1. National Coordination & Implementation : Success factors for national coordination & implementation of USI programs Ruth Situma Nutrition Specialist - New York Achieving Universal Salt Iodisation for Optimal Iodine Nutrition UNICEF, IGN, GAIN, MI EAP Regional Meeting 12-14 October, Bangkok #commit2USI

2. 12-14 October 2015 Bangkok USI NATIONAL COORDINATION & IMPLEMENTATION  What are the key programme features required for successful national coordination and implementation of USI ?  What should we be doing/ aware of to ensure the gains made are sustained and the efforts to improve and expand USI programme continue?  How do we respond to the changing USI programme environment? 2 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION Big Questions

3. 12-14 October 2015 Bangkok OUTLINE  Coordination -Political commitment -National coordination -Intergration  Implementation -Institutional capacity for implementation and enforcement of USI legislation -Communication and advocacy -Targeted strategies to different supply segments 3 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

4. 12-14 October 2015 Bangkok Success factors for national coordination 4 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

5. 12-14 October 2015 Bangkok  Multi-sectoral high level political awareness  Iodine nutrition maintained on national agenda: oversight and renew commitment  USI is mandated by national legislation - All types of edible salt are included in legislation a) table salt, b) salt for at least some processed foods, c) salt for livestock feed.  Legislation enacted and implemented - enforcement mechanisms  National coalition and coordination body; salt and food processing industry key players 5 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION POLITICAL COMMITMENT

6. 12-14 October 2015 Bangkok USI NATIONAL COORDINATION  A national coordination alliance exists including private, public, civic and scientific sectors and led by the government  Public/private trust  without salt producers no iodized salt! 6 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION PERFORMANCE OF USI NATIONAL COORDINATION, 2014 NUTRIDASH

7. 12-14 October 2015 Bangkok INTERGRATION OF USI INTO NATIONAL NUTRITION PLANS AND STRATEGIES  Elimination of IDD through USI integrated into national food and nutrition policies, strategies, plans, databases and budgets e.g SUN, food fortification  Information on elimination of IDD and USI progress is included in annual policy reviews. Results are discussed for corrective actions  Updated short & long term national work plans exist  Incorporate use of iodized salt in processed foods into the national agenda, as relevant 7 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

8. 12-14 October 2015 Bangkok Success factors for national implementation 8 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

9. 12-14 October 2015 Bangkok INSTITUTIONAL CAPACITY FOR IMPLEMENTATION AND ENFORCEMENT OF USI LEGISLATION  Nationally-supported quality assurance and control systems exist and are functioning as planned (to ensure sustained production/ importation of adequately iodized salt).  Iodine premix: sustainable and predictable procurement and supply  Nationally-supported systems are in place to monitor population iodine status and use of iodized salt coverage (as defined by legislation) in order to make adjustments to salt supply and demand areas 9 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

10. 12-14 October 2015 Bangkok 10 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION COMMUNICATION AND ADVOCACY IN USI 1990s, 2000s  what was done then?  Secured political, legislative and financial commitments.  Created demand among consumers through education and awareness raising. The remaining gaps represent the “Last Mile”  More difficult & resource intensive  Last mile challenges require new strategies.  Doing the same thing will not bring different results Now to 2020  what should we do? Iodized salt coverage 1990: 20% 2000: 70% 2008: 70% 2014: 75% 2015 -75% Progress so far … Low Hanging Fruit Picked

11. 12-14 October 2015 Bangkok Processed Foods Public, private, academic other groups involved in optimal iodine nutrition Imported Salt ENABLING ENVIROMENT KEY AUDIENCES COMMUNICATION AND ADVOCACY IN USI Analysis & intervening at strategic points in the value chain

12. 12-14 October 2015 Bangkok COMMUNICATION AND ADVOCACY IN USI 12 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION  The role of advocacy and communications for USI is to motivate specific actions—not just provide information  The key to A&C success is the identification of specific actions needed, and specific actors who make them, in order to achieve goals  Communication is important but cannot replace regulatory monitoring in the context of mandatory legislation

13. 12-14 October 2015 Bangkok TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Business and Reg Model  Formal to Informal Product  Loose to coarse Consumer & Market  Urban to Rural Imports Large Medium Small Salt supply segments >15 PPM 1- 15 PPM0 PPM Salt Supply, Market & Regulatory Environment

14. 12-14 October 2015 Bangkok TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Business and Reg Model  Formal to Informal Product  Loose to coarse Consumer & Market  Urban to Rural Imports Large Medium Small Salt supply segments Adequate InadequateNot Iodized Salt Supply, Market & Regulatory Environment

15. 12-14 October 2015 Bangkok TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS Business and Reg Model  Formal to Informal Product  Loose to coarse Consumer & Market  Urban to Rural Imports Large Medium Small Salt supply segments Adequate Inadequate Not Iodized Salt Supply, Market & Regulatory Environment ImproveExpand Sustain

16. 12-14 October 2015 Bangkok EXAMPLE FROM CAMBODIA Ref: 2008 CSIN, 2011 CSIN, 2014 Market Monitoring (WYD). Preliminary DHS/Micronutrient Survey 2014 results: urinary iodine status is inadequate

17. 12-14 October 2015 Bangkok SUSTAIN, IMPROVE AND EXPAND 17 EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION Improve Expand Sustain

18. 12-14 October 2015 Bangkok Sustain current proportion of adequately iodised salt;  Adequate capacity & motivation –Monitor and adapt to potential changes –Industry recognition TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS

19. 12-14 October 2015 Bangkok Improve proportion of adequately iodised salt;  Some but inadequate capacity & motivation –Expand capacity building channels to industry  Increase incentives and motivation for producers. –Strengthen regulation and inspection. TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS

20. 12-14 October 2015 Bangkok Expand iodisation to salt not currently iodised  Little/no capacity or motivation -Identify gaps: capacity, knowledge and/or motivation  Structural barriers: small producers, food producers –Few models & experience TARGETED STRATEGIES TO DIFFERENT SUPPLY SEGMENTS

21. 12-14 October 2015 Bangkok CONCLUSION  National partnership and long-term industry and government commitment underpin successful programs  Communication is important but cannot replace regulatory monitoring in the context of mandatory legislation  Targeted strategies to different supply segments is important Equity Analysis 21

22. Thank you! #commit2USI