Achieving Universal Salt Iodisation for Optimal Iodine Nutrition

Achieving Universal Salt Iodisation for Optimal Iodine Nutrition UNICEF, IGN, GAIN, MI EAP Regional Meeting 12 -14 October, Bangkok #commit 2 USI National Coordination & Implementation : Success factors for national coordination & implementation of USI programs Ruth Situma Nutrition Specialist - New York

USI NATIONAL COORDINATION & IMPLEMENTATION § What are the key programme features required for successful national coordination and implementation of USI ? Big Questions § What should we be doing/ aware of to ensure the gains made are sustained and the efforts to improve and expand USI programme continue? § How do we respond to the changing USI programme environment? 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 2

OUTLINE § Coordination - Political commitment - National coordination - Intergration § Implementation - Institutional capacity for implementation and enforcement of USI legislation - Communication and advocacy - Targeted strategies to different supply segments 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 3

Success factors for national coordination 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 4

POLITICAL COMMITMENT § Multi-sectoral high level political awareness § Iodine nutrition maintained on national agenda: oversight and renew commitment § USI is mandated by national legislation - All types of edible salt are included in legislation a) table salt, b) salt for at least some processed foods, c) salt for livestock feed. § Legislation enacted and implemented - enforcement mechanisms § National coalition and coordination body; salt and food processing industry key players 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 5

USI NATIONAL COORDINATION 1 4 36 2 6 7 11 5 4 3 O AR C R O SA W M EN AR R O O 1 C AR O 2 ES O PR EA IS C EE C 2 4 LA 3 19 G §Public/private trust without salt producers no iodized salt! 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% lo ba l % countries §A national coordination alliance exists including private, public, civic and scientific sectors and led by the government PERFORMANCE OF USI NATIONAL COORDINATION , 2014 NUTRIDASH Coordination works effectively 12 -14 October 2015 Bangkok Coordination does not work effectively EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 6

INTERGRATION OF USI INTO NATIONAL NUTRITION PLANS AND STRATEGIES §Elimination of IDD through USI integrated into national food and nutrition policies, strategies, plans, databases and budgets e. g SUN, food fortification §Information on elimination of IDD and USI progress is included in annual policy reviews. Results are discussed for corrective actions §Updated short & long term national work plans exist §Incorporate use of iodized salt in processed foods into the national agenda, as relevant 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 7

Success factors for national implementation 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 8

INSTITUTIONAL CAPACITY FOR IMPLEMENTATION AND ENFORCEMENT OF USI LEGISLATION § Nationally-supported quality assurance and control systems exist and are functioning as planned (to ensure sustained production/ importation of adequately iodized salt). § Iodine premix: sustainable and predictable procurement and supply § Nationally-supported systems are in place to monitor population iodine status and use of iodized salt coverage (as defined by legislation) in order to make adjustments to salt supply and demand areas 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 9

COMMUNICATION AND ADVOCACY IN USI 1990 s , 2000 s what was done then? § Secured political, legislative and financial commitments. § Created demand among consumers through education and awareness raising. 12 -14 October 2015 Bangkok Progress so far … Iodized salt coverage 1990: 20% 2000: 70% 2008: 70% 2014: 75% 2015 -75% Low Hanging Fruit Picked Now to 2020 what should we do? The remaining gaps represent the “Last Mile” § More difficult & resource intensive § Last mile challenges require new strategies. § Doing the same thing will not bring different results EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 10

COMMUNICATION AND ADVOCACY IN USI Analysis & intervening at strategic points in the value chain ENABLING ENVIROMENT Public, private, academic other groups involved in optimal iodine nutrition Imported Salt Producer Process & Pack Transport, Distribute, Wholesale Retail Sale Household Processed Foods KEY AUDIENCES Government (National and Local) 12 -14 October 2015 Bangkok Producers (Large, Medium, Small) Refiners, Packers, Food processors, Others Truckers, Distributors, Wholesalers Retailers (large stores, small, shops markets, non -formal sector) Households

COMMUNICATION AND ADVOCACY IN USI § The role of advocacy and communications for USI is to motivate specific actions—not just provide information § The key to A&C success is the identification of specific actions needed, and specific actors who make them, in order to achieve goals § Communication is important but cannot replace regulatory monitoring in the context of mandatory legislation 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 12

TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS >15 PPM 1 - 15 PPM 0 PPM Salt Supply, Market & Regulatory Environment Business and Reg Model Formal to Informal Product Loose to coarse Consumer & Market Urban to Rural Salt supply segments Imports Large Medium Small 12 -14 October 2015 Bangkok

TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Adequate Inadequate Not Iodized Salt Supply, Market & Regulatory Environment Business and Reg Model Formal to Informal Product Loose to coarse Consumer & Market Urban to Rural Salt supply segments Imports Large Medium Small 12 -14 October 2015 Bangkok

TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Sustain Improve Expand Adequate Inadequate Not Iodized Salt Supply, Market & Regulatory Environment Business and Reg Model Formal to Informal Product Loose to coarse Consumer & Market Urban to Rural Salt supply segments Imports Large Medium Small 12 -14 October 2015 Bangkok

EXAMPLE FROM CAMBODIA 100% 0. 3 90% 80% 17 35. 6 70% 16 62. 2 60% 50% Preliminary DHS/Micronutrient Survey 2014 results: urinary iodine status is inadequate 40% 30% 42. 8 45. 8 29. 8 20% Inadequately iodized 10% 8 0% 2008 12 -14 October 2015 Non-iodized 2011 Ref: 2008 CSIN, 2011 CSIN, 2014 Market Monitoring (WYD). Bangkok 2014 Adequately iodized

SUSTAIN, IMPROVE AND EXPAND 100 90 10 Expand 60 50 Improve 15 Non iodised 60 50 40 40 80 30 30 40 10 Inadequately iodised Adequately iodised 20 Sustain 10 0 0 12 -14 October 2015 Bangkok 90 70 50 20 5 80 80 70 100 Year A Year B EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 17

TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Sustain current proportion of adequately iodised salt; § Adequate capacity & motivation –Monitor and adapt to potential changes –Industry recognition 12 -14 October 2015 Bangkok

TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Improve proportion of adequately iodised salt; § Some but inadequate capacity & motivation –Expand capacity building channels to industry § Increase incentives and motivation for producers. –Strengthen regulation and inspection. 12 -14 October 2015 Bangkok

TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Expand iodisation to salt not currently iodised § Little/no capacity or motivation - Identify gaps: capacity, knowledge and/or motivation § Structural barriers: small producers, food producers –Few models & experience 12 -14 October 2015 Bangkok

CONCLUSION § National partnership and long-term industry and government commitment underpin successful programs § Communication is important but cannot replace regulatory monitoring in the context of mandatory legislation § Targeted strategies to different supply segments is important 12 -14 October 2015 Bangkok Equity Analysis 21

Thank you! #commit 2 USI