the Act as per its commitment to an international convention it ratified without adequate preparation at home. While addressing an all-party advocacy meeting on Wednesday, Minister for Health and Population Birodh Khatiwada vowed to discourage the use of tobacco products by taking strict measures. But he did not elaborate on the measures his ministry was planning to take to effectively implement the law. If Bhutan can effectively implement the ban on smoking there, what has prevented Nepal from implementing the law? Although advertisements of tobacco-related products in the mass media have been totally banned, the law has barely made a dent in reducing its consumption, especially in the rural areas, because of the cheap price and its high use among the poor community that is not aware of the law. Nepal is also the only country in South Asia to impose low taxes on tobacco products, which has led to its easy availability. The only way to reduce its consumption is to enforce the law effectively with an awareness drive and educate the young generation, which is more educated than the old one.
Manpower crunch
It's a problem peculiar to most government hospitals outside the major cities of the country. Damauli Hospital in Tanahun is facing a shortage of doctors and other health personnel, which is affecting the treatment of patients. The 15-bed hospital has added 27 beds on its roof but has only two permanent doctors made available by the government, while the other doctors have been hired on contract basis or appointed locally by the hospital management committee.
The hospital may be in for more trouble as the contract of the 21 of its 30 staff members, who were recruited during the COVID-19 crisis, have not been extended.
Nepal has come a long way since the 1970s where there was just one doctor for as many as 40,000 people.
Today about a dozen medical institutes in the country train hundreds of doctors and other related human resource annually, not to speaks of hundreds others who graduate from colleges abroad. However, most doctors prefer to stay in the capital, working in 70 or so hospitals and in private clinics. The over concentration of doctors in big cities and a lack of them in the hinterlands could not have happened were it not for the lopsided policies of the government.
A version of this article appears in the print on November 26, 2021, of The Himalayan Times.
