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(Summary)
Salt
Department
Ministry
of Industry
1999
List
of Contents
Contents
1. Introduction
2. External
Evaluation of the Status of National
Iodine
Deficiency Disorders Control Programme
in
3. Internal
Evaluation of the Universal Salt
Iodization
in
Objectives
Study
Design and Methodology
Findings
and Observations
(i) Production, Packaging and Storage of
Iodized
Salt
(ii) Quality Control and Transportation of
Iodized
Salt
(iii) Procurement and Distribution of Iodized Salt
(iv) Consumption at the Household Levels
(v) Inter-Sectoral Coordination
(vi) Legal Measures
(vii) Information, Education and
Communication
Conclusions
4. Recommendations
5. Salient
Findings and Recommendations of the
Evaluation
Studies for Sustaining the Programme
and
Increasing the Production of Iodised Salt
Introduction
Iodine
is one of the essential elements required daily for proper mental and physical
well-being of the human beings. Though
required in a very minute quantity (150 microgram per day, its deficiency
results in wide array of preventable disorders collectively known as iodine
deficiency disorders (IDDs) which are major public health problems in India.
In
Following
the successful classical studies of Prof.V.Ramalingaswamy and his associates in
Kangra Valley of Himachal Pradesh during 50’s which revealed that consumption
of iodized salt result in significant reduction in the goitre prevalence,
iodization of edible salt was accepted by the Government of India as the
sustainable low cost solution for prevention of IDD. Consequently, Govt. of
By
1989, the salt iodization capacity created was 45 million tonnes which was
double the requirement of the then notified goitre endemic areas. Most of the plants were operating below the
production capacity. The focus of the
programme during the phase therefore shifted from increasing the production
capacity to creating demand and market for iodized salt at consumption
level.
By
1992, though the goal of Universal Iodisation of edible salt could not be
achieved, 28 lakh metric tonnes of the total edible salt was iodised as against
the target of 50 lakh metric tonnes.
Meanwhile IDD received international attention as new evidences came to
light about their impact on children by way of irreversible brain damage and loss
of IQ points. The 43rd World Health
Assembly, the World Summit for Children, Colombo SAARC Conference on State of
Children in South Asia, all adopted resolutions aiming at elimination of IDD
through Universal Access to Iodised Salt.
The Government of India reiterated its commitment to Universal
Accessibility of Salt by 1995. In 1992,
the constraints in reaching the USI goal was reviewed and the nomenclature of
National Goitre Control Programme was changed to National IDD Control Programme
(NIDDCP) to emphasize on the wider implications of iodine deficiency.
By
this time it was realized that increasing the production capacity of iodized
salt without adequate quality control at production level only sensitizing the
key players along the chain of logistics would not help in sustaining the programme
in the country. Upto 1993, the programme
remained a low priority unisectoral programme of the Ministry of Health.
At
this juncture, UNICEF came forward to assist Indian programme financially and
technically and a new phase of collaboration in the form of GOI-UNICEF project
emerged with the main objectives to (i) adopt a multi-sectoral approach to the
programme; (ii) step up IEC activities; (iii) enlist support from all the stake
holders in the programme viz., manufacturers, traders, NGO’s, consumer
groups, state governments; railway, etc., and (iv) strengthen MIS at
production level. As a result a
multisectoral plan was launched with support of UNICEF in consultation with the
Salt Department, Ministry of Industry.
This project aimed at meeting the overall goal of elimination of IDD by
the year 2000. The objective of the
project was to ensure universal iodization of edible salt and ensure
accessibility and consumption of iodized salt by 100% of the population by the
year 2000.
The
implementation of this project saw an acceleration of activities towards
achieving the mid decade goal of universal salt iodization, with the focus on
increasing production of iodized salt and creating demand for the same.
With
a view to identify the key contextual and programme factors responsible for the
successes and constraints, the GOI and UNICEF planned a mid-term evaluation of
the Universal Salt Iodisation Programme with the objective to provide inputs to
support future planning to achieve and sustain USI for achieving the goal of
elimination of IDD. As a result in 1996,
at the macro level the USI activities were evaluated by a team of external
evaluators from Micronutrient Initiative, Canada. This evaluation study was limited to only
four states with very limited scope and objectives. Later on Salt Department, in consultation
with the UNICEF decided to carry out a detailed evaluation study of the
programme with highly enlarged scope and objectives which was carried out in
1997-98 by the Indian Institute of Health Management Research, Jaipur.
Findings
of both the studies, their conclusions and recommendations have been given
briefly and separately in the following pages.
External Evaluation of the
Status of National Iodine Deficiency Disorders Control Programme in India, 1996
Background
The Canadian International Development Agency (CIDA) has been
supporting the IDD elimination programme in many countries of
At the initiative taken by the CIDA a mission visited India
during 19th August - 5th September, 1996 to review India’s progress towards the
goals of USI and elimination of IDD. the
objectives of the mission were to assess the (i) progress towards reaching the
goal of USI and evaluate the potential to sustain the progress; (ii) progress
towards reaching the goal of elimination of IDD; (iii) significance of the
contribution of CIDA to the National Programme of IDD Control in India; and
(iv) make suggestions and recommendations about how the programme might be
improved and identify technical assistance that might be provided.
The mission officials held discussions with the officials of
the Ministry of Industry and the Ministry of Health & Family Welfare, staff
of the UNICEF, WHO and a few resource persons and participated in the meeting
of the steering committee constituted by the Ministry of Industry to oversee an
evaluation of the USI component of the NIDDCP.
They conducted field visits to the states of Gujarat, Himachal Pradesh,
Madhya Pradesh and Sikkim to see salt production/iodisation activities,
monitoring procedures, IEC activities and to meet Salt Traders Association,
industry and medical personnel and UNICEF fields staff and also reviewed
reports and publications.
FINDINGS OF THE EXTERNAL
EVALUATION
It was found that the total common salt production in India is
about 12.5 million tonnes per year. The major salt producing states are Gujarat
(9.0 m. tonnes), Tamil Nadu (2.0 m. tonnes), and Rajasthan (nearly 1.0 m.
tonnes). Some amount of salt is also produced by eight other states. There are
nearly 8500 procedures with individuals capacities ranging from a few thousands
of tonnes per year. Approximately half of the total production is for
industrial and other non-edible purposes. Small scale manufacturers account for
about 40% of total production.
Salt iodisation plants began to be established in 1955. by 1981
there were 15 plants with a total annual production capacity of 2.5 lakh tonnes
and the actual production of iodised salt increased from 60 thousand tonnes in
1970 to about 6.4 lakh tonnes in 1986. in the next 7 years it increased to
nearly 3.0 million tonnes in 1993 and by 1996 it reached nearly 4.1 million tonnes.
The current total capacity of iodised salt production greatly exceeds the
current actual production which is close to the internal needs of the country.
The study mission felt that the story of USI in India is one of remarkable
achievements. In the course of finding
solutions to its own problems India has offered to the world two programmatic
technologies : iodising machinery and the spot testing kit which are important
tools for producing good quality iodised salts.
The study revealed that there is no single approach that is applicable
to all the states of the country uniformly, but each state has adopted basic
principles to suit its own nature and needs.
The study mission was able to get first hand experience of the success
of the USI programme in four states viz., Gujarat, Himachal Pradesh,
Madhya Pradesh and Sikkim.
Gujarat
Gujarat is the major producer of salt in India accounting for
nearly 70% of the India’s total production. Ninety nine percent of the
production is in private hands while 1% remain in public sector. The private sector is divided into 70% major
producers, 18% small producers and 12% cooperatives. The small producers are increasingly movings
towards forming cooperatives which is important for their future survival. The producers are increasingly switching over
to producing good quality powdered iodised salt packed in half and one kilogram
polythene bags. As a result the powdered
salt is replacing the ‘Kurkutch’ and ‘phoda salt’ which presented porblems in
iodisation as either they were impure and required washing, thereby removing
the iodine or the crystals were so big that iodisation was not effective.
The other important initiatives of the Gujarat government were
the instructions issued to all Integrated Child Development Services (ICDS)
schems to use only iodised in the preparation of supplementary foods and the
decision to introduce iodised salt in the Mid-Day Meal Programme.
The equipment and machinery used for the iodisation are very
effective and reasonably efficient. The
laboratories of the Salt Departments and private salt works were well equipped
for iodine testing and records well kept.
The mobile salt laboratories of the Salt Department have proved very
successful. The distribution of salt is
carried out both by rail and road transport.
For longer distance, transporation by rail has been found
economical. However, the policy of
allotment of railway rakes in some cases caused producers to lose extensive
revenue because of late deliveries of the rail wagons.
Himachal Pradesh
There are only two wholesalers in the state and the stores on
an average sold between 50-75 kilograms of salt per month. Iodised salt is easily available in the state
and it was evident that iodised salt is reaching the towns and villages well
packed and iodised. Four different
brands of salts were found in the state; all with adequate amount of
iodine. It was found that much effort
has been put into the dissemination of IDD information utilising various
organisations. Training programmes,
awareness camps for women and rallies with school children have been held in
order to create awareness and demand for iodised salt.
Madhya Pradesh
The study team found that launching of the Rajiv Gandhi Mission
for the Elimination of IDD throughout the state on August 20, 1994 has
dramatically changed the scenario and has made spectacular progress to the
current status of excellence. The
Mission approach was an innovation in administration, management and
implementation of time-bound activities oriented towards specific goals. The most important feature of the approach
has been its in-built system of involving the community in planning,
implementing and monitoring activities which created the base for self
sustainability. Two years after it was
launched, the Mission Approach was deemed to have achieved its goal and so was
terminated and dedicated to the people.
Random checks carried out by the study team at shops,
restaurants, homes and in all cases found that the wholesalers of M.P. have officially
taken an oath not to deal in non-iodised salt and traders are committed to
trade only in iodised salt. Study team
found that the messages regarding the ill effect of using non-iodised salt has
percolated upto the grass root level and even the rural folk from far flung
areas were found to have learned that the iodised salt was good for ones health
and brain and prevented goitre. Rural
community members were found to be using salt with adequate amount of iodine
not only for the self consumption but for their live-stock also.
Sikkim
Sikkim has had a particularly high prevalence of goitre and
cretinisn which prompted the decision to promote and supply exclusively iodised
salt. This activity was greatly
accelerated in 1993. All the salt
samples spot tested by the study team were found to be well idoised. It was found that the people were aware of
IDD and of the implications of not using iodised salt. People were following the proper storage
practices and were aware of consequences of not
doing so. It was also found that
the Thyroid Centre laboratory regularly tets salt samples from market. In the year ending August 1996 titrations
were done on a total of 242 salt samples; only 2 samples had nil iodine, 18
contained 8-15 ppm and remaining more than 15 ppm of iodine.
The Mission found that there are seven issues that have an
important bearing on the future sustainability of the USI. These are :-
· Role of the Salt Department
· Regisrtration of salt producers/manufacturers/wholesalers
· Management of structures at production level
· Management of laboratories at factory level
· Distribution by railways and road
· Formation of cooperatives and Assocations
· External monitoring.
Conclusion
At the end the Mission concluded that India has made
spectacular progress in recent years towards the goal of USI. It was revealed that while on one hand the
Salt Department has been successful in ensuring the supply of good quality
iodised salt for human consumption, the state authorities, on the other hand
have been active in enlisting the support of salt traders and motivating the
public to demand for iodised salt. This
has proved more effective. This also has
greater potential for sustainability.
The contribution of UNICEF to this success was found to be substancial
and significant.
The Mission felt that the NIDDCP can be said to be entring a
second phase and there is a need to consolidate the broad gains that have been
made, introduce certain improvements and institutionalise the procedure.
The target date for providing Universal Access to Iodised Salt
is approaching fast. However, it is
being increasingly felt that the programme must be sustained beyond 2000 A.D.
which needs persistent vigil. The
Mission cautioned that the story of Kangra should not be repeated where once
the IDD appeared to have been completely controlled, people became complacent
until it was suddenly realised that the goitre was returning. Investigations revealed that the non-iodised salt
had suddenly appeared in the market. It
is, therefore, necessary that a continuous watch must always be kept and
monitoring procedures must be institutionalised.
Specific Recommendations
Based on the findings of the on-the-spot study during the
visits to different states and discussions/interaction with personnel/officials
of various departments/agencies, the Mission team has made the following
specific recommendations for the sustainability of the USI Programme in the
country:
1. Establish
high level Policy and Coordinating Committee.
2. Monitoring
IDD, develop statistically sound strategy for periodic surveys.
3. Consider
participation of external and international experts in technical review of IDD
monitoring strategy.
4. Review
laboratory procedures and training programmes and provide written guidelines.
5. Provide
practical training for laboratory technicians at factory and state level.
6. Ensure
Salt Department is able to provide adequate supervision and training.
7. Reconsider
use of Cess as a resource.
8. Ensure
that all states ban the sale of non-iodised salt.
9. Register
all producers, manufacturers and their wholesale outlets.
10. Where
possible, set up check points for road transport at state entry points using
the spot test kit. (Because it may not
be practicable to monitor all roads into a state, is no reason why the few
major routes should not be controlled.)
11. Provide
incentives to small producers so that they form cooperatives.
12. Railways
to stream-line and render more efficient service, including provision of loading
and off-loading facilities.
13. Salt
Department to invest in a computerised Management Information System.
14. Consider
inviting UNIDO consultant to advise on computerised information system for Salt
Department, and for District MIS.
15. Establish
a proper monitoring linkage and respective responsibilities between producers,
Salt Department, Health Department and Food & Civil Supply.
16. Ensure
that those producing or selling illegally packed (e.g. false addresses)
non-iodised salt be prosecuted.
17. Support
both the Chamber of Commerce and the Indian Standards Institute in their
participation in the future sustainability of the programme.
18. Maintain
and in certain states increase the IEC campaign.
19. MOHFW
to issue guidelines to states for operation of District MIS.
20. Continue
to use STKs for monitoring and to maintain consumer demand, as in MP and HP.
21. Analyse
results in such a way as to direct attention to areas or activities meriting
intervention.
22. Reconsider
use of internationally accepted criteria for monitoring IDD.
23. Consider
establishing upper limit for concentration of iodine in salt at production
level say, 50 ppm.
24. Strengthen
efforts in southern states, especially Kerala.
25. Ensure
effective inter-agency coordination.
26. Continue
UNICEF support to NIDDCP through 2000 AD.
internal evaluation of the universal salt iodization
in india
Objectives
1. Assess the
quantity and quality of iodized salt production against the requirement, with
special focus on processes/policies introduced for reaching and sustaining the
goals, as well as measures taken to overcome the constraints identified.
2. Study the
system in operation for monitoring iodized salt at production and consumption
levels with special reference to sustainability and regularity, and linkages to
corrective actions.
3. Study the
availability of iodized salt at consumption level with reference to the quality
at wholesale, retail and household levels.
4. Undertake
resource analysis of the USI component of NIDDCP activities, as well as
evaluate the role of various departments, agencies, institutions and other key
groups in the USI.
5. Review the
masures taken for overcoming specific constraints during programme
implementation and also identify those which need to be resolved for
accelerating and sustaining universal salt iodization.
6. Suggest major
programme inputs that need to be addressed to accelerate the programme
implementation towards reaching and sustaining the USI goal.
7. Identify
critical factors of the USI programme that have facilitated the implementation
and draw lessons for sustaining USI.
Study Design and Methodology
The
focus of the evaluation study was on issues related to (i) review of policy and
processes; (ii) the production and distribution of iodized salt at the
manufacturer’s level; (iii) the requirement of iodized salt for various states;
(iv) monitoring system at the production, distribution, supply, sale and
consumption levels with respect to quantity and quality; (v) distribution and sale
of iodized and non-iodized salt through wholesalers and retail outlets; (vi)
consumption patterns of salt by households in the rural and urban areas; and
(vii) role of different departments, agencies, institutions and other key
organisations involved in the implementation of USI programme.
A
detailed review of the policy of the Ministry of Industry, Food and Civil
Supplies, Health and Family Welfare, Railways was undertaken, with regard to
iodization of salt including issues such as production, distribution, supply,
sale and consumption as well as monitoring and quality control. A detailed
situational analysis of the universal salt
iodization component at the national and state level was also conducted
and assessment of impact of privatization on quantity and quality of iodized
salt was also made. Resource analysis in terms of availability of funds,
iodization plants, laboratory facilities, salt testing kits, supply of
potassium iodate, training and development of human resources constituted an
important aspect of the study.
The
evaluation study covered 8 states in India, out of which 3 were salt producing
and 6 salt consuming states. The salt
producing states were Gujarat, Rajasthan and Tamil Nadu, while the salt consuming states were Manipur, Karnataka,
Bihar, Gujarat, Himachal Pradesh and Madhya Pradesh. Gujarat was included in both the categories.
A
reprsentative sample of 73 salt producing units were covered in Gujarat, Tamil
Nadu and Rajasthan. Of these, 5 were
unregistered units. The salt units were classified as per the classification
used by the Salt Department viz. big, medium and small on the basis of
their production capacity. Parameters for evaluation included production,
policies, quality control and monitoring system, packaging, storage,
distribution, pricing, etc. The country level of estimates regarding
total iodized salt production was obtained from secondary sources and relevant
authorities. Site visits of the manufacturing units were made for an on the
spot observation of the iodization, availability of equipments and laboratory
facilities, storage and transportation arrangements.
The
meetings were organized and interviews conducted with various officials
including the Director, Ministry of Industry, Salt Commissioner, Dy. Salt
Commissioners, Programme Officer of the UNICEF, Railway authorities and the
experts from the All India Institute of Medical Sciences, New Delhi.
At
the state level, the interviews were conducted with households, wholesalers,
retailers, manufacturers, state and district level officials of various
departments and functionaries of the Health, Salt, Food and Civil Supplies
departments, PHC, Anganwadi and ICDS staff. For each category of people,
separate pretested questionnaries were used to elicit information on various
aspects of USI, IDD. NIDDCP and to understand their role in effective
implementation of the USI programme.
Among
the salt consuming states, 10 districts were selected to understand
procurement, distribution, and consumption of iodized salt at the household
level. A total of 44 wholesalers selected randomly and 831 retailers. (5 from
each urban clusters and 2 from each rural clusters) were covered under the
study. A household survey, covering a total of 450 households (A total of 300
rural and 150 urban households in each district) was conducted using cluster
sample technique. Thirty clusters were selected from each district (20 from
rural and 10 from urban areas) and in each selected clusters 15 households were
covered systematically with 2 random start to ensure proper representation of
all the communities in the cluster. The heads of the households were
interviewed using a predesigned questionnaire to obtain information on salt
consumption pattern, problem encountered in obtaining salt, preference for a
type of salt, knowledge regarding IDD and its impact and the source of
information, etc. The study was also extended to students from 5 schools from 2 urban sites each of the selected
clusters. Salt samples obtained from 450 households and 375 schools were tested
using salt testing kits.
The salient findings of the study are
summarized as under:
The
major stragegic thrust of USI has been on enhancing the production and
simultaneously creating demand for iodized salt and promoting its consumption
throughout the country. The emphasiss has been on improving the uitlisation of
the existing capacity i.e. decresing the
gap between production capacity and actual production, streamlining proper
distribution by rail and road as well as increasing awareness regarding the
importance of daily consumption of iodized salt among salt producers, traders
and consumers.
There
are about 650 iodized salt production units in the country located mainly in
Gujarat, Rajasthan and Tamil Nadu. Only 557 of the 650 (86%) units were
registered with the Salt Department.
The impact of Universal Salt Iodisation
project was clearly evident. The total annual installed capacity of production
of iodized salt has reached 8.7 million tonnes against the requirement of only
6 million tonnes. The actual production which was 2.8 million tonnes in 1992,
increased to 3.7 million tonnes in 1995, and then to 4.1 million tonnes by
1996. Thus, there was an overall increase of 46% in production of iodized salt.
The
study revealed that the production of iodization salt has achieved the level of
sustainability. This was reflected from the tacit policy support and commitment
on the part of Salt Department on one hand,
and continuing rise in production even after removing the subsidy on iodizing
chemical potassium iodate (from 1.3.92) on the other hand.
Out
if 73 production unit covered under the study, 46.6% were producing only
iodized salt, while 53.4% were producing both iodized salt producing units
revealed that highest proportion (57%) of such units were located in Gujarat,
followed by Rajasthan (46.7%) and Tamil Nadu (26.7%). It was reported that
nearly half of the salt iodization units, (50.7%) were not producing iodized
salt as per the permitted capacity. On an average, per unit production of
iodized salt was 10,239 tonnes in 1993,8,385 tonnes in 1994, and 10,055 tonnes
in 1995. It was interesting to note that the per unit production was lower in
1994. This was mainly due to the fact that the number of production units
increased during this year, bringing down the average production per unit,
although the overall production increased. Average per unit annual production
of iodized salt was highest in the state of Gujarat.
The main reasons for not producing the
iodized salt as per the permitted capacity being higher and some other problems
such as non-availability of railway wagons, labour and storage problems.
Most
of the manufacturers (98.5%) were using HDPE
material for bulk packaging of iodized salt in 50 and 75 kg bags. The study
showed that 39.7% manufacturers were storing salt in open space and another
8.2% in open space covered with polythene sheets. Only 52% manufacturers had
covered godowns facilities for storage of iodized salt. The state-wise
distribution of manufacturers with covered godown was 30.0, 64.4 and 73.3% in
Gujarat, Rajasthan and Tamil Nadu, respectively. It was revelaed that 77% of
manufacturers were storing salt only for 1-15 days and 22% for upto one month.
The
awareness of the manufacturers about the ban on sale of non-iodized salt was
very high. All the manufacturers of Gujarat and 96.4 and 93.3% manufacturers of
Rajasthan and Tamil Nadu, respectively were aware of than ban.
Monitoring the
quality of iodized salt is the responsibility of both the manufacturers and the
Salt Department. Iodized salt producers are required to establish laboratories
for the quality control of iodised salt manned by a qualified and competent
chemist, who can draw and analyse samples from the plant and advise the plant
operator for suitable corrective measures. Initially all the authrised iodised
salt producers set up laboratories but they found it difficult to obtain services of competent chemists,
specially in remote salt producing areas. As a result individual laboratories
were converted into group of laboratories were converted into group of
laboratories serving a group of salt producers.
The
Salt Department also take appropriate measures to monitor the quality of
iodised salt with the help of a network of 26 static and 3 mobile laboratories.
Most of these laboratories are located in the major salt producing states viz.
Gujarat, Rajasthan and Tamil Nadu and analyse iodised salt samples collected by
the salt inspectors.
External
monitoring of the production and quality of iodised salt was done in almost all
the units, as 97.2% of them reported that the samples of salt were drawn by the
personnel of the Salt Department. Most of the salt units (93.1%), received
feed-back regarding the quality of the salt by the Salt Department. The feed
back was found to be 100% in Rajasthan and Tamil Nadu.
Regarding
the quality of salt in terms of level of iodine at production level, about
61.0% of the salt iodization units conformed to the standards of 30 ppm of
iodine. Salt samples from 45% of the units in Gujarat and 47.0% of those in
Tamil Nadu had less than 30 ppm of iodine at the time of manufacturing.
Most
of the manufacturers were transporting salt by both rail and road (53.4%).
However, 24.7% manufacturers were dispatching the salt exclusively by rail, and
22% only by road. In all , 78% manufacturers were using rail transport. The
exclusive use of rail transport was
highest in Gujarat (46.7%), whereas 53.3% manufacturers of Tamil Nadu used only
road trasport. The Salt Department has little check on the quality of salt
moved through road.
Most
of the manufacturers (61.4%) transporting iodized salt by rail were getting
adequate number of wagons. A majority of
them (66.7%), received railway wagons within a few weeks of requisition. However, as reported by 61% manufacturers,
intimation of availabilty of the wagons was received suddenly. It was reported that wagon quota remained
unutilized in the state of Tamil Nadu.
Manufacturers
generally felt that the railway staff was indifferent, not supportive, and at
times, obstructive. However, about 30%
of them reported that the railway authorities were very supprotive.
The
sensitization of iodized salt manufacturers was an important activity aimed at
increasing the production and quality of iodized salt. The Salt Department regularly organised
sensitization workshops for the manufactuers, and as many as 74% manufacturers
had attended these workshops. As part of
the IEC strategy the Salt Department, with support from UNICEF produced various
types of IEC material focusing on
production, storage, sale and consumption of iodized salt. Most of the manufacturers (85%) received IEC
material from the Salt Department, which mainly included pamphlets, booklets
and posters on IDD. The distribution of
pamphlets, booklets and posters on USI indicated that the IEC activities were effectively
undertaken in all the salt producing states.
In addition, the Salt Department also produced audio-visual material for
the benefits of salt manufacturers.
Procurement
and Distribution of Iodized Salt
The
ultimate objective of the USI is to make iodized salt available at the community
level with adequate amount of iodine for household consumption. While one of the main strategies of the USI
programme is to increase the production of iodized salt the other is to
streamline and strengthen the procurement and distribution of iodized salt from
production site to various states in the country. The wholesalers and retailers are considered
very crucial in the efforts to make iodized salt available to people. The evaluation
study covered 44 wholesalers and 831 retailers in the six selected consumption
states.
It
was revealed that the wholesalers received iodized salt directly from
manufacturers both by rail (42.9% or 43%) and road (50%). About 69% of wholesalers were distributing
iodized salt only in bulk packing, another 19% in retail and remaining 12% were
distributing in both bulk and retail packing.
Most of the wholesalers did not re-pack the iodized salt for further
distribution to retailers. Only 14.3% wholesalers
were repacking the salt for retailers from the lots they received from the salt
work. Repacking was being done only in
Gujarat and Himachal Pradesh.
The
opinion of the wholesalers were divided on whether the price of iodized salt
influences the choice of retailers/consumers.
In Gujarat, Himachal Pradesh and Manipur most of the wholesalers were
affirmative, while in other states like Bihar and Madhya Pradesh, they reported
that the price did not influence the use of iodized salt. It was found that 81.0% wholesalers were
checking label for level of iodine content.
More than half (52.3%) actually did not check the iodine content of the
slat, whereas 42.9% wholesaler were using salt testing kits for this purpose. A
majority of them were aware that less than 15 ppm of iodine is not a
satisfactory level.
Seventy
four percent of the wholesaler in the various states had adequate storage
space. Number of wholesalers with insufficient storage space was more in
Manipur. Majority of the wholesaler (78.6%) were storing iodized salt
separately but remaining 21.4% were storing iodized and non-iodized salt
together. Nearly 29% wholesaler were moving their stock within a week, 38%
within 10-20 days and 33.3% within 21-50 days after receipt.
A
majority of the wholesalers in the states were exclusively dealing in the
iodized salt except in the state of Karnataka where 78% of the wholesalers were
dealing in both iodized and non-iodized salts.
The
procurement of iodised salt by retailers was found to be high, with 81.1%
retailers in urban and 64.4% in rural areas procuring only the iodised
salt. In Karnataka state, more than 41%
retailers from the rural areas were procuring only common salt. The situation in the other states was much
better. In the states where district MIS
is in operation the situation of iodized salt procurement by retailers was
better compared to those with no district MIS.
On
an average, each retailer procured about 527 kg iodized salt annually in urban
areas and 176 kg in rural areas.
However, in Bihar, the average procurement of iodized salt per retailer
was 1,626 kg, mainly because in Bihar the retailers were covering a large area
and population. Overall, about 390 kg iodized salt was procured by each
retailer annually in the urban and rural areas.
On
an average the purchase price of iodized salt at the retailer level was Rs.3.5
per kg. as compared to Rs.1.4 per kg. for loose common salt. The difference was noted to be more than Rs.2
per kg. and the same difference persisted in almost all the states under study. The average selling price of iodized salt to
consumers was Rs.4.3 per kg. as against Rs.2.5 per kg. of common salt. The profit margin was also found to be higher
for common salt.
It
was observed that 27% retailers performed some kind of checks such as label of
iodized salt, level of iodization, smiling sun logo, date of packing, etc.
to assess the quality of salt at the time of procurement. The practice of quality check was not common
in Manipur, Himachal Pradesh and Madhya Pradesh, whereas in Karnataka, most of
the retailers checked and ensured it.
A
revealing fact emerging from the study was that knowledge of the ban
notification was relatively low (only 37%) among the retailers. In Himachal
Pradesh, where the ban has been in force
since 1986, only 47% retailers (39% in rural and 53% in urban areas) were aware
of the ban notification under the PFA Act.
It is evident that the government agencies have not ensured percolation
of information about the ban notification at the level of retailers, as of those
who were aware of the ban, 58% had learnt it through newspapers, 25% through
radio and 68% through television. Nearly
81% retailers related the usefulness of iodized in preventing the goitre,
24.2% in preventing other diseases while
39.6% told that it is good for health.
Checking
of salt samples at the retailers level
was found to be poor as according to retailers, seldomly any agency/individual appraoched
them to collect salt samples for testing.
This was also reflected from the fact that on an average only 47 salt
samples were collected in a year. In
Himachal Pradesh the lifting of samples for testing was highest, whereas in
Bihar negligible number of samples were collected. As for the effect on demand for iodised salt
was concerned, according to the all
India scenario, 64% retailers (57% in rural and 70% in urban areas) could
perceive an increase in demand for iodized salt. They felt optimistic about increase in demand
of iodized salt in the future.
Consumption
of Iodized Salt at the Household Level
Universal
accessibility of iodized salt in both urban and rural areas throughout the
country was the main objective of the USI programme. The emphasis has been on increasing the
consumption of quality iodized salt at the household level by increasing the
distribution and monitoring its availability in adequate quantity.
A
total of 4500 households (3000 in rural and 1500 in urban areas) were covered
in the mid-term evaluation study to elicit the information on the availability,
and consumption of iodized salt, preference for a type of salt, reasons for
using/not using iodized salt etc. as also for testing the level of
iodine in the salt samples.
Salt
samples were tested for the presence of iodine using the salt testing kit as
well as iodometric titration
method. Testing by STK revealed that 89%
of the households were using iodized salt, and as high as 70% of the households
were using iodized salt with 15 ppm and more iodine. The consumption was higher in urban (78.1%)
areas compared to rural areas (63.3%).
The states where the district MIS was in operation, the consumption of
iodized salt was higher e.g., the
consumption of iodized salt was very high in Himachal Pradesh (97.3%), Manipur
(92.9%), and Madhya Pradesh (85.7%). In
the state of Gujarat, only 57.7% household salt samples could meet the level of
15 ppm of iodine. The urban and rural
differentials were only marginal in Manipur and Himachal Pradesh, while in the
other states, the differentials were higher favouring urban areas.
Iodometric
titration is the standard method for the estimation of iodine content of the
iodized salt. Recently the use of salt
testing kit has been widely propagated for determining the iodine content of
the salt. The mid-term evaluation study
also tried to assess the validity of the STK using iodometric titration on
standard. Results of the estimation of
iodine content of salt by the STK as well as iodometric titration on 4306 salt
samples revealed that the sensitivity of STK against the standard titration
method was 90.8% and specificity 60.8% at the all India level. The positive predictive value was found to be
as high as 77.6%.
On
an average 2.1 kg of iodized salt was purchased per month by each household @
Rs.4.2 per kg (between Rs.3.3 - 6.6 per kg in different areas). On the other hand average purchase of common
salt was 2.2 kg per month @ Rs.2.0 per kg.
Over 61% of all households were reportedly consuming iodized salt.
Statewise in Karnataka (79.7%), Madhya Pradessh (73.8%), Himachal
Pradesh (65.7%) and Manipur (61.9%) started using iodized salt during the last
3 years when USI activities has been intensively implemented. This is a clear reflection of positive impact
of USI activities.
Nearly
62% of the households preferred iodized salt packets. It was found that people in Karnataka (80.7%)
and Bihar (59.4%) preferred loose salts, whereas those in Manipur (96.2%),
Himachal Pradesh (94.2%), Madhya Pradesh (81.7%) and Gujarat (71.8%) preferred
packed salt, mainly in smaller (500 gm/1 kg) polythene packing. It was heartening to note that 55.0% of
households included in the study (71.4% in urban areas and 46.7% in rural
areas) were using air tight containers for storing iodized salts. This practice was followed by a majority of
households in Himachal Pradesh (9.8%), Manipur (81.1%), Gujarat and Madhya
Pradesh (51.2%). The overall awareness about the adverse consequences of iodine
deficiency during pregnancy, childhood and adulthood was very low in all the
states (26.5%).
Inter-Sectoral
Coordination
USI
involves participation and coordination of several departments of the
Government of India. While the Ministry
of Health and Family Welfare is the nodal ministry for National Iodine
Deficiency Disorders Control Programme (NIDDCP), the Ministry of Industry
through the Salt Department has a crucial role in production and distribution
of iodized salt under the USI
activities. The other key organisations
closely related with the implementation of programme are the Ministries of
Railway, Education, Food & Civil Supplies, Social Welfare etc. UNICEF has played a pivotal and key role in
accelerating the programme activities by providing financial and technical
support to organise state and national level inter-sectoral coordination
meetings and to provide assistance to small salt producers.
Legal
Measures
All
the states covered under the study had imposed a complete ban on the sale of
non-iodized salt for edible purposes.
However, nearly 50% of the health workers were not aware of the ban
notification issued by the respective state governments. In Karnataka (where ban was imposed only in
1996) 78% of the health personnel contacted were not aware of it, followed by
those in Bihar (70%). Even in Himachal
Pradesh and Manipur, there was low level of awareness on the ban despite higher
use of iodized salt.
In
the states which had fully banned the sale of common salt for human
consumption, the PFA Act had been imposed by the state government. But 69.8%
health personnel in these states did not know who were responsible for the
implementation of the PFA Act. This
ignorance prevailed widely in all the states, except Manipur. Overall 13.4% health workers indicated that
it was the responsibility of the Food and Drugs Administration, while 16.8%
were of the view that it was the responsibility of the Health Department.
Information,
Education and Communication
Strengthening
of Information, Education and Communication (IEC) was a major component of the
USI programme. The IEC strategy mainly
focussed on sensitising producers, traders and wholesalers. At the consumption level the strategy also
involved educating people regarding proper storage of iodized salt by the
households during home visits, and Mahila Mandal/Gram Sabha meetings. The IEC material was produced in the form of
books, booklets, posters, pamphlets, flip books/charts etc. for
sensitisation and creating awareness among salt producers, wholesalers and
retailers as well as consumers. Various
other media were also used for IEC.
Television and radio (43.9%) played an important role in creating
awareness about the consumption of only iodized salt. This was followed by posters/pamphlets
(16.9%), group meetings/discussion and other IEC activities (11.6%).
Training
of health personnel in USI/NIDDCP was another important component of the USI
programme. However, a majority of health
personnel (65.7%) in various states reportedly did not receive any training
under the programme. The programme was
found to be strongest in Himachal Pradesh, where 62.5% of the health personnel
reported having received training in IEC and MIS, followed by those in Gujarat
(44.6%), Manipur (30%) and Madhya Pradesh (26%). The study also revealed that 61.0% of the
health personnel had never participated in the NIDDCP related meetings.
To
supplement information on consumption pattern of iodized salt a total of 375
schools were contacted in the states selected for the study and salt samples
brought by the students were tested using STK.
The students were also asked about their knowledge on availability of
iodized salt, demand of iodized salt in the community and the reasons for using
iodized salt.
Out
of a total 3660 salt samples collected from students, 81.6% were found to have
15 ppm or more iodine. At the state level almost all the salt samples collected
in the schools in Himachal Pradesh, Manipur, Bihar and Madhya Pradesh had 15 ppm or more iodine, while in Gujarat
and Karnataka only 63.4 and 59.7% samples respectively had adequate amount of
iodine. The results of salt analysis
collected from students were closely similar to that of household samples.
The
study revealed that a fairly large proportion of students were aware of the
availability of iodized salt in their areas, ban on sale of non-iodized salt,
and National Iodine Deficiency Disorders Control Programme. On an average majority of students were aware
of iodized salt (88.5%) and the availability of iodized salt in their areas
(84.3%). However, the awareness about the
ban on sale of non-iodized salt and NIDDCP was found to be low (47.5 and 18.7%
respectively). The state-wise comparison
revealed that the students of Gujarat were comparatively less aware regarding
the various aspects of USI pgoramme. In
Himachal Pradesh the awareness about the iodized salt and its availability was
as good as 100%.
Inter-state
comparison also revealed that the students from a majority of schools in three
states viz, Himachal Pradesh (98.0%), Manipur (94.0%), and Madhya
Pradesh (85.4%) reported demand for iodized salt by the community in their
respective areas, while only 41.6 and 41.2% students from Gujarat and Karnataka
respectivley reported the demands for the iodized salt.
The
infrastructure development during 1993-94 stands as a very positive factor for
sustainability. The sense of commitment
and leadership of the Salt Department adds further to this positive
environment. However, the sustainability
requires a recurring public investment to maintain the positive environment and
exploit the economies to scale to the fullest extent. It is also felt that external support is
still required to sustain some of the capital and technical activities. This is especially applicable for IEC at the
lower levels.
The
mid-term evaluation study has thus provided sufficient evidence that the USI
has achieved a major success in universalisation of consumption of iodized salt
during 1993-96. Not only the production
capacity for iodized salt has increased, but actual production has also
increased significantly. The
distribution of iodized salt from production site to the consumption level has
also been streamlined to a great extent.
On the other hand, the awareness of the importance of iodized salt as
well as consumption has also shown a high degree of improvement. Involvement of private sector has further
improved the production of iodized salt as well as its availability at the
consumption level. The experience in USI
programme clearly demonstrates that the goal of NIDDCP through USI is
achievable. However, efforts should
continue to consolidate the gains made so far and improve programme management
for greater success and improved sustainability.
CONCLUSIONS
Iodisation
of salt and its availability at the household levels are the critical
components of the Universal Salt Iodisation programme, which aims at elimination
of Iodine Deficiency Disorders in
On
the basis of indepth studies and surveys the mid-term evaluation study has
arrived at the following conclusions:-
With
the active and sustained support of the UNICEF the 1993-96 programme of the
Government of India has yielded rich dividend in terms of Universal Salt
Iodisation in India. There has been an
overall increase of 47% in production of iodized salt during 1993-95. The impact of univeral salt iodization
project has become visibly evident. The
total annual installed capacity of iodized salt production has reached to 8.7
million tonnes against the requirement of only 6.0 million tonnes. The actual
production, which was only 2.8 million tonnes in 1992 increased to 3.7 million
tonnes in 1995 and 4.1 million tonnes by 1996.
There
were sufficient indications that the production of iodized salt has achieved
the level of sustainability. The private
producers with the infrastructural support of plants and laboratory, have
helped in attaining tremendous increase in the iodized salt production. This was evident from the achievements of the
last six years despite removal of subsidy on the potassium iodate (from March,
1992). This was further reflected from
the tacit policy support and commitment on the part of the Salt
Department.
It
was also found that the consumers prefer packed iodized salt with little
variation between rural and urban consumers.
The availability of packed salt has also increased. The study also reflected upon the consumer
behaviour, revealing that, on an average, each household purchases 2.1 kg of
iodized salt per month, paying an average price of Rs.4.20 per kg. It is further revealed that nearly 62%
households prefer powdered iodized salt packed in polythene bags.
Overall,
a significant proportion of the household (91.6% in urban and 87.1% in rural
areas) in the country were consuming iodized salt. Seventy per cent people (78% in urban and 63%
in rural areas) were consuming iodized salt with the iodine content of 15 ppm
and above.
The
legal measures adopted in the form of banning the sale of non-iodized salt for
human consumption are paying rich dividends in terms of increased production as
well as consumption of iodized salt. The
intensification of USI activities and issuing of ban notification by the
governments of various states have greatly facilitated the increased
consumption of iodized salt. As a result
of continuing and sustained efforts, the ban on sale of non-iodized salt has
been imposed in all the states and union territories of India, except the state
of Kerala, 14 districts of Maharashtra, and 16 districts of Andhra
Pradesh.
Monitoring
of quantity and quality of iodized salt has emerged as an improtant activity
under the USI programme. Monitoring for the quality of salt was found to be
very effective at the production level.
The salt laboratories, particularly, the mobile laboratories of the Salt
Department have specially strengthened the monitoring system by improving the
mobility as well as accessibility of the monitoring teams in the field.
The
monitoring of the salt at the consumption level is the responsibility of the
respective state governments as per the policy of the Ministry of Health and
Family Welfare. The district level
monitoring information system (MIS) using salt testing kits has been found to
be functioning well in the states of Himachal Pradesh, Manipur and Madhya
Pradesh. The work on MIS has been
initiated in Gujarat and other states.
The use of STK has helped in creating awareness and demand for iodized
salt.
The
Salt Department has been successful in effectively coordinating with the
Railways for allotment of adequate number of wagons and institutionalisation of
distribution system. The role of
railways is very critical in the distribution and supply of iodized salt,
particularly in the distant areas of Bihar and Manipur which received iodized
salt mainly through rail.
The
Information, Education and Communication (IEC) strategy has focussed mainly on
high level of advocacy, sensitisation of producers, manufacturers, traders,
consumers and the personnel from the Salt and Health Department. The findings of the study revealed high level
of awareness among the salt producers and traders regarding the USI programme,
local ban notification on sale of non-iodized salt and to a great extent about
the need and necessity for iodization of salt.
However, at the consumption level, the households and retailer did not
have sufficient knolwedge about the USI and the need for iodization of
salt. It has been revealed that this was
mainly due to the fact that IEC strategy has mainly focussed the producers and
traders. The awareness creation at the
community level was mainly the responsibility of state health department.
The
average consumption of edible salt per person per year has been worked out to
be around 4 kg. Taking into
consideration the livestock requirement of salt
6 kg per capita is taken to compute the edible requirement of the country.
RECOMMENDATIONS
Based
on the findings of the mid-term evaluation study and discussions/interactions
of the study team with the personnel from various departments associated with
the USI programme as well as the traders, households and students, the study
has made the following recommendations:
Policy
and Planning
1. The role of the
Ministry of Health & Family Welfare and Ministry of Industry (mainly the
Salt Department) has been very critical, particularly at the stage of policy
and planning of the programme. UNICEF
has played a proactive and pivotal role in accelerating the pace of programme
activities. While it is highly desirable
that the UNICEF continues to provide suppport to the programme, it is
recommended that the Salt Department and the Department of Health and Family Welfare
in the Government of India and states as well as various other departments
associated with the implementation of the programme make coordinated efforts so
that USI becomes sustainable. Iodised
salt with appropriate amount of iodine has reached 60% of the population of the
country. Another 28.5% peoople are also
receiving iodized salt but with less than 15 ppm of iodine. More intensive and concerted efforts are
still needed to ensure appropriate levels of iodine in the salt. It is highly desirable to strengthen the
mechanism of iodization, monitoring and quality control to ensure appropriate
iodization at the production level and retaining of iodine level during
distribution and supply.
2. There is a need
for an integrated approach between the various departments/agencies associated
with the implementation of the programme.
USI is centered around the Salt Department which does not have an
effective network at the state level.
The other departments which have a wide network at the state level,
namely Medical and Public Health, Food and Civil Supplies, Social Welfare,
Education and Transport should also gear up and play an active role in the
implementation of USI interventions.
However, the roles of each of these departments should be clearly identified,
and the mechanism of coordiation well defined to avoid overlapping and
confusion. It is recommended that the
state health/food and drugs department should be identified as a nodal agency
to plan, implement and monitor USI.
Ensuring the availability and consumption of iodized salt should be
integrated and made a part of the Reproductive and Child Health (RCH) programme
of the Government of India.
3. The state IDD
cells created in the Directorates of Medical and Health Services in various
states, have not been functional effectively in almost all the states. It has been revealed that the state IDD cell
is generally headed by a junior ranking officials as the NIDDCP is perceived a
low priority programme. There is a need
to redefine the role of the IDD cell and give it due status as it also has to
undertake the responsibility of monitoring the quality of salt by using salt
testing kits and iodometric titration methods and help in the implementation of
the ban order and the provisions of the PFA Act in the respective state’s
through the existing network of the health system. The staff strength and budget allocation of
states IDD cells need to be reviewed and further strengthened appropriately.
4. In Madhya
Pradesh, the Rajiv Gandhi Technology Mission was involved in the implementation
of USI programme. The mission has
achieved tremendous success in sensitizing the masses, creating the demand and
increasing the consumption of iodized salt with adequate amount of iodine. After this mission was discontinued, the
programme efforts have declined and implementation of the programme has
suffered substantially. It is thus
recommended that this aspect should be thoroughly reviewed and corrective
measures initiated immediately for the sustainability of the programme.
Production
5. The Salt
Department has made a signficant contribution towards the universal iodization
of salt and has played a crucial role in increasing the production of iodized
salt and its distribution throughout the country. It is highly recommended that the Salt
Department should continue as the Nodal Agency for the production, quality
control and distribution of iodized salt and the implementation of USI as well
as NIDDCP programme. However, it should
be strengthened with additional resources, especially with regard to manpower,
financial support and statutory powers.
Presently, only 67 posts are funded under the NIDDCP by the Ministry of Health and Family
Welfare. These posts are renewed on
annual basis. It is, therefore,
recommended that for the sustenance of the programme these positions should be
encadred permanently.
6. Quality control
and monitoring of iodized salt at production and distribution levels, is one of
the primary responsibilities of the Salt Department. Deploying more mobile laboratories and
augmenting manpower should also be given a proper consideration to further
facilitate the sustainability of the quality control mechanism in force. It is recommended that monitoring and quality
control system should also be strengthened.
Various recommendations pertaining to this important area are grouped as
under:-
(i) The area of operations of the salt inspector
is very large and remote and their mobility is limited, restricting the
monitoring and quality control activities.
It is recommended to enhance the mobility of salt inspectors by
providing them suitable means of transport.
(ii) Static and mobile laboratories should be
strengthened with equipment and personnel.
There should be more mobile laboratories for the distant and far flung
areas.
(iii) The monitoring information system needs
strengthening to speed up the feedback to manufacturers. It is recommended that computers should be
installed at various levels for speedy data collection, storage and information
dissemination, for providing timely and regular feedback.
(iv) Use of STKs for monitoring the quality of
iodized salt at the distribution and consumption levels should be
promoted. The evaluation study has
revealed that STK is highly sensitive with higher positive predcitive value. The monitoring activities can be extended to
schools including the teachers and students.
Transportation
7. Road transport
of salt is a reality and measures should
be initiated to monitor salt movement by road to states from the production
sites, as done in the case of rail transport.
The entry of salt may be monitored at the check-posts/octroi posts at
the state borders. The experience of
Madhya Pradesh in monitoring the road movement of salt should be used by the
other states. The USI project was found
to be successful and movement of common salt for human consumption by road
transport has been restricted to less than 11 percent and some of the states
have reduced it to upto less than 1 per cent e.g. Himachal Pradesh. It is recommended that quality control should
be ensured by the respective state governments through enforcement departments
like Food and Civil Supplies, Medical and Health, Food and Drugs, Excise and
Education, etc.
8. While movement
of salt through road transport needs to be given proper attention, the
distribution and logistics system associated with the movement of salt by rail
also needs serious consideration. The
manufacturers and the distributors generally experienced inadequacy of railway
wagons as also delays and unpredictability of allotment. The Salt Department and the Ministry of
Railways should develop a mechanism for better coordination for supply of
wagons.
9. Wholesalers
sometimes found to have inadequate space for storing iodized salt, especially
when it is unloaded. The state governments
should ensure that the wholesalers are having adequate and covered godown
facilities for proper storage of iodized salt.
Consumption
10. Realising the
urgent need for effective implementation of the ban notification in the various
states, the Government of India has redefined edible salt as one having more
than 15 ppm of iodine. The public
awareness regarding the ban on sale of non iodized salt for edible purposes was
not very high, particularly at distribution and consumption levels. Similarly, knowledge about the PFA Act was
also very low. There was lack of clarity
among the health personnel about the responsibility of PFA Act
implementation. Immediate steps should
be initiated, firstly to implement the ban notification and the PFA Act effectively
and secondly to improve awareness among manufacturers and distributors of
iodized salt and the health personnel.
11. Successful
implementation of USI programme in those states where sale of non iodized salt
has been banned and the IEC strategy and activities undertaken by the Salt
Department and the State Health Departments demonstrate that these efforts need
to be intensified throughout India for achieving the goals of USI and NIDDCP.
12. Several brands
of iodized salt are available in the market.
Some identification mark, like the Sun logo, should be made mandatory
for identification of iodized salt. The
distributors should as well be encouraged to use the right type of packing
material. The culture of using packed
powdered salt is rapidly increasing among consumers, and the retailers must be
encouraged to sell the iodized salt in polypacks. Standard messages regarding IDD should be
disseminated on packings at the production level.
13. Presently there
is a significant difference between the selling prices of iodized and non
iodized salt and the margin of profit seems to be low for iodized salt. Some control mechanism should be worked out
to curb the escalation of the prices of iodized salt with the involvement of
Government of India. Joint meetings of
salt traders, state governments and Salt Department officials should be
organised in order to resolve the pricing issue.
14. There is a need
to intensify IEC activities at all levels in the country with particular
emphasis at the community level. The Salt Department has developed large number
of IEC material for different group of people.
Some state governments have also taken initiative and developed IEC
material at the state level in local languages.
There is an urgent need to make more concerted efforts to develop IEC
material for retailers and distriutors.
There is a need to organise IEC workshops and orientation programmes at
various levels involving participants from the local community. Some of the local level festivals can be used
as effective media for carrying out IEC activities as has been tried out
successfully in Madhya Pradesh. This
type of IEC campaign organised in the form of “by the people for the people”
are of immense help in spreading out useful information. Retailers should also
be oriented for exclusive trading of iodized salt.
15. The network of
Reproductive and Child Health (RCH) services and Integrated Child Development
Services (ICDS) can be utilised for promoting the consumption of iodized salt,
especially by organising IEC activities.
The clientele of these two services need more attention as far as
conusmption of iodized salt is concerned.
The states which have recently issued ban notifications should be
targetted for sensitisation for increasing the consumption of iodized salt.
16. Efforts must be
made to make iodized salt available in rural areas, especially those located in
remote and inaccessible parts of the country.
A vast network of the public distribution system (PDS) exists throughout
the country. It has been used very
effectively in some of the states for distribution of iodized salt. The PDS can be utilised to ensure supply of
iodized salt to the people in other states too.
It will not only make iodized salt available in remote areas, but will
also help in monitoring the quality of iodized salt through the network of the
enforcement departments.
Salient Findings
and recommendations of the Evaluation Studies for sustaining the programme and
increasing the production of
iodized salt
It
can be seen on the basis of the findings of both the external evaluation as
well as the detailed evaluation study carried out by the Institute of Health
Management Research, Jaipur initiated by the Salt Department with the
assistance of UNICEF that the USI programme has achieved remarkable success in
its endeavour of making good quality iodized salt available and consumed by
everyone in the community. The Salt
Department with effective support of UNICEF has been the key player in not only
steadily increasing the production of good quality iodized salt, but in its
distribution in very nook and corner of the country.
But
there is no time for complacency. Still
a lot needs to be done with increased zeal and vigour and more concerted
efforts are required to not only increase the production of iodized salt but to
sustain the programme. It is of
paramount importance that the UNICEF continue to play a catalytic role in
sustaining the programme in the larger interest of the community at large.
More
and more sustained efforts should be made to imrpove distribution and logistics
through smooth and efficient transportation of salt by rail as well as road so
that good quality salt reaches to consumers in time, time gap between the
production and actual consumption of salt is reduced and producers also need
not incur additional expenses on storing the salt for longer duration.
The
Salt Department need to be strengthened with additional resources and statutory
powers to carry out its role as Nodal Agency for the production, quality
control and distribution of iodized salt and implementation of the USI as well
as NIDDCP programme. There is a need for
effective and enhanced collaboration between the Salt Department at one hand
and various agencies/departments especially those having effective and
elaborate network at the state level viz., Medical and Public Health,
Food and Civil Supplies, Social Welfare, Education, etc. on the other
hand for the success and sustainability of the USI programme.
Effective
quality control and monitoring of iodized salt at production and various level
of distribution is of paramount importance for the success of the USI
progamme. This activity of the Salt
Department should be strengthened by establishing more laboratories and
augmenting manpower. A proper
computerized management information system should be developed and proper
monitoring linkages and respective responsibilities should be established
between Salt Department, Health Department, producers, distributors, etc.,
for speedy data collection, storage and information dissemination for providing
timely and regular feedback. The state
IDD cells should also be strengthened so that they are able to fulfill their
responsibilties of helping in the implementation of the ban order and provisions
of the PFA Act in the respective states.
The
IEC activities need to be intensified at all levels in the country especially
at the community level and for retailers and distributors, for successfull
implementation of the USI programmes.
Local level festivals can be used for effective percolation of IEC
messages upto the grassroot level.
In
a nutshell it can be summarized that if concerted efforts are made on the lines
suggested as above, it will not only help in consolidating and sustaining the
achievements made so far in the USI programme but in reaching to those who are
still not being served properly. The
experience gathered so far in the course of USI programme implementation
clearly demonstrate that the goals of USI and NIDDCP are achievable. Efforts should continue in the direction of
consolidating the gains and improve programme management for greater successes
in the future. Serious and continued
efforts are required to make the programme sustainable as the IDD elimination
depends on continuous and regular consumption of iodized salt.
Annexure
MEMBERS
OF STEERING COMMITTEE
Joint Secretary
Ministry of Industry, Deptt. Of IPP,
New Delhi.
Deputy Secretary
Ministry of Industry
Deptt. Of IPP, New Delhi
Salt Commissioner
Jaipur
Deputy Salt Commissioner (NIDDCP)
Jaipur
Incharge
NIDDCP
Ministry of Health & Family Welfare
New Delhi, or his representative.
THE
DEPUTY ADVISER (HEALTH)
Planning Commission
Yojana Bhavan, New Delhi
Consultant
Micronutrient Initiative
Chief Child Development & Nutrition
UNICEF, New Delhi
Project Officer, CD&N, UNICEF, New Delhi
All India Institute of Medical Sciences
Ansari Nagar,
ENMASS.
Central Salt & Marine Chemical Research
Institute
Gijubhai Badheka Marg, Bhavnagar-364 002
Director
Indian Council of Medical Research,