Between 1981 and 1997, a programme to administer injected iodated oil was implemented in districts with high rates of Iodine Deficiency Disorder (IDD). Universal Salt Iodization (USI) was then found to be more practical. In 1989, the Government of Bangladesh passed a law making it mandatory for all edible salt to be iodized. Fortification of salt with iodine was initiated in 1990 to meet the urgent need for a cost-effective and sustainable intervention for the Control of Iodine Deficiency Disorder (CIDD). This activity, initiated after careful trials, also complied with a global recommendation for USI.
Two prototypes of Salt Iodization Plants (SIPs), one made in India and the other in Bangladesh, were tested. Then SIPs were produced by a local Bangladesh firm with UNICEF’s financial assistance, and distributed to salt factories in 14 districts.
Quality control is a key element in Universal Salt Iodization (USI) in Bangladesh. The project has put together a kit that can measure the iodine content at field level. This is packaged with other devices in a portable box and is now even exported to other countries. Every factory has been provided with this kit and all factory managers and plant operators have been trained in plant operation, salt law and iodine testing procedures. However, quality control remains the main concern and there is a clear need for strengthened monitoring and supervision systems.
Despite substantial progress in salt iodization over a short period, a 1996 survey showed that only 4.8 per cent of samples taken from 138 factories were properly iodized and that much of the salt was not being appropriately packed. The same survey reported that only 22 per cent of rural households and 19.1 per cent of urban households had adequately iodized salt. However, as a result of various information, education and communication activities that have been undertaken to improve awareness of the importance of iodized salt among consumers, retailers and wholesalers, there were relatively high levels of consumer knowledge about the benefits of iodized salt. In 1999, a UNICEF survey indicated that the proportion of households consuming iodized salt had risen to 71 per cent.
Monitoring and evaluation of USI has played a key role in CIDD in Bangladesh. In 1999, based on the recommendations arising from an intensive review of USI quality control system by BSCIC and UNICEF, a comprehensive monitoring and quality control system was implemented. A standardized monitoring form is now used for each salt factory and the data is computerized. Detailed status reports for each factory are now being assessed with the use of the monitoring data set and a standardised supervisory checklist has been developed for periodic use by Bangladesh Small and Cottage Industries Corporation (BSCIC) inspectors.
USI in Bangladesh has strong political commitment and administrative support from the Government. The private sector gradually started to take over financial responsibility for procuring potassium iodate after July 2000 to ensure financial sustainability of USI, based on a phased takeover plan.