The enforcement of the Tobacco Control Act is still poor in public hospitals as direct smoking or evidence of smoking has been found in 71 per cent of hospitals in the capital, said a recent study.
The survey was conducted by the National Heart Foundation of Bangladesh (NHFB) to assess the implementation of the Act in all public hospitals in Dhaka.Despite a ban, one might find frequent smoking in the public hospitals in Dhaka as the law against the practice is simply smoked away due to lack of enforcement.
Amendments to the existing tobacco control law can change the scenario, recommends the study.
Under the Smoking and Tobacco Products Usage (Control) Act, smoking in hospitals is completely banned, but as in other cases, a slack in enforcement has led it to be widely ignored. Moreover, the law simply defines the hospital building as smoke-free, rather than the entire campus.
“Smoking is totally prohibited in the hospital area as there is also a provision of fine for smoking in such places. Signboards are also displayed prohibiting smoking in hospitals. And the respective institutions also enforce laws and directives regarding it,” Dr Md. Farid Hossain Miah, Director (Hospital) of Directorate General of Health Services (DGHS), told the Daily Sun.
Dr Md Khalilur Rahman, director of Shaheed Suhrawardy Medical College Hospital, said “Smoking is totally prohibited in our hospital premises. We actively monitor the matter and our concerned employees and Ansar members also take necessary action against smoking in the hospital area.”
Smoking was witnessed in 44 per cent of health care facilities, cigarette butts were found in about 71 per cent of health care facilities, the odour of smoking was found in 12 per cent of hospitals and cigarette ashtrays were found in about 10 per cent hospitals, the study added.The survey was conducted in November 2020 in 41 hospitals in Dhaka. Among the health care facilities, 22 were hospitals having in-patient service and 19 were outdoor clinics.
The study found that violation of tobacco control law by evidence of smoking was more evident in hospitals having indoor services (100 per cent) than in outdoor clinics (37 per cent).
It said that in about 76 per cent of health care facilities, smokeless tobacco consumption (SLT) was observed or evidence of the SLT use was found.
“The SLT use was observed in about 49 per cent health care facilities, betel leaf spit was present in 68 per cent health care facilities and SLT use was more evident in hospitals having inpatient facilities (96 per cent) than in outdoor clinics (53 per cent),” the study added.
The study said in about 15 per cent health care facilities, tobacco products were found to be sold, in 2 per cent health care facilities tobacco products were found to be sold at the buildings, in 12 per cent HCF, points of sale (POS) were found to be at the premise and in about 76 per cent HCF, POS was present just outside the HCF, within 100 meters of the boundary.
Talking to Daily Sun, Principal investigator of the survey Dr Sohel Reza Choudhury, professor and head of the Department of Epidemiology and Research at the NHFB, said tobacco control act compliance in government health care facilities is still poor.
“Tobacco consumption in the HCF has increased by an insignificant amount. Probably lack of monitoring during COVID-19 pandemic is the major cause behind this increase,” he said.
He also recommended an amendment to the existing law to ban POS within 100 meters of HCF and proper enforcement of the existing act.
The Directorate General of Health Services (DGHS) needs to arrange programs for HCF staff to orient and aware of their responsibility in the implementation of the tobacco control act and tobacco-free health care facilities implementation guidelines, he added.
Sohel Reza Choudhury further said supervision and monitoring on compliance with the Tobacco Control Act are needed to be enhanced locally and centrally.
According to a report published in the Lancet, tobacco is the second most leading risk factor for mortality worldwide. Secondhand exposure to tobacco smoke has a similar health impact. Globally 1.2 million deaths of non-smokers are attributed to secondhand smoking.
The Global Adult Tobacco Survey (GATS) Bangladesh 2017 said 12.7 per cent of adults visiting health care facilities have been exposed to second-hand tobacco smoke.
Smoking in the HCF is a punishable offence by law as the Directorate General of Health Service (DGHS) published ‘Tobacco Free Health Care Facilities Implementation Guidelines’ in 2018 to ensure tobacco-free HCF in line with the vision for ensuring tobacco-free Bangladesh by 2040 as declared by the Prime Minister.