Towards assessing the tobacco control law enforcement systems within Indian states: a rapid review and document analysis

Background Tobacco use contributes significantly to deaths and diseases globally. In India, it accounts for nearly two million adult deaths and costs about USD 27.5 billion annually. India has made notable strides in tobacco control ratifying the World Health Organization Framework Convention on Tobacco Control and enacting the Cigarettes and Other Tobacco Products Act, 2003. While there has been some decline in tobacco use prevalence over time, the enforcement of tobacco control laws remains suboptimal and inconsistent across Indian states. India, being a democracy with union of states, states remain crucial in implementing tobacco control laws. This study aims to inform a framework for assessing tobacco control law enforcement systems at the state level in India. Methods We used document analysis to identify tobacco control laws and guidance for their enforcement in India. We used a rapid review of literature to identify key elements of effective law enforcement by reviewing major relevant frameworks, indices, and tools. Building on the findings from these exercises and using a system thinking lens, we identified key themes that can inform a framework for assessing tobacco control law enforcement systems in Indian states. Results We identified four major themes (leadership and governance; human resources; finances; enforcement tools and materials) and several specific elements relevant to Indian contexts that could inform development of a meaningful and pragmatic framework for assessing tobacco control law enforcement systems in Indian states in order to strengthen tobacco control law enforcement. Conclusion It is important and timely to focus on tobacco control law enforcement at sub-national (state) level in India using a systems thinking approach that is informed by lessons about effective enforcement systems from across sectors.