Role of NGOs in tobacco control in India: An MPOWER-based mixed method study

Non-Governmental Organizations (NGOs) are key stakeholders in advancing tobacco control in low- and middle-income countries like India. However, their roles, particularly in supporting MPOWER implementation, remain under-documented.

A cross-sectional mixed-method study was conducted among 16 NGOs from 18 Indian states, selected through snowball sampling. A semi-structured, pre-tested questionnaire captured organizational characteristics, program reach, and MPOWER-related activities. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis using NVivo. A heatmap mapped reported challenges across MPOWER components.

NGOs were most active in "Warn" and "Offer Help," focusing on awareness campaigns and community-based cessation. Least engagement was observed in "Raise Taxes" and "Enforce," due to institutional and technical barriers. Barriers included limited funding, inadequate staff capacity, community resistance, and industry interference. Sustainability issues were especially noted under Warn and Enforce, reflecting dependence on short-term donor cycles. Industry interference, including CSR masking and indirect sponsorship, was widely reported in Protect, Enforce, and Raise components.

Indian NGOs have proven their effectiveness in awareness generation and tobacco cessation support but remain underrepresented in fiscal advocacy, enforcement, and monitoring. Greater integration within NTCP structures, enhanced capacity for policy engagement, and sustainable, transparent funding are essential to maximize their impact. Leveraging NGO strengths offers actionable opportunities to advance India's tobacco control agenda within the MPOWER framework.