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Base de datos de evaluación

Evaluation report

ROSA 1999: UNICEF South Asia Regional Evaluation of Progress Towards Universal Salt Iodization, 1993-1998



Executive summary

Background

The UNICEF South Asia region comprises Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. All of these countries, except Afghanistan, are working towards the goal of elimination of Iodine Deficiency Disorders (IDD) by the year 2000 through the strategy of Universal Salt Iodization.

Purpose / Objective

This evaluation examines the extent to which the SAARC goal of universal access to iodized salt by 1995 has been pursued and the supporting role of UNICEF. The aim is that:
- Conclusions and evaluative judgements will assist UNICEF nutrition program officers and their government counterparts take stock of progress and provide them with insights and ideas on how to improve their support for Universal Salt Iodization (USI)
- It will serve as a report on progress so far for the numerous generous donors to UNICEF support for USI efforts who have not been able to see first hand what has been done with the result of their contributions

Methodology

Questionnaire was sent to UNICEF nutrition program officers in each country office. They collected information on salt iodization at the household level. Other source materials include country-level studies, evaluations and other reports related to USI in South Asia written in the last few years. Interviews were conducted with persons knowledgeable with USI programs in South Asia.

Key Findings and Conclusions

A scoring system was used by the evaluation to derive an evaluative judgement on the merit of national efforts to reach USI. Based on a scale of zero to five (zero for poor, five for excellent), the average scores for each country were: Bangladesh 3.2, Bhutan 4.2, India 3.5, Maldives 0.7, Nepal 3.2, Pakistan 2.4, and Sri Lanka 1.9. The results are broken down by: appropriate legislation and regulations, enforcement procedures, supply of iodized salt, monitoring system for iodized salt at production level, availability of iodized salt at household level, IEC activities, monitoring of IDD: national planning and coordinating mechanisms, and sustainability.

Whereas most countries would seem to have fair to good legislation, most have poor enforcement records. However, poor enforcement of food law is not peculiar to USI programs but seems to be a general characteristic of the region.

In the countries where most, if not all, salt is produced indigenously - Bangladesh, India, Pakistan and Sri Lanka - the production of iodized salt does not match the potential in terms of the availability of appropriate equipment. In Bhutan, Nepal and Maldives, all salt must be imported. In the first two of these countries, iodization is now done chiefly within their borders by a single agency. But, in all of them, inspection procedures at points of importation need to be strengthened or established to ensure that imported iodized salt is of satisfactory quality. Only two countries, Bhutan and Nepal (with Bangladesh running close), meet the WHO/UNICEF/ICCIDD recommendation that 90% of all food grade salt be iodized.

Most countries have a monitoring plan at the production level, with guidelines for procedures and (sometimes) follow-up action. However, these are not always followed and supervision is generally weak. External verification is not done systematically. Usually, a combination of rapid test kits and titration is used. While frequent reference is made to support to training, there appears to be little or no assessment of the quality of that training and of performance in practice.

Most countries have monitoring systems in place for household access and habitual use of salt with the prescribed levels of iodine. Results are especially encouraging in Bangladesh, Bhutan and most Indian states. However, districts in some Indian states as yet do not have access to iodized salt and remote areas in Balochistan, Bangladesh and parts of Nepal have difficulties with access that may require special strategies.

Preoccupation with the priority to establish USI seems to have led to the relative neglect of its ultimate justification, namely the elimination of IDD. While assessment of thyroid size and function need to be done only periodically, monitoring of iodine should be systematic and more frequent. While most countries claim the facility to measure iodine in urine, it seems that none have an institutionalized system for regular monitoring linked to review of program components.

The conventional thinking has been that a national high-powered intersectoral committee is necessary to establish overall policy, ensure appropriate coordination between sectors, oversee the development of a comprehensive national plan of action and periodically review implementation. However, experience in the region suggests that, in practice, this may not be so important. Much has been achieved despite the absence or poor performance of national committees.

Recommendations

UNICEF tends to have adopted a pragmatic approach to key actors, such as Ministries of Industry and the private salt sector, in order to promote USI. This approach has highlighted the importance of the role that can be played by a committed agency that is on the spot and able to question, advocate, follow-up and probe. This is the role that UNICEF is perhaps uniquely qualified to fill; no other development agency has this capacity.

A further requirement for sustainability is that countries should have ready access to potassium iodate (or iodine) at a reasonable price. UNICEF might have a role in this respect.

 



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Report information

Date:
1999

Region:
ROSA

Country:
Intra-regional

Type:
Evaluation

Theme:
Health - Micronutrients IDD

Partners:

PIDB:

Follow Up:

Language:
English

Sequence Number:
1999/800

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