Tobacco Free Initiative (TFI)

The missing O: Scaling up tobacco cessation in India using mobile technology

Quitting tobacco is difficult. But innovative measures to help people kick the habit, such as a mobile phone-based initiative in India, are vital to ending the tobacco epidemic.

In India every year, an estimated 1 million people die from tobacco-related illnesses, all of which could have been avoided by stopping tobacco use.

The WHO MPOWER measure of “Offering help to quit tobacco use” provides a cost-effective approach for countries that helps increase the likelihood that a smoker will quit successfully, in turn reducing their risk of a slow and painful death.

The prevalence of tobacco use across India makes offering cessation support an essential part of any tobacco control strategy. Almost 50% of men in India regularly use tobacco, exposing them and their families to tobacco-related deaths and diseases.1 However, access to cessation clinics has traditionally limited the number of people able to access the support they need.

During the past 12 months, the government of India, together with WHO and ITU, have been working to overcome this problem by using mobile phones to significantly increase population access to cessation programs.

This mTobaccoCessation program has been a collaborative effort between a national team and global experts, working to help people quit tobacco use through support delivered by mobile phones. In particular, WHO and ITU have been providing technical support in India to develop and adopt elements of Be He@lthy Be Mobile, a global initiative helping governments scale up mHealth solutions as part of national health systems.

Technical support includes providing disease-specific content based on WHO guidelines, delivery mechanisms based on clinical trials and a strong monitoring and evaluation component to assess efficacy.

Users of the India mTobaccoCessation program self-enroll through a missed call or web registration service, and then receive tailored advice and support via daily and weekly SMS messages sent to their mobiles. The program provides targeted support to help people overcome the personal challenge of maintaining efforts to quit tobacco use. It also generates real-time data on people who join the initiative, how they are using it and if they are quitting or not.

The impact of the Indian initiative on access to cessation services has been huge. Since January 2016, approximately 2 million people have registered thanks to the Ministry of Health’s nationwide promotion of the mTobaccoCessation program, which ranks as the world’s largest. The Indian initiative also represents a turning-point in the approach to scaling cessation services for the country and others.

India’s experiences are also being shared through the WHO-ITU initiative with other countries developing mTobaccoCessation services, including Tunisia and the Philippines. This feedback process is helping create a global repository of knowledge and experience, and promoting horizontal collaboration between countries.

This is an important step forward for tobacco control. However the potential of mHealth to improve access to health services is not restricted to tobacco alone. It is also opening up new possibilities for public health to use mobile technology to provide population-level access to health services for noncommunicable diseases (NCDs), particularly cardiovascular and lung diseases, cancers and diabetes.

In July 2016 a mobile-based diabetes service was launched in India and currently provides information to over 97,000 people on simple measures to prevent diabetes and manage their condition in between clinic visits. Far from being a neglected area, mHealth is bringing NCD control to the forefront of public health.