3
Building Political Commitment
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| IDD programs have been generally very successful in attracting the attention and support of national leaders. Long associated primarily with visible goiter which is considered basically a cosmetic problem, iodine deficiency is now widely recognized as a "disease," a serious cause of mental retardation and a real threat to development.
However, building political commitment is a continuing obligation. It is not enough that governments signed the Child Summit Declaration, or that the Prime Minister or heads of government said good things about iodine and IDD elimination. |
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The strong political will shown at the 1990 Children Summit is certain to be diluted among policy and decision makers unless they are reminded of their commitment and kept informed of the progress, or lack of it, in the flight against IDD. Commitment should be regularly and imaginatively renewed because political leaders change, the audiences change, the opportunities change and the needs change.
Participatory activities
IDD Day provides an opportunity every year to take a fresh look at where we are headed and think of new ways to get there. Introduced in 1995 when we met the mid-term goal of universal iodization of salt, this day of celebration and rededication helps keep up the momentum toward virtually eliminating IDD by the year 2000. This special day helps inform the public, educate those at risk, and keep the focus on what still needs to be done. But the IDD Day needs a broad-based, participatory activity to generate excitement and action.
A global children’s drawing competition on IDD themes, such as cooking with iodized salt, is an educational, participatory activity that can generate media, public and political interest as well as boost fundraising efforts, especially by Kiwanis International which would like to raise $75 million for UNICEF work in this area.
Sub-national advocacy
Today, governments are increasingly decentralized, and local planning is vital to increased awareness of IDD and demand for iodized salt. We cannot assume that district and community leaders will follow through on policies established in the capitals. Even if the prime minister says iodized salt is important, unless the provincial governor or the village chief or the various district level officers see the value of IDD work in terms of their own priorities, the IDD effort will not get the attention it needs to succeed. And if communities and local leaders are not informed and involved in planning they often resist change.
Therefore, it is not enough to advocate only at the national level. Advocacy efforts at the district and local levels also need attention. Health and economic data for severely affected areas, not only national data, should be provided to regional, district and community leaders because they are the ones who play a major role in keeping programs going. Local leaders are not always moved by a national or global issue. The threat has to be brought home to them with a presentation of local benefits and consequences. Community level data is needed to shift the priorities at the sub-national levels.
Certainly we can leave to the economists how best to make comparisons and seek out their ideas. Economists might study the effects of reducing IDD in an area that has been iodizing salt for five years. Or they might use computer models to calculate economic benefits of eliminating IDD. Perhaps a combination of educational and economic arguments will be most convincing.
In any case, advocacy at the sub-national levels should communicate a sense of urgency. We should not shy away from the consequences of IDD, even though they may be unpleasant. Scientists have proved that iodine deficiency causes brain damage, an average loss of over 13 IQ points across large populations, along with other mental and physical defects. National leaders have responded to IDD once they realized the extent of brain damage it causes in their countries. Local leaders respond for the same reason, whereas they may not care as much if the problem is presented only in terms of "cosmetic" visible goiter.
| Special attention to the bureaucrats and technocrats
Bureaucrats are too often presumed to follow orders from decision and policy makers. A government bureaucracy is not a monolith; it is made up of hundreds of units, each with its own agenda, bias, and self interests that may run counter to IDD elimination. These interests can be personal, they can be professional, and they can be simply inertia and natural resistance to change. Many development programs have failed because they ran up against the rock of bureaucratic resistance or even sabotage. |
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In many unexpected ways, bureaucrats can be the unseen enemy of development. Remember, groups and individuals don't have to oppose IDD control openly to undermine it. In China, for example, every unit of government or unit of production is responsible for its contribution to economic development and, more importantly, for its workers’ "bonus." If the unit chief sees no economic return in IDD work, which will affect his or her ability to give the staff "bonus," the chief will pay lip service to the national commitment and give it low priority.
The chief or the district official does not have to say, "I’m against iodized salt." All the official has to say is, "Low priority," and the program stalls. So it is better to use some arguments, often more economic than social, to move the issue to a higher priority. The arguments should seek to prove that the IDD effort has direct relevance to productivity and economic gain, because that is how the official may measure importance. Since health is generally considered consumption rather than investment, it is important to "reposition" IDD by presenting even very simple economic data relating higher IQ with higher productivity. This information will allow a constructive discussion addressing the official’s true concerns and is more likely to lead to genuine support.
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Box 3 - An Example of Bureaucratic Resistance (Ecuador) A conflict of interest within the same ministry once threatened to slow or sabotage IDD work in Ecuador. Provincial IDD teams credited their access to computers (and the development of non-biological indicators) for their ability to quickly assess and report their progress and decide where resources were most needed. Whenever there was a new Minister of Health or a change of government, the IDD teams could quickly produce an up-to-date status report. However, other health workers looked on the computer-using IDD workers as "privileged" and became jealous and uncooperative. The problem was resolved diplomatically by providing the other health program workers with computer time on equipment purchased for IDD control and encouraging them to handle their own information using computer technology. Small conflicts such as this one may seem silly and inconsequential to the outside observer, but they are of serious importance to the health worker in the field who works under difficult conditions with few resources. Rivadeneira (1991) |
