7
Sustaining the Progress
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| Regardless of its success in iodizing salt, no country can afford complacency. In the 1960s and ‘70s, several countries, including Guatemala and Columbia, believed IDD was under control. Then, as government and public support for IDD programs waned, the problem returned as seriously, sometimes more seriously than before. Their job won’t be over until they have made iodized salt commonplace and the reason for consuming it common knowledge.
The future of IDD control depends on teaching children how and why to use iodized salt. It depends on an informed and supportive health system that makes sure mothers know the importance of iodine in the diet. The future also depends on a demand for iodized salt that allows industry to assume the costs now subsidized by governments and international agencies. |
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Full circle of communication
Finally, the future of IDD control depends on creating a full circle of communication. We need to keep testing the iodine levels in people, in the salt they use at home, and in canned and prepared foods they buy. Then we need to report the results of these investigations back to policy makers, to the salt industry, and to the public. These reports should also include an evaluation of the knowledge of school children, teachers, and health professionals, reviews of legislation, and a record of continuing media involvement. This monitoring should be at regular intervals -- not when brain damage causes another public outcry, when it means starting over, wasting ten or twenty years of hard work.
These surveys should have consequences -- positive or negative. Ecuador’s IDD program found, for example, that a combination of education, rewards, and punishments worked best to ensure good quality control of iodized salt. (see Box 11)
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Box 10 Three Types of Quality Assurance There are three types of quality assurance which are equally vital to sustaining progress: 1. Quality assurance of the Product, a responsibility of companies and industry with legal oversight. 2. Quality assurance of the Process, including raw material imports, management, training of human resources, communication, professional overview, legislation, etc. 3. Quality assurance of Progress in human nutrition through surveys, urine testing and other indicators. Quality control of product and progress are well known and not as complex as we often make them out to be. However, quality of process, which deals with management and communication issues, is often overlooked by governments and development agencies including some of the most active proponents of IDD work. And we overlook that middle piece at our peril. David Haxton, ICCIDD Board Member |
| International Support
International attention can also help sustain progress. In 1996, a team of experts evaluated Bolivia’s IDD program, finding the country to be virtually free of IDD. This favorable review was then published and distributed for other countries around the world concerned with IDD. The evaluation team found that Bolivia eliminated iodine deficiency at the national level, but now has the perhaps more difficult task of avoiding complacency. The program has to seek out pockets of rural areas where iodine consumption is still relatively low, make quality control improvements, maintain monitoring systems, and sustain political will. Program managers have to keep bringing the results of surveys to the attention of government leaders, the public, and the salt industry. The evaluation team also recommended that the history and causes of IDD, and the importance of iodized salt be incorporated into all levels of the education system. |
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As more countries reach the level of success attained by Ecuador and Bolivia, the ICCIDD or another international bodies may want to consider presenting an award for achieving and sustaining universal salt iodization and consumption. Some recognition is already afforded by UNICEF, which keeps a country-by-country status report on IDD elimination as part of its Progress of Nations. It is not enough that about 90% of the salt in countries affected by IDD is iodized. We need to highlight each nation’s achievements, continue to build commitment for IDD work, and keep examining the forces that cause practice to lag behind policy.
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Box 11 - Manufacturers: Education and Enforcement (Ecuador) "For the salt producers, not only were there activities aimed at controlling the quality of the product, but information workshops were organized and technical assistance provided, as well as a stock of iodine to be used in case of iodine importation problems...The procedures used for wholesale distributors are relevant. When a salt manufacturer was discovered supplying a defective product or simply did not iodize his salt, the appropriate public officials were notified so that they could adopt the relevant legal measures (fines, shutdown, etc.). On a few occasions, these measures were enough to correct the salt iodination problem. This strategy was all the more effective when their major clients (wholesale distributors) were advised that the brand that was being investigated could be impounded and taken off the market. Thus, the producer, because of the sudden drop in demand, had no other recourse but that of leaving large amounts of salt in his warehouses. Afterwards, the producer’s situation could improve as long as the laboratory analyses ratified the product’s high quality." Vanormelingen, K. and Vanderheyden, J.M., 1994 |
We are still learning
Using the social mobilization approach of identifying partners, encouraging dialogue, building political commitment, and working with all concerned is a good way to uncover "resistance points" and obstacles to development goals. As we continue to test communication theories and learn more about managing programs, no doubt the mobilization strategy will be improved and revised. But right now, so much is at stake in ending IDD that we should use every effective tool available to us. We should apply what we know about how to foster strong, widespread support for IDD programs -- support we need to reach every mother and child in danger and create a momentum for IDD protection that will carry it forward to future generations.
