KARACHI:
Last September, the Sindh government banned all tobacco and nicotine products – cigarettes, vapes, gutka, betelnut, nicotine pouches – from every educational institution in the province. For anyone who has watched the toll these products take, the notification read like a rare piece of good news.
However, nine months on, with the Federal Budget for 2026-27 now tabled and Sindh’s development envelope cut by Rs180 billion under pressure from the IMF, one question remains unanswered: who is paying to enforce this ban?
Banning tobacco and enforcing the ban are two different things. A 2025 study published in BMC Medicine documented exactly what happens when the money isn’t there. Tobacco zoning rules around Pakistani schools were simply ignored, not because the rules were wrong, but because no one had the capacity to police them. Sindh’s Provincial Tobacco Control Cell holds the mandate to enforce. It does not hold the funding. The budget was the moment to change that, but it has not.
The irony is sharp. Two months after the ban, the School Education and Literacy Department launched SAMRS, a monitoring platform now rolling out across Sindh’s 40,000 schools, with support from the World Bank, GPE, UNICEF and ADS. At its launch, Chief Minister Murad Ali Shah called for integrating SAMRS with health screenings and child wellbeing data. Yet SAMRS contains no tobacco compliance indicator. There is no flag for banned products at school gates. The infrastructure exists. The commitment was spoken aloud. But decisive action is missing.
The clinical stakes are real. Oral cancer is the most common cancer among Pakistani men. Between 2021 and 2024, the AKUH treated 2,101 patients for head and neck cancers. Nearly four in five were men. The single most common site of the tumour was the buccal mucosa, the soft lining of the cheek where gutka sits. These patients are the clinical endpoint of exactly the habit the September notification set out to stop, and exactly the habit we are now choosing not to fund the prevention of.
Three things were needed before the close of the Finance Bill: 1) named budget line for the Tobacco Control Cell inside the Sindh Annual Development Programme, so that the mandate finally has money behind it; 2) ring-fenced funding at the district level through local government, so that enforcement reaches the gate and not just the gazette; and 3) a tobacco compliance indicator built into SAMRS.
The September 2025 ban was the right decision. Funding its enforcement is the only way to honour it.
Dr Zeerak Jarrar
AKU, Karachi
