Background and challenges to implementation:
Tobacco is a significant public health concern in rural India. In Maharashtra, India's second largest state, 31.4% of adults report tobacco use (Global Adult Tobacco Survey India, 2009). In villages, tobacco use is endemic. Smokeless tobacco use is engrained in social and cultural norms. At the same time, poor rural health care infrastructure poses challenge to diagnosis and treatment of tobacco-related diseases.

Intervention or response:
Under rural initiative 'Salaam Mumbai Foundation' (SMF) started by Salaam Bombay Foundation (SBF) in 2007, initial needs assessment was conducted in nine villages across Chandrapur district in Eastern Maharashtra. This assessment reported 45% of all villagers using tobacco which also included two years old children. After needs assessment, SBF initiated capacity building sessions with 60 female community health workers known as "sakhis" to empower them to become the primary implementers of tobacco control in villages they serve. Capacity building activities included sensitization workshops covering tobacco's harmful health effects, existing tobacco legislation; follow up sessions to assess progress, and specific guidance to address tobacco control issues in villages.

Results and lessons learnt:
60 trained female community health workers implemented various tobacco control activities at village level using methods like songs, street plays, puppet shows, anti-tobacco rallies, and incorporated anti-tobacco messages into their other health activities. Through these activities they reached to 28,000 residents in 60 villages. An evaluation conducted one year after the program revealed that awareness on harmful effects of tobacco use increased up to 90% among the residents of intervention villages and tobacco consumption had reduced.

Conclusions and key recommendations:
Community health workers are uniquely situated to implement tobacco control programmes due to their access to community members, their role as trusted sources for health information, and
their ability to understand the unique issues faced in their communities. Hence, they can be trained to implement tobacco control activities in villages and work with all the stakeholders.