The International Resource Laboratories for Iodine (IRLI) Network is the global network of iodine laboratories supporting the task of monitoring progress in the global campaign against IDD. It strengthens the capacity of laboratories to accurately measure iodine content in urine and in salt. For further information, please see The Network for the Sustained Elimination of Iodine Deficiency.
REPORT OF THE IRLI HARMONIZATION WORKSHOP, NOVEMBER 2002,
CAPE TOWN, SOUTH AFRICA
At the United Nations Special Session on Children in May 2002, the commitment of governments worldwide to fulfill the unfinished principles and humanitarian objectives from the 1990 World Summit for Children was defined in the General Assembly’s “A World Fit for Children” document, which comprises a Declaration and Plan of Action. The Plan of Action contains a “promoting healthy lives” goal, which includes the strategy to achieve sustainable elimination of iodine deficiency disorders (IDD) by 2005. This strategy is strongly backed by the collaborative efforts government leaders, private industry leaders, and representatives from international organizations, non-government agencies, and the scientific and technical community.
Sustainable elimination of IDD requires verification that the population is receiving adequately iodized salt and its iodine status is adequate. Proper monitoring of the salt situation and population iodine status is complicated by (1) use of various methods for determining both salt and urinary iodine, (2) significant differences in the proficiency and capacity of laboratories throughout the world, (3) lack of organized salt and urinary iodine external quality assurance programs, and (4) limited access to resource laboratories for necessary technical and analytical assistance.
In response to these challenges, an International Resource Laboratories for Iodine (ILRI) Network was established. The structure and early goals of the IRLI Network were determined at an international conference in Bangkok, Thailand (May 2001), which was attended by researchers, policymakers, and public health professionals from 31 countries. The conference participants agreed that an international network of iodine resource laboratories would strengthen the capacity of individual country laboratories to accurately measure iodine in urine and salt. The plan of action was to select one or two laboratories from each of the six World Health Organization (WHO) regions on the basis of their laboratory performance, capacity and infrastructure, solid links to a national IDD programming body, and geopolitical representation. Nominations for regional resource laboratories were collected from conference participants. The IRLI coordinating body, which includes representatives from the Centers for Disease Control and Prevention (CDC), International Council for the Control of Iodine Deficiency Disorders (ICCIDD), Micronutrient Initiative (MI), United Nations Children’s Fund (UNICEF), and WHO, then selected 12 laboratories as resource laboratories of the initial IRLI Network.
Twenty-eight representatives from the 12 IRLI resource laboratories and from the co-sponsoring agencies convened in Cape Town, South Africa, for the IRLI Harmonization Workshop during November 10-14, 2002. The workshop was co-sponsored by the CDC, ICCIDD, MI, UNICEF, and WHO, and hosted by Dr. Pieter Jooste and his colleagues of the Medical Research Council, Tygerberg, South Africa. The goals of the workshop were to harmonize the operating procedures among IRLI laboratories, equip IRLI laboratories for their role as resource laboratories, improve communications among laboratories and with the coordinating body, plan next steps to implement network activities at the regional level, and develop long-range plans of action for the six regions.
Technical and operational considerations affecting the acceptance, viability, and sustainability of the IRLI network were openly discussed throughout the workshop sessions. The workshop sessions included
· Laboratory network’s connection to national programs,
· Obstacles and needs of IRLI laboratories,
· Relation between the laboratories and monitoring,
· Sustainability and resource needs of IRLI laboratories,
· Information exchange and discussion of training experiences,
· Creation of a framework for the regional networks,
· Strengthening of multisectoral collaborations,
· Discussion of urinary and salt iodine methods and external quality assurance programs such as Ensuring the Quality of Iodine Procedures,
· Total quality assurance issues, and
· Overview of the training manual.
The sessions were productive and engaging because of the small number of participants with varied experience in laboratory and policy issues as well as in nutrition program management. To complement the sessions and stimulate further discussions, a tour of the iodine laboratory at the Medical Research Council was incorporated into the workshop agenda.
The workshop enabled the representatives to work together with other IRLI laboratories in their regions to brainstorm and develop early plans for action for the establishment and acceptability of regional networks. To gain acceptance in their respective regions, the IRLI laboratories recognized the need to develop marketing plans emphasizing the added value of their laboratories. The regional marketing plans will be used to gain support from other laboratories in the region but also function to garner government backing and strengthen collaboration among multiple sectors.
A second major outcome of the workshop was the acknowledgement that the IRLI laboratories must develop creative strategies resulting in financial sustainability within 3-5 years. These strategies are based on the notion that seed money from multilateral agencies will be available only for a limited time, so regional financial plans using the sliding scale model must be developed. The financial plans must emphasize a return on investment, and exploration of a fee-for-service approach was suggested. The fee-for-service approach would be one way for the laboratories to recover material, personnel, and overhead costs---progress toward financial sustainability.
The workshop resulted in additional programmatic and operational consequences. These included completion of the IRLI training manual and establishment of a listserv or other means of effective communication by the end of January 2003, and development of an operation manual for the IRLI Network by the end of March 2003. Regional activities agreed upon by IRLI laboratories involve a situation assessment of each region by the end of March 2003, planning and implementation of regional meetings by the end of July 2003, and continual efforts to engage the salt industry.
Merely two months after announcing the designation of IRLI resource laboratories, at least two laboratories received additional resources from their governments as recognition and reinforcement of their new regional function. These early successes validate the approval and support for the IRLI Network, which provides a positive platform for the IRLI Network’s future success. The potential for future success is intensified by the hard-working, passionate representatives of the IRLI laboratories who have pledged their commitment to the IRLI Network. Their commitment and contribution toward strengthening the capacity of individual country laboratories to accurately measure iodine in urine and salt is vital to ensuring achievement of the goal of sustainable global elimination of IDD by 2005.
