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Evaluation of progress toward Universal Salt lodisation in South Asia

Appendix A

CountryBangladesh

Bhutan

India

Maldives

Nepal

Pakistan

Sri Lanka

UNICEF Financial inputs (US$) by category in support of USI, 1993-1997Year

CategoryIECFactory Quality AssuranceField Monitoring andEvaluationSalt lodisation SuppliesTraining/Networking

Year Total

1993161,000

097,100

330,0000

588,100

199483,400

423,600178,600

466,0000

1.151.600

1995252.70022,800

0

55,1000

330.600

199662.80022.20016.400

215.00042.700

359.100

199772.10029,4008,500

645.5009.300

764.800

CategoryTotal

632,000498,000300,600

1,711,60052.000

3,194,200

IECFactory Quality AssuranceHeld Monitoring andEvaluationSalt lodisation SuppliesTraining/Networking

Year Total

IECFactory Quality AssuranceField Monitoring andEvaluationSalt lodisation SuppliesTraining/Networking

Year Total


Year Total

IECFactory Quality AssuranceField Monitoring andEvaluationSalt lodisation SuppliesIodised Oil SuppliesTraining for IodineSupplementation

Year Total


Year Total


Year Total

013,740260

7,8290

21,829

00

40

19059

2.16500

013,685.1415,850.14

00

29.400

00

29.400

2.6917.610580

011.40522.286

4.85621,35030,280

7,84825.090.1489,424.14

352,4500

12,970

056,950

422,370

603,7500

460,000

099,600

1,163,350

463.1600

98,000

410,000115.570

1.086,730

1 10.6300

119,820

777,70017,000

1.025.150

-

-

1,529,990

690,790

1,187,700289.120

3,697,600

-

-

-

-

00

10,365

00

10,365

000

000

000

000

00

10,365

00

10365

000

077,293113,761

191,054

12,78100

0261,038104,927

378,746

01,910

0

060,9125,111

67,933

30,75049,435

0

235,66572,602

0

388,452

8,3467,08157,773

11,211235,96847,659

368,038

51,87758,42657,773

246,876707,813271,458

1394423

-

_

225,52638,71434,085

107,850311,303717,478

1,023,55259,85811,520

467,750527,200

2.089,880

485,00061,237372,121

0179,010

1,097,368

24435840,171284,958

076,580646,067

1,978,436199,980702,684

575,6001,094,0934,550,793

-

70,1380

6,048

16,8676.84099.893

134,0430

4,701

244.1568.419

391,319

35,2950

677

34,05227.20797.231

00

16,405

17,3253.77437.504

239,4760

27,831

312,40046,240

625,947

61

Appendix BNATIONAL SALT NEEDS, IODISATION CAPACITY, AND NATIONAL KIO3 NEEDS

Avg. Daily Salt Annual Salt Annual Salt 1997 lodisat Ion 1997 Supply of Annual Need Annual NeedPopulation* Intake (gms) Need (in gms) Need (tonnes) Capacity (tonnes) Iodised Salt of KIO3" (gms) of KIO3" (kgs)

AfghanistanBangladeshBhutan""IndiaIndia"*MaldivesNepalPakistanSri Lanka

20,883,000120,073,000

600,000944,580,000944,580,000

263,00022,021,000

139,973,00018,100,000

101010101610101010

76222950000438266450000

219000000034477170000005516347200000

95995000080376650000

51090145000066065000000

76223438266

219034477175516347

96080377

51090166065

02,400,000

14,40010,800,00010,800,000

043,000

unknownunknown

n/an/a

4,9004,000,0004,000,000

594114,000

n/an/a

128436738479

369058094039295045

1618135435860869111320

128738

458099295

2135861111

"Population estimates for year 1996 taken from 1998 State of the World's Children."Annual amount of KIO3 required to iodise salt at 65 ppm, assuming per capitadaily requirement of 200 meg of iodine."India's MOH has estimated that the average intake is 16/gms/day.

62

Evaluation of progress towards Universal Salt fodisation in South Asia

Appendix C:

Secondary Evaluation Report Submitted by Frits van der Haar

Dr. Frits van der Haar is an Associate Professor in the Department of InternationalHealth, Emory University School of Public Health. He is also Technical Director forthe Program Against Micronutrient Malnutrition (PAMM) housed at EmoryUniversity. Dr. van der Haar is a founding member of ICCBDD and has workedextensively with iodine as an important public health intervention, including co-authoring "A Practical Guide To The Correction Of Iodine Deficiency" on publishedby ICCIDD, UNICEF, and WHO (1990)._________________________

I. Overview

This report gives the details of a commendable evaluation of the progress madetowards universal salt iddization in the SAARC region. Although there are enormousvariations in size, countries in this study represent about 20% of the world's totalpopulation, including the world's second populous nation. Therefore, the results ofthis evaluation are important as a yardstick in the global elimination of IDD throughsalt iodization. Moreover, the contribution by the evaluation to our ability of assessingthe critical factors for success and, particularly, the durability of USI, are at leastequally important.

Tremendous progress has been made towards USI in the SAARC region since thebeginning of the decade, when iodized salt constituted only a small part of householdsalt consumption, maybe 10% at most. The present evaluation reports that by 1996-1997, in Bangladesh, Bhutan, India and Nepal about 75%, and in Pakistan and Nepalabout 25% households countrywide used salt with at least some iodine added. Thisprogress and its short time frame are without equal given the ages of duration of ourignorance, and the decades of global scientific exploration about the impact of iodinedeficiency on human health and development! A close look at the ways and means bywhich this extraordinary achievement took place is therefore appropriate. Also it issaid that the study would help in identifying remaining challenges and obstacles incountries, and complete and sustain national "Freedom of IDD".

As in virtually all other countries in the world with a public nutrition problem ofiodine deficiency, UNICEF is the main external agency in South Asia assistingcountries to eliminate IDD through salt iodization. Thus, the report includes anappraisal of UNICEF's own involvement in program planning and implementation.The primary audiences are the UNICEF country and regional program managers, theUNICEF Executive Board, and the donors who have channeled resources towardsUSI support through UNICEF. The evaluation is being coordinated by a SteeringCommittee of UNICEF advisors in planning, health & nutrition and monitoring &evaluation. Data on program status were collected through UNICEF nutrition programofficers from countries in the region, and the draft report was developed by a primarynutrition expert evaluator, familiar with UNICEF support for national IDDelimination programs through salt iodization.

ROSA Report No. ***

In designing the method for evaluation, the Committee made a special effort to assurethat the merits of each national program are judged in a transparent way. A list ofattributes of USI programs, considered essential by the Committee, was developed,and scoring system devised for obtaining a numerical expression of the judgement foreach attribute. The overall merit of USI programs is obtained as a composite scorebased on the combination of scores for each attribute.

Because of the transparency, the evaluation system risks perception that it was mainlydevised to capture the needs of UNICEF, rather than the range of USI programstakeholders involved or affected. This does not necessarily present problems whenUNICEF's policy for support and assistance are aligned and equitable to the interestsof the other stakeholders in national USI programs. A USI program is a publicnutrition endeavor in which the public and private sector interests do not alwayscoincide. The report states that UNICEF at times had to decide using the pragmaticapproach to key actors in programs, rather than attempting to accomplish progressthrough national coordination. This is acknowledged in the report as the virtue of "acommitted agency that is on the spot and able to question, advocate, follow-up andprobe". I would hasten to add encouragement to UNICEF to continue working in thisfashion, because the future type of assistance needed to fully accomplish national IDDelimination will require more attention to the needs of salt industry in achievingcoverage and penetration with good quality iodized salt, and ultimately sustaining thesuccess of USI, once achieved.

Given the differences in interests between the public and private sectors in matters ofUSI, the major challenges in progressing have been (1) bridging of thecommunications gap between public officials and industry leaders, (2) coordinatingthe responsibilities of raising public awareness, acceptance and demand for iodizedsalt, and (3) creating a just system for assuring the quality of iodized salt. UNICEFhas very ably played the broker's role in all these three areas, and will need tocontinue to do so for bringing sustainable USI to successful accomplishment.

The monetary value of UNICEF's assistance has been small and strategic, leveraginglarger commitments from other national stakeholders. The typical UNICEFcontribution for USI in the region (data for India pending) averaged at $0.04-0.05 forthe five-year period 1993-1997, or Icent US per capita per year! In the final analysis,therefore, the main investment in USI has been made by salt producers. In allcountries of the region, responsibility for continuous provision of good quality iodizedsalt with the regulated amounts of nutrients rests with the private salt producers,traders and retailers. Governments' role has been the creation of the regulatoryenvironment in which these private actors operate, by devising and enforcing thestandards for their product. In the long run, this can continue only if consumersdemand the "better" product and assume the price increase justified by theseinvestments.

The evaluative process, in the words of the designers, has an element of subjectivity.The weights assigned to each attribute and criteria have been determined in iterationbetween the members of the Committee. The present effort of obtaining independent(external) judgements and the use of a comparative approach at interpretation willlessen this perceived weakness. Nevertheless, the proposed method and system should64

Evaluation oforoeress towards Universal Salt lodisation in South Asia

be open to improvement. Other groups, including the International Council forControl of Iodine Deficiency Disorders (ICCEDD), the Micronutrients Initiative (MI),the Program Against Micronutrient Malnutrition (PAMM) and others have beenmaking attempts at developing a tool and methodology for countries to make the sameprogress assessment. A discussion among the groups would be helpful to arrive at aunified approach.

The attributes included in the evaluation model represent a selection made by theleading Committee. One could argue that a reasonable alternative to the linear modelof nine attributes which together shape a national program by a certain weightingformula, is that the minimum essential components of USI programs consist of justthree main attributes: (1) the salt supply "column", (2) the communications effort, and(3) the monitoring system. All these components are equally important, and only incombination will they achieve a comprehensive, sustainable program. In comparison,the major aspects of USI programs insufficiently captured or represented in thepresent model are those associated with the salt column. The report has a chapter onthe "role" of the private sector rather than its "input", and the supply of iodized salt isdescribed as a "program", rather than an "industry" input. Aspects of the conduct bythe private salt sector in the national endeavor are scattered in various sections of thereport, rather than being treated as a connected set of activities. If we know that thesalt industry has taken the main risk in pursuing USI in the market in these countries,and when the salt column, as many of us believe, holds the key for the fullaccomplishment and sustainability of national IDD elimination, an assessment of theirsupport, contribution and behavior deserves comprehensive and critical attention.

In analogy to the present evaluation method, the criteria for judging the merit ofefforts in the salt supply column are: (1) Iodized salt production; (2) Productpackaging; (3) Trade in iodized salt; (4) Pricing of salt in markets; and (5) Householdaccess. Most of these criteria also feature in the present model, but without cohesion.Criteria for communications effort include: (1) Advocacy; (2) Strategic mobilization;(3) Marketing of iodized salt; (4) IE&C, and (5) Training. For the monitoring system,the following criteria may be used: (1) Salt industry (manufacturing) practices; (2)Legislation; (3) Standards and inspections; (4) Program quality assurance, and (5)Impact assessment.

I am not suggesting that this alternative is necessarily an intrinsically superior, orbetter system. In terms of assessing the merits of past efforts and contributions, andparticularly for projecting the needs of development and assistance towardsfulfillment of USI, the alternative approach may help in a more accurate definition ofmain actions required and the main actors to be involved in their accomplishment.Ultimately, an improved ability in performing these evaluations, and more unity inapproach among the main involved organizations can be brought about by debate andjoint further development efforts. Time is short.

ROSA Report No.

II. Notes on Chapters

Ch I: Overall Assessment and Judgement of a Program's Merit

The evaluation scoring system adopted nine major attributes for a good USIprogram:

Attribute1. Legislation2. Enforcement3. Iodized Salt Supply4. Monitoring at Production5. Availability at Households6. DEC Activities7. IDD Monitoring8. National Coordination9. Sustainability

In the report, the merits of programs in the countries of the region aredescribed following the outline of "Product" (Program Input), "Process"(Program Process and Output), and "Progress" (Program Outcome).

In the scoring system, each attributes is subdivided into several criteria to bescored on a sliding scale of zero to five (scoring by whole numbers notnecessary). Both the criteria and the attributes have been given unequalweightings. The report acknowledges the large degree of arbitrariness andsubjectivity of this system, but it is remarks that, overall, the resultingjudgement is "not devoid of significance".

Ch H: Program Inputs by UNICEF

Expenditures by UNICEF on IDD elimination are tracked for the 1993-1997period. UNICEF general resources played a major role in total UNICEFassistance in Bangladesh and Pakistan. Government inputs (mostlyunspecified) were high in India, Pakistan and Bhutan. The fact that most of theinvestment for USI is carried by the salt industry itself is largely ignored. Bynecessity, industry passes the incremental cost on to the consumer(particularly, see Ch 7.26 onwards on packaging, Ch 9 on retail prices, and ChXII on sustainability).

GOI supports the Nepal program for -50%. In India, GOI is the majorcontributor. Assistance expenditures by UNICEF vary greatly from country tocountry (from Bhutan at $89K to India at $....K). Expressed per capita,however, the typical UNICEF contribution averaged at $0.04-0.05 for the 5year period, or -Icent US (based on data from Bangladesh, Nepal, Pakistanand Sri Lanka).

66

Evaluation ofpronress towards Universal Salt lodisation in South Asia

A breakdown of UNICEF contributions to various categories also revealssignificant variations among countries. In Nepal, half of the total assistance forthe 1993-1997 period went for iodized oil supplies (oil injections are stillongoing in selected areas of the country). Iodized salt supply constituted themost significant category of UNICEF assistance in Bangladesh (53%), Nepal(36% of the 50% remaining expenditures) and Sri Lanka (50%); EEC inPakistan (44%) and India (..%) and field monitoring for the Maldives (100%)and Bhutan (34%). India's data are pending.

Reported proportions of UNICEF assistance for training constituted only asmall proportion of the total UNICEF contribution, varying from 2% inBangladesh to -25% in Bhutan and Pakistan (In Nepal, the 40% reported wasassociated with iodized oil injections team training; see Ch 7.18 and AppendixA). Only in Bhutan was factory QA a significant proportion of UNICEFassistance (-25%).

Ch 2.6 mentions UNICEF assistance to potassium iodate supplies (See Ch 2).In Bangladesh, Bhutan and India, potassium iodate has been supplied for free,at least to some producers for some period of time. In Nepal, GOI subsidizedthe cost of manufacturing iodate by India from iodine supplied by STC.UNICEF subsidized the supplies of potassium iodate to salt manufacturers inPakistan and Sri Lanka for a limited period.

Some UNICEF contribution mentioned in other Chapters of the report are nottallied in the Tables of this Chapter (e.g., advocacy, awareness creation and atraining workshop for food handlers in Maldives - see Ch 6.8 and 8.18).

Ch ffl: Program Input - Supply of Iodized Salt

The percentages of domestic salt supply reported as iodized in Table 3.1clearly are overestimated. In Bangladesh where practically all salt is locallyproduced, the actual performance shows 87% of all supplies iodized, similar tothe percentage in Bhutan where all the salt is imported. India says that -75%of its salt supply is iodized, while Maldives doesn't have a current estimate(estimated at 66% in 1995). In Nepal, the government monopoly agency STCiodized all its salt, but import of other salt from India and Tibet continues. InPakistan, the percentage of salt supplies iodized is increasing slowly and hasreached at present -one-quarter to one-third. Of the salt supply in Sri Lanka,about one-third is iodized.

Countries having sufficient capacity to produce all domestic supplies forhuman consumption in iodized form include Bangladesh, Bhutan, Maldivesand Nepal. A major effort in Bangladesh has been the development ofindigenous technology for iodized salt processing by BSCIC, but no mentionis made of this effort in the report. India has about 9,000 salt producers, butthe GOI system through the Salt Department doesn't capture a large number ofsmall producers who are exempted from licensing. The known (registered)capacity in India is estimated at about three-quarters of the total (Ch 3.10). In

ROSA Report No. ***

Pakistan, the capacity for iodized salt processing is about 70% of the totalproduction, but not all is utilized. Sri Lanka has two state-run salt corporationsand two associations of small producers. Both have been assisted with saltiodization capacity.

Ch IV: Program Input and Process - Role of the Private Sector

The "role" of the private sector is paramount (supply and sustainability), yetfew questions in the evaluation address their part in making national programseffective. For instance, in Bhutan, the commitment by the Bhutan SaltEnterprises (BSE) management maintained the program when common saltsupplies from India stagnated and monitoring had completely broken down(Ch 4.2). Only in Nepal salt industry has some government ownership; in allother countries the industry is totally private.

Important private entities include the mass media (India, Pakistan) and NGOs(important in all countries). Most UNICEF assistance in Pakistan is channeledthrough an NGO. Yet the evaluation doesn't attempt to specifically capturetheir contribution to the overall efforts.

A number of key aspects of the private sector's role in the national program(Overall coordination, industry QA, production monitoring, packaging andmarketing efforts) are included in respective other Chapters.

Ch V: Program Process - National Plan and Coordination

A National Committee is established in Bangladesh, Bhutan, Nepal andPakistan. Except for Pakistan, committees are chaired by Health. Committeesin Bangladesh, Bhutan and Nepal are multi-sectoral in composition. In India,neither the National Task Force nor the Technical IDD Review Committee,both of which are chaired by Health, ever met. The Ministry of PlanImplementation in Sri Lanka hasn't yet revitalized a previous national sub-committee. There is no national structure in Maldives concerned with IDD.

In Bangladesh, work is not guided by a national plan, nor do the reports of theregular meetings indicate a review of progress towards agreed targets. Bhutanhas a national plan and reports are available from the national Committee'smeetings. Coordination in India is devolved to the States, but the performanceat State levels varies greatly. Maldives has a plan for eliminating IDD, but nostructure is in place to coordinate efforts. In Nepal, true national coordinationis difficult given the strong influence of GOI on STC. Pakistan is still planningsince a 1996 appraisal. The National Plan of Action in Sri Lanka includes IDDelimination, but awaits approval from the Cabinet.

68

Evaluation of progress towards Universal Salt lodisation in South Asia

Ch VI: Program Process - Legislation and Enforcement

Laws or regulations are enacted in Bangladesh (1995), Bhutan (1981 and1986), 29 of the 32 States of India (by end 1997), Nepal (1996), 2 of 4Provinces, and some districts of the Northern Areas of Pakistan (1996), and inSri Lanka (1995). Penalties for infringements have not been defined in Nepal'slaw. Inspection capacity is weak in all countries, but especially in Bangladesh,Maldives, Pakistan and Sri Lanka. Only in Bhutan and India have legal actionsat enforcement been pursued. In all countries, guidelines for routine qualitycontrol and enforcement by local inspection officers are non-existent, or weakat best.

Maldives does not specify any salt iodine level; Bhutan and India specifylevels at production, retail and household. Iodine levels at production have notbeen specified in Sri Lanka, so no effective control of production is possible.Except from Pakistan, the existent laws haven't specified an allowed uppersalt iodine level in any country.

Guidelines for packaging in HDPE are included in laws of Bangladesh(labeling), India, Pakistan and Sri Lanka; Bhutan in practice packages the37.5kg batches in HDPE bags. Nepal and Maldives haven't specifiedregulations for packaging.

Ch VII: Program Process - Quality of Iodized Salt

Monitoring plans at production exist in Bangladesh (using paper strips),Bhutan (for imports and BSE processing - laboratory), India (for "authorized"plants only - laboratories in 92%), Nepal (for imports and STC processing -laboratory), and Pakistan (using rapid kits). High variations in salt iodinelevels have been documented as part of the QC process in Bhutan, India andNepal, and by independent surveys in Bangladesh (1996) and Pakistan (1997).

Internal monitoring (QA) at production/imports is being practiced by industryin Bangladesh, Bhutan, India, Nepal and Pakistan. Verification by titration isavailable in Bangladesh (through BSCIC, but rather cumbersome), Bhutan(BSE), India (large manufacturers only), Nepal (internal production by STC)and Pakistan (large manufacturers only). Record keeping is weak overall, butparticularly in Bangladesh, India (non-licensed small producers) and Pakistan.External QC is provided in Bhutan (PHL), India (Salt Department, problemsof mobility and licensed plants only), and Pakistan (ISSF). Guidelines forcorrective action and/or follow-up generally are lacking, or insufficient.

Packaging in small sized units and HDPE adds substantially to the costs ofproduction. The report gives no information about present packaging practicein Bangladesh (see photograph on page 29). In Bhutan, all 37.5kg crystal saltand 1kg fine salt is packaged in plastic. In India, all 1kg iodized salt ispackaged in plastic (25% of all iodized salt), leading to a mark-up in consumerprice of -20%. In Nepal all crystal and most crushed iodized salt is packaged

ROSA Report No. ***

in large 50kg and 75kg, and all the rest in 1kg HDPE bags. In Pakistan, -50%of iodized salt is sold in 1kg plastic bags with price mark-ups to consumers upto 100%, although the cost increase to producers is estimated at -10%. Noinformation of present packaging practices is provided from Maldives and SriLanka.

Ch VIII: Program Process - Demand for Iodized Salt

From the perspective of this evaluation, demand for iodized salt has beenstimulated through demonstrations by rapid test kits and by advocacy or EECefforts.

The role of the rapid test kits varies from country to country. Kits have beenreported as useful for advocacy at various levels (notably, policy makers,administrators, religious leaders and school children) in Bhutan, India, Nepal,Pakistan and Sri Lanka. Test kits or paper test strips are used for productionQA in Bangladesh, India, Pakistan and Sri Lanka. A direct application forincreasing the acceptance and demand for iodized salt by consumers (use ofkits in shops and households) is cited from Bhutan, India and Sri Lanka only.The kits have been used for surveys of salt at retail or households in India,Nepal and Pakistan. Although Bangladesh produced its own test kit (a bottlecontaining test liquid), no mention is made of this in the report.

IEC efforts in Bangladesh have focused on advocacy at Thana level andsupport for producing communications materials. IEC materials are also citedin Bhutan, where the EEC effort has been conducted through many media.Advocacy in India, and acceptance of USI by the bureaucracy and the variousprofessional bodies is said to be strong, but still there is significant resistanceby the medical, NGO and small-producer sector. UNICEF support for DEC inIndia has been directed at various advocacy actions, planning of thecommunications strategy, information dissemination, promotional meetingsand workshops at various levels. UNICEF support in Maldives has beendirected at political advocacy, promotion of consumer awareness, andeducational leaflets. IEC and advocacy in Nepal has directed the joint effortsamong MOH, STC and UNICEF towards political leaders and bureaucrats,and the general public through mass media. Pakistan has implemented a strongsocial mobilization campaign but still struggles with opposition from themedical, and (some) producers' and religious sectors. A three-phase massmedia campaign in Sri Lanka in 1995-1996 has increased demand for iodizedsalt. Advocacy efforts directed at national and salt industry leaders in SriLanka have not been effective in producing significant political or productioncommitment.

Information of efforts at training is sparse, although reported UNICEFassistance for training was high for Bhutan and Pakistan. Information on IDDand iodized salt has been included in regular educational curricula in Bhutanonly.

70


Ch IX: Program Output - Monitoring Salt at Retail and Households

In terms of coverage, some two-thirds of households in Bangladesh wereconsuming iodized salt by a 1997 national survey (urban coverage is higherthan rural). There are some hilly and island districts not effectively reached,and the 50% price hike over non-iodized salt is problematic. In Bhutan,coverage is >75% virtually everywhere as apparent from regular monitoring.Competition on basis of price from India is the major threat in Bhutan.Coverage in India is variable, depending on State. The regular district-basedMIS in 1996 showed coverage >90% in 12 of the 22 States, >50% in a further6 States, and <25% in 3 States. Household access varies by district with railsupply problems and weak district MIS systems. In Maldives in a small 1995survey, only 8% of household salt was adequately iodized, and 43% not at all.On basis of a 1996 national survey in Nepal using the rapid test kit, 65% ofsalt in households had sufficient iodine, and 28% some iodine. Iodized saltdoesn't reach some Imillion population in very remote districts. In Pakistan,the 1996 appraisal found that only -25% of households used iodized salt. Only5% of retailers stock iodized salt exclusively and 45% of retailers stock onlynon-iodized salt. Large areas of the country (Balochistan, Northern Areas,AJK) have no access to iodized salt. In Sri Lanka, a 1995 survey found 54% ofhouseholds having non-iodized salt. At retail, both iodized and non-iodizedsalt is marketed.

The preference in households for crystal salt is strong in Bhutan, rural Indiaand Nepal. Market price differences between non-iodized crushed salt andcrystal salt are small. The consumer price of iodized salt of whatever type ishiked in many countries (Bangladesh, Bhutan, India, Nepal, Pakistan and SriLanka) beyond the level justified by the increase in production costs fromiodization and packaging.

Ch X: Program Input - Provision of Iodine by Other Means

Oral or injected iodized oil has been the only alternative means of providingextra iodine in the region. Bangladesh (1997), Bhutan (1991) and Pakistan(1994) have discontinued the use of oil, but Nepal continues to provide area-based oral supplementation to <15 year-old children and women ofreproductive age, some 625,000 people in total. In Bangladesh, until 1997iodized oil injections were part of the national NHEP for which the countrytook a World Bank loan and this is still a "stand-by" strategy for those areasnot reached by iodized salt. Pakistan doesn't consider an alternative means toiodized salt appropriate, likewise to India, Bhutan and the others.

Ch XI: Program Outcome - Monitoring of IDD

The capacity for HDD assessment on basis of recommendations does exist inthe region although the report is not specific on its current state. Labs for UIEexist in Bangladesh, Bhutan, India, Nepal and Pakistan and they have

ROSA Report No. ***

supported recent national surveys in Bhutan (1992), Maldives (1995 withsample processing in India) and Nepal (1998).

Ch XII: Sustainability

Program cost, and its transfer to indigenous sources, is obviously an importantfactor. Budgets for UNICEF assistance are projected to decrease in proportionof total program costs, in Bangladesh and Pakistan, but not in Maldives. InIndia, UNICEF assistance for advocacy and IEC, and particularly consumermonitoring will remain needed. Earmarks for the future contributions byUNICEF to programs in Nepal, Pakistan and Sri Lanka will remain substantialbut are not very clearly stated in the report.

Key constraints to further progress are cited as follows:CountryBangladesh Price hikes of iodized salt; Lack of enforcement at

productionBhutan Shortage of trained manpower; Salt seepage from IndiaIndia Lagging of GOI funding; Limited MOH buy-in; lodate

supply problems; Weak monitoring at production andhouseholds

Maldives Absent law; Weak food inspection; Absent enforcementNepal Lagging of GOI funding; Quality control at production

difficult to implement; Consumer preference for crystalsalt

Pakistan Lagging of GOI funding; Limited MOH buy-in; Weakinspections

Sri Lanka Limited MOH buy-in

The realization has not yet occurred in the region that USI provides a realexample for further efforts at using food fortification for the elimination ofother micronutrient malnutrition issues. Actions to facilitate or promote ironfortification of flour, or vitamin A fortification of sugar or cooking oil arelagging in countries of the region, or being pursued as trial demonstrationprojects.

Ch XIII: Conclusions

Law and regulations:1. Most countries have fair legislation, but enforcement is weak (as it is for

food generally);

2. There is need for harmonization of standards among countries, and forspecifying a maximum allowed for iodine levels in salt at production;

Iodized salt supplies:

72


3. The existing iodized salt processing capacity in the countries producingsalt indigenously (Bangladesh, India, Pakistan and Sri Lanka) generally isbeing under-utilized, although amounts provided match the amountsneeded;

4. In Bhutan, Maldives and Nepal, inspection at import need strengthening toensure that supplies to consumers is of adequate quality;

Production Quality Assurance:5. While most countries have a plan -often with guidelines- for production

monitoring, supervision generally is weak. External quality control isusually not performed routinely. The training of salt production and foodinspection personnel, and assessment of performance by this personnelneed strengthening;

Product characteristics:6. The trend towards better packaging and small sized packets, already taking

place in the countries of the region (particularly in urban areas), willaccelerate. The effect of this trend on the price consumers need to bear isdifficult to manage, and eventually will be determined through competitionin a free market;

Iodized salt use by households:1. The results of household iodized salt use from sporadic surveys and weak

monitoring systems are encouraging, particularly in Bangladesh, Bhutanand most States of India. Households do not have access to iodized salt inremote areas of Balochistan and Northern Areas of Pakistan, hilly andisland districts of Bangladesh, and certain districts of India and remoteareas in Nepal, however. For these under-served "pockets", iodized oilsupplements may need to be considered as a measure to complement theuniversal salt iodization policy;

Demand creation:8. There is confusion of the utility of rapid test kits in production quality

assurance, and monitoring at all levels. There seems to be generalendorsement, however, for their use as a means for creating awareness andfor demand mobilization;

9. UNICEF assisted efforts at demand creation have focused on advocacyand communications efforts at all levels. In countries of the region, thepressure from public opinion is required to sustain the commitment ofpublic officials and the performance of salt industry;

Use of iodized oil:10. In only Nepal, iodized oil supplementation is ongoing. The strong view in

all countries is that salt iodization is the most sustainable way of achievingfreedom from HDD;

IDD assessment:

ROSA Report No.

11. While most countries claim to have the indigenous capacity for UrinaryIodine Excretion measurements, nowhere is a system in place for regularmonitoring, linked to a revision of appropriate program components;

Role of the private sector:12. The salt industry in countries of the region is gradually realizing its

opportunity of assuming the key position for sustaining national freedomfrom IDD, through its association with a public health benefit and byprofitable salt iodization. Generally, the other stakeholders are not yetsufficiently aware of this transition. UNICEF has not yet adjusted itsstrategy of assistance to take full advantage of this changeover of primeresponsibility from government to the private sector;

National plans and coordination:13. Contrasting with conventional logic, experience with USI in the region

indicates that a pragmatic approach towards the key actors mayaccomplish more than an effort in a national committee. This approach hasbeen followed ably by UNICEF, which is the only agency in countriesuniquely positioned to question, advocate, follow-up and probe;

Long-term donor support:14. In the period under review, UNICEF support for national IDD programs

has reportedly been larger than the resources committed by governments.In the next few years this balance may shift. Long-term costs will need tobe borne by the consumer, however, through the price paid to adequatelyiodized and good quality salt. Governments will need to continue theirsupport for quality control, and for monitoring of IDD;

Sustainability:15. Three key requirements are: a good law; good monitoring, and prompt

action. All are under the purview of government. In the short future, extraeffort by UNICEF may be required to enable continuous access byproducers to potassium iodate.

III. Allocation of Merit Scores

Attribute 1: LegislationComments: Avoid qualifiers ("Appropriate")! Regulations are attendant to Legislation- no need for additional mention.

CriteriaScope is nationalApplies to all saltPrescribes concentrations at alllevelsPackaging and labelingregulationsPrescribes QA procedures

Bangladesh543

3

0

Bhutan455

2

2

India445

3

2

Maldives300

0

0

Nepal543

1

1

Pakistan244

3

2

Sri Lanka442

3

0

74


Specifies inspectionresponsibilitiesSpecifies penalties forviolations

3

5

5

5

5

5

1

0

0

0

2

2

5

5

Two difficulties with scoring:Theory and practice often are very different

- Once a law is non-existent, other criteria are also scoring zero (doublepunishment).

Attribute 2: Enforcement

CriteriaInfringements are identifiedProsecutions are successful

Bangladesh20

Bhutan43

India32

Maldives10

Nepal20

Pakistan30

Sri Lanka20

Difficulty:If things are going well (e.g., Bhutan) infringements will not beidentified/prosecution not needed. Still enforcement will be effectively adeterrent to improper practices!

Attribute 3: Iodized Salt Supply

CriteriaCapacity of production/importActual iodized salt supplyversus needsPercentage of supply effectivelyiodized

Bangladesh54

4

Bhutan55

4

India43

2

Maldives41

0

Nepal54

3

Pakistan32

0

Sri Lanka32

1

Difficulties:- "Capacity" to iodize (or import) is not clearly defined. Machinery? Human

skills? All?- The denominator for actual supply is not defined (What "needs" are

relevant: Theoretical consumption or effective demand?)- "Effectively" iodized is not well defined (According to standards?)

Attribute 4: Monitoring at Production

CriteriaPlan for internal/externalmonitoring existsGuidelines exist for monitoringproceduresRegular reporting takes placeEffective supervision, includingtrainingEvidence of follow-up action

Bangladesh5

4

22

0

Bhutan5

4

44

2

India4

3

22

0

Maldives0

0

00

0

Nepal5

5

22

1

Pakistan4

4

24

0

Sri Lanka0

1

01

0

Difficulties:

ROSA Report No. ***

Little evidence, if any, is given in the report of "monitoring guidelines" incountries. Do all parties consider the UNICEF/MI/PAMM/etc Guide as the"universal" guideline?

- "Regular reporting" is well enough not defined. Frequency? By whom?"Public" reports?

- Same for supervision. Of what/whom? Production outcomes, inspectionefforts?

Attribute 5: Household Availability

CriteriaPlan for monitoring existsMonitoring occurs regularly% households using iodized salt

Bangladesh313

Bhutan554

India312

Maldives000

Nepal313

Pakistan311

Sri Lanka312

Difficulties:Unclear what "plan" for monitoring is referred to: National plan?Government plan? Salt industry plan? UNICEF plan?Some "monitoring" eventually occurs "regularly" everywhere, for instancein many countries "salt monitoring" now is part of "ad-hoc" surveys, DHS,etc

Attribute 6: IEC activities

CriteriaAdvocacy is directed at all levelsEmphasis on IDD and role ofiodized saltEvidence of training and trainingmaterials

Bangladesh55

3

Bhutan55

4

India55

3

Maldives35

2

Nepal55

3

Pakistan55

4

Sri Lanka55

1

Difficulties:- Advocacy and 'Test Kits" in the report are by-and-large used as

synonyms. For many of us, "advocacy" is a specific communications effortand event, however.

- All IEC reported on in the report addresses EDD and role of iodized salt(by necessity). The quality of IEC and of IEC materials has not beenaddressed, however!Training was not addressed as to its scope, quality, frequency andoutcomes either

Attribute 7: IDD Monitoring

CriteriaUSI is component of IDD programPlan exist for systematic UIEmonitoringFunctional UIE laboratory exists incountryPlan for regular thyroid statusmonitoringReporting of program outcomes

Bangladesh53

4

3

3

Bhutan55

4

4

5

India53

5

3

3

Maldives00

0

0

0

Nepal55

4

4

4

Pakistan52

1

1

1

Sri Lanka51

0

0

076


takes place

Difficulties:Systematic UIE monitoring and regular IDD monitoring are overlappingconcepts. The latter's "regularity" is redundant for this evaluation (exceptif "plans" also count)

- It is assumed that a lab for UIE should exist in country. However, in acountry like Maldives, it presumably was perfectly acceptable to dependon a reliable regional laboratory

Attribute 8: National Coordination

CriteriaHigh level multi-sectoral committeeexistsCommittee takes effective actionComprehensive national plan exists

Bangladesh5

10

Bhutan5

55

India4

21

Maldives0

02

Nepal4

31

Pakistan3

11

Sri Lanka1

01

Difficulties:High level committee should be multi-sectoral, (not interagency)Unclear what comprehensive national plan is referred to: For IDD,nutrition, social sector, human development? Any of these?

Attribute 9: Sustainability

CriteriaFunding for future is assuredPolitical commitment exists

Bangladesh45

Bhutan55

India34

Maldives10

Nepal44

Pakistan21

Sri Lanka20

Difficulty:Uncertain what political commitment is being referred to (and whatevidence to use in the context of assessing sustainability). The onlyprogram stakeholder making salt iodization sustainable is the saltproducing industry, but this is usually not being referred to as "political"commitment.

ROSA Report No. ***

Secondary Evaluation Report Submitted by David P. Haxton

David P. Haxton retired from UNICEF after thirty years. He served in all of thecountries of South America, in Indonesia and his last assignment was RegionalDirector in South Asia, located in New Delhi. During the eight years of service inSouth Asia he prefers to suggest that the most memorable UNICEF activities were:good solid country programme planning and executive in each country; remarkablestaff of dedication and principle; the first ever political meeting on children: TheSAARC Conference on Children, a forerunner and "practice" for the subsequentGlobal Summit; the national EPI programme in India dedicated as a "LivingMemorial to Indira Gandhi"; and pressing forward on improved nutrition planningand programming, in particular the elimination of IDD.

ICCIDD was founded and in its early years, substantially was supported by UNICEFin South Asia.

In retirement he writes. He also works on national programmes of elimination ofMOM, specifically IDD. He serves on the Board of ICCIDD; is an advisor to theExecutive Director of Micronutrient Initiative; and is a consultant to PAMM.

Here is my report. I have tried to be brief, but clear, and I have tried to followyour guidelines for the evaluation. I must confess, however, that while fullysupporting the concept of evaluating our work (a form of quality assurance control), Ihad he feeling that the texts you sent on the subject had more to do with perfecting theevaluation than with addressing key issues in the programs themselves. I comment onthis point later in this note, but at this stage, I observe that key actors in the dramawere not involved in the work...salt producers for one, communicators on iodine foranother and salt traders.

I have tried to keep my comments orderly and in groups. I have completed thecountry sheets according to my understanding of your methodology. I wouldrecommend a readjustment of those sheets and later in the note offer somesuggestions. A preliminary one, at this stage, however, is to devise language thatallows direct participation of private producers in the process.

General Comments

A. The report of the first evaluator.

It is a good document that fairly and accurately reports on the situation. It is clearand easy to read even for those that might not have had opportunities to witnessnational activity on the ground. For those that have had such experience, it is apleasure to read. The evaluator was presented with some handicaps and overcame thewell. The first handicap was the absence of a better and more complete report fromIndia...a major problem. A second handicap was the omission of information directlyfrom producers and civil society, most of the material came from UNICEF reportingsources. A third handicap in my view was the limitation on making suggestions for

78


obvious pursuit, or correction. A fourth handicap was the persistent one of countinginvestments as important only if they come from donors or donor agencies (includingUNICEF). UNICEF might want to look at evaluating activities mostly in the privatesector with another optic especially if statements of concern on "sustainability" are tobe taken seriously.

B. This set of comments applies to your document "draft evaluation...etc"

1. You might want to correct the history a bit by recalling that the SAARCConference on Children in South Asia preceded the Global Summit by some years, infact, the organization, format and suggested list of topics was used in the Summitpreparations. (Para 0.2)

2. One notes that the collection of information, the collation of it, the managementof it and the proposals for evaluating efforts at USI were, for the greater part,functions of UNICEF personnel with little reference to producers, regulators,marketers, consumers, etc. This (I believe) naturally led to limiting the TOR as theywere and to limiting the potential utility of the results of the evaluation by thestakeholders and actors most involved. It is, of course, important to report to one'sfinancial supporter on effective use of the investment, but it is equally important touse this opportunity to address issues in time to correct them for effectiveimprovement of human nutrition.

3. The notes (0.8 to 0.10) do not suggest ways rapidly to apply knowledge to theprocess of production, management and monitoring. And, to this reviewer, those maybe more important than reporting to donors, as valuable and necessary as that is. Amajor problem (in my view) of most evaluations and other qualityassurance/monitoring is the lapse between discovery and application of correction.Too often the latter takes place after the problem has solidified or disappeared to bereplaced by another.

4. Investments by private producers are nearly overlooked in the review and that isa pity. The time, talent and others investments of companies is important not only forfactual reporting, but it is the keystone of sustained elimination, whether private orparastatal. In companies obviously involved n India, Pakistan, and Bangladesh, forinstance, the decision to continue to iodize is vital. The investments by governmentsin time, policy formulation, inspection, monitoring, analysis, etc., surely can beestimated by UNICEF staff...or extracted from official documents. This wouldrepresent a significant contribution to progress and evaluation of it. Investments inaltered production techniques, lab work, packaging, marketing, training, are essentialto sustained elimination. The first evaluator was not presented with sufficientinformation on these points.

5. A similar comment relates to paragraph 2.7. The title of our work is"...progress toward USI"... However, most measurable references refer to UNICEFinputs, or expenditures, or staff time. It is essential to grasp that in national iodizationefforts, all the investments of production in time, staff, facilities, money and trainingare important to sustained elimination. Moreover, reaching USI is but a plateau, notthe end. We do not want to leave the impression that only UNICEF invested and that

TO

ROSA Report No. ***

USI is our goal. The country reports might lend themselves to these erroneousconclusions.

6. Throughout the document there are numerous references to UNICEF opinionsabout costs, profit margins and the like. There seems to be little indication thatUNICEF is aware of the essence of market systems to evaluate the cost of production,establish sales prices, compete for market share and get a fair price for a goodproduct.

7. There is surprisingly little information about communication strategies in thecountry papers it seems. There is mention of EEC, but that omits a range of vitalcommunications activities essential to success. There is little about the interchangesbetween science and operations and between those and the medical community;between official positions and private producers. There is very much less ineducation efforts to assist in sustaining elimination. How does a nation sustaindemand for iodine absent serious communications in and through school systems,medical colleges, and other learning systems to create knowledge on iodine anddangers of iodine deficiency? Advertising is a key element and needs encouragement.

8. Investments in training and in laboratory work are essential to continuedsuccess. (After all, all trainees do not stay static). Labs in various forms are needed atplant sites, sub national entities both public and private, certainly in central units forpersistent sustained biological monitoring.

9. Monitoring of production is mentioned in many country reports. Monitoring asa need to assure progress in human nutrition receives important mention. But theconcept of monitoring as a national norm receives surprisingly little attention in thecountry information. There are perhaps three sets of things to look at in theseprogrammes: The Product, the Process, and the Progress in Human Nutrition. In thefirst, there are such things as iodization level, quality of the salt, packaging, storage,training availability of raw materials like potassium iodate and bagging materials, etc.In the group one might call "The Process" are things like regular overview, regulation,and enforcement, national standards, training, laboratory management,communications, trade, etc. The Progress in Human Nutrition involves the vitallyneeded surveys, biological analysis and regular reporting publicly to assure a balancebetween public knowledge, public policy and nutrition practice.

10. History seems to suggest to us that we need to pay more attention to politicalcommitment to this national endeavor and I wish the reports from countries presentedmore evidence of that commitment. Political commitment, like annual operatingmatters, needs annual renewal or it will fade like the morning mist. The evaluationliterature produced by ICCDDD, PAMM and UNICEF calls for including this elementin any concluding evaluation along with financial commitment and biological testingof needs.

It has been a pleasure to read the Evaluator's Report. It has equally been pleasantto live national programming through the written reports on progress. I appreciate theopportunity and stand by for assisting in any clarification or amplification of the newsherein and attached as may be required.80

Evaluation oforoeress towards Universal Salt lodisation in South Asia

Secondary Evaluation Report Submitted by Robin Houston, MD, MPH

Dr. Robin Houston is currently an independent contractor for epidemiologic issues,including micronutrient deficiencies. He previously worked with Program AgainstMicronutrient Malnutrition (PAMM) and the Centers for Disease Control andPrevention (CDC; Atlanta, Georgia). Dr. Houston co-edited "Monitoring UniversalSalt lodization Programmes" published by UNICEF, ICCIDD, PAMM, WHO, andMI (1995), and has worked on micronutrient deficiencies in South Asia, namelyNepal.________ __________________

I. Introduction and Background

The purpose of this report is to provide a secondary evaluation of progress made inestablishing universal salt iodization programs to address iodine deficiency in 7countries in South Asia. UNICEF has made substantial contributions to the efforts ofthese countries, and recently supported an evaluation of progress to date. Thisprimary evaluation was done by reviewing the key elements of the national program,and used a series of attributes and criteria for each attribute which were weighted andscored for each country. The purpose of this secondary evaluation is to:

X review the primary evaluation report and comment on additional informationthat might improve the accuracy of the report, and comment on theconclusions drawn by the authors

X provide additional input on the merit of each country programX use the same system of weighted attributes and criteria to generate a score for

each country programX comment briefly on the attributes, criteria and weighting system used for the

primary evaluation

Extraordinary progress has been made toward elimination of iodine deficiency, notonly in South Asia, but throughout the world. The likely consequences of thisprogress, in improved intellectual capacity, is a major public health success, for whichUNICEF, as the leading donor agency assisting countries, deserves special credit. Itis unfortunate that, like many other success stories in the social sector, the generalpublic knows very little about how much as been done to eliminate iodine deficiency.

This secondary evaluation is done taking into consideration two important points.First, nearly all countries have made extraordinary progress in a very short timeperiod, taking less time to establish programs than most industrialized countries.Second, elimination efforts must continue, and the evaluation must consider all thevarious program elements necessary to ensure access and use of iodized salt forgenerations to come.

ROSA Report No. ***

II. The Primary Evaluation Report

The report Toward the elimination ofIDD in South Asia: Draft evaluation of progresstoward universal salt iodisation in South Asia (December, 1998) is an excellent andobjective summary of the key elements of the national EDD programs for 7 countries-Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. The report isorganized as follows:

program inputs: financial inputs, UNICEF Support, iodized salt supply and therole of the private sector

program process: national planning and coordination, legislation and regulation,quality assurance, stimulating demand

program output: retail and household coverage

program impact: monitoring IDD (biologic and clinical indicators)

sustainability: costs, constraints, integration with other micronutrient activities

The primary evaluators used weighted attributes and weighted criteria for eachattribute to score each country. These scores were not provided to the secondaryevaluators in order not to influence the opinions of the secondary evaluators.

Comments on program inputs:

In section 2 there is a summary of expenditures for IDD for each country. This is anexcellent overview of expenses, although as noted in the text, governmentexpenditures were not available for some countries. For Bangladesh the total costshould $5480 rather than $5210. While this gives a good picture of the relationshipbetween UNICEF expenditures and government expenditures (for those withinformation available), it would also be useful to view this by year, for the past 5years to see any trends in increased government financial commitment. A graph oftotal expenditure for UNICEF and government by year for each country might beuseful.

The breakdown of UNICEF expenditures by type of activity is also very helpful.Clearly different countries have had different needs, as reflected by the strikingdifferences in assistance for IEC or monitoring between countries. If the informationwere available, it would also be interesting to see if there were changes over time inthe distribution. Providing this breakdown would help understand whether countrieswill need to continue IEC efforts at the same level in the future, or whether expensesfor IEC are greatest when programs are young. Similarly, it would be helpful to havesome estimate of the total cost for IDD efforts per capita for each country.

In section 2.6, it would be useful to add a table with the total KIO3 needs, totalsupplied by UNICEF, and the cost. Since long term provision of KIO3 is critical tosalt iodization programs, and since most countries have not passed this cost fully on toconsumers, the cost implications are important.00


The section covering salt production and iodization provides good summaryinformation on capacity and the mix of large and small producers. For each countrythere should be available a salt situation analysis (often done by UNICEF), and itwould be useful to reference the sources of information for each country. It wouldalso be helpful to provide a consistent summary table that includes the estimated totaledible salt need (for the human population), the estimated current capacity, in additionto the current per cent iodized.

Tables 3.2 and 3.3 provide good data on production, although in each, the units arenot clear (thousand tons for Bhutan and million tons for India). The Salt Departmentof India formula for calculating estimate need seems unusual 16 gm/person andlivestock/day, since the normal range is 5-15 gm/person/day excluding livestock.Section 3.12 on the Maldives seems incomplete. There should be additional availableinformation on imported salt, most of which is likely to come from a country withiodization capacity. For Nepal, there is new information from both Salt TradingCorporation and from the recent Micronutrient Survey on household salt use, and theproportion of the population using iodized salt. Information later in the documentsuggests that in 15 districts of Nepal much of the population is not reached by iodizedsalt. The recent data suggest that this is likely no longer the case. The paragraph 3.24is not clear with regard to calculation of estimated annual requirements and per capitaintake.

Comments on program process

In section 5, it is not always clear whether there is a national plan or not. Since such aplan may be very general, such as activities embedded within the nutrition section ofthe MOH annual work plan, or quite specific, such as the IDD plan that appears tohave been developed in the Maldives. The report might be strengthened by morespecific comment for each country on the status of these plans, including the workplan for UNICEF. The comments on the national EDD committees are very good,providing insight into their actual function. Similarly, in section 6 it is not alwaysclear whether there is a specific law banning non-iodized salt, or rather a regulationproviding specifications for iodized salt. Where legislation is pending, it would behelpful to provide information about the process (and likelihood) of passage.

Section 7 on monitoring at production level is excellent, and provides goodinformation on what is actually being done, in some detail. Similarly, Section 8provides an excellent picture of the level of effort that governments are undertaking tostimulate demand, and continue with advocacy efforts. This section in fact creates animpression of the degree of commitment, and this appears to be reflected in betterscores for other sections.

Comments on program outputs

Section 9 is a critical section, since in includes information on perhaps the mostimportant process indicator, household coverage. It is impressive that there isreasonable data on coverage, and the report brings this information out well, enhancedby the maps showing trends. Though beyond the scope of this evaluation, it would be

ROSA Report No. ***

very nice to see more data points on coverage (for more years), and map the percentchange over time. For Bangladesh, there may be additional information from thenutritional surveillance system in place. As noted earlier, recent data suggest that thepopulation not reached by iodized salt is decreasing. Since the percentage of overallfunds for IDD going for supplementation is quite large in Nepal, it is important tounderstand this trend, since the supplementation program may be able to bediscontinued, preserving funds for improving quality assurance.

Comments on program impact and sustainability

The introduction to Section 11 is excellent, noting the importance of including periodimpact assessment. It is also impressive that there is the capacity to measure urinaryiodine in the majority of the countries. It is also telling that there have been relativelyfew recent surveys for biologic or clinical indicators of program impact. The sectiondoes not mention any regional cooperation with regard to laboratory quality assuranceor development of regional laboratories (for use by countries without nationalcapacity). In addition, there is little in the section on use of TSH in newboms. Thissituation for the region may be a reflection of the evolution of national programs, withan emphasis on production and availability to be followed by concern for impact.

The section on sustainability would benefit from an additional breakdown on fundingrequirements, particularly the amount needed for potassium iodate on an annual basis.While it will likely be chronically difficult to mobilize government funds, it is alsodifficult to pass the additional cost of potassium iodate on to consumers, though this isbeginning to happen in some countries. Since some countries appear to haveestablished adequate capacity and are achieving adequate household coverage,external funding needs should diminish, although it may be premature to be able tomeasure this. It would be interesting to see data on changes in the uses for externalfunds over time, if these data are available.

Section 12.5 highlights the key main constraints for sustained USI, and the reportdraws the reader to these same conclusions. Regarding the country specificconstraints, this reviewer would differ for constraints facing Nepal. For each of theimportation sites in Nepal, there is an excellent monitoring system in place thatrecently identified some specific problems in the Far West. In addition, there is someevidence suggesting that there is a gradual transition toward more refined salt (awayfrom the phoda or larger crystal salt). The program has as a stated goal promotingthis transition. The larger crystal salt has been iodized, and although the iodizationlikely results in greater variability in iodine content, much of that larger crystal saltdoes maintain adequate iodine.

Finally, in Section 12.8 on relevance for other micronutrients, there is no mention offortification of cooking oil with vitamin A in Pakistan-something that has been donein theory since partition, but which suffers from poor quality control.

84


III. The Merit of Country Programs

Table 1 below provides the summary scores, using the attributes, criteria andrespective weights provided. (Complete scoring details are provided in thespreadsheet in Appendix I)

Table 1: Robin Houston's weighted scoring, by attributeAttribute

Legislation

Enforcement

Supply

Monitoring

HHAvailability

EC

Monitoring ofIDD

NationalPlanning

Sustainability

Total,weighted byattribute

Bangladesh

4.35

3

5

3.2

3.3

2.9

2.25

3.6

5

3.70

Bhutan

4.15

4.6

4.2

3.2

4.4

5

2.65

4.6

5

4.22

India

3.75

3.8

3.6

3.4

4

5

2.25

3.6

4.2

3.79

Maldives

0

0

1.4

0

1.8

2.9

1.35

2.8

3.4

1.49

Nepal

2.45

3.4

4.8

4.2

3.7

5

2.85

3.3

4.6

3.87

Pakistan

3.85

0.6

0.8

3

1.1

4.2

2.65

3.9

3.8

2.59

Sri Lanka

4.35

4.2

2.2

0.2

0.9

3.9

1

2.2

3.2

2.41

In completing the attribute forms, there were several areas in which there was someroom for interpretation. For legislation, it was not always clear whether a food lawmade iodization mandatory, and it was also not completely clear how to scorecountries in which legislation was developed, but not yet passed. Similarly, it was notalways clear how to score for monitoring. For example, in Nepal, with the saltiodization units managed by a parastatal organization, scoring for external monitoringand follow-up action was difficult. For most countries, there was not muchinformation on the extent of training efforts for monitoring. For monitoring HDD,most countries had done some survey work for goiter rates and urinary iodine, butwhether this process was systematic was less clear, again making scoring difficult.Finally, for Sustainability, all countries appeared to have adequate funding, when bothinternal and external sources were included.

For this reviewer, familiar with the programs in Nepal, Pakistan, India, Bhutan andBangladesh, the final scoring reflects the impression of the country programs frompersonal experience. Bhutan is known to have developed their program early, withgood results. The report reflects earlier concerns about some reduction in qualitycontrol during privatization, and those issues appear to be being addressed. ForNepal, the program has also been very successful, through a combination of

ROSA Report No. ***

advocacy, collaboration with India, diligence on the part of the staff at STC assignedto the goiter project, and the hard work of the staff at each importation site. Therecent Micronutrient Survey, national in scope, reflects this success with highhousehold coverage rates, although the concurrent goiter rates do not show asdramatic results perhaps because of residual small goiters.

In Bangladesh, UNICEF was particularly catalytic through the supply to the multiplemedium and smaller producers. This effort appears to have resulted in solidunderstanding and commitment on the part of the producers, which, combined withattention to monitoring (partly through BSCIC) has helped increase both quality andcoverage.

The program in India perhaps suffers from its sheer magnitude, and from thedecentralized approach. Some states apparently have not focused on HDD, and forthose areas, progress has been slow. It also appears that the commitment on the partof the government (nationally and by state) and on the part of the bulk of theproducers has not been as strong as would be ideal. In spite of these constraints, andother concerns with enforcement, production capacity is strong, and householdcoverage is increasing.

In Pakistan, the program has long suffered from difficulty gaining optimal politicalcommitment. It is interesting that the commitment on the part of the private sectorhas been good, in spite of some difficulty early on. Further IEC efforts may beneeded to improve the balance between motivation of producers and demand, sinceenforcement is likely to be difficult for the foreseeable future.

The Sri Lanka program may suffer from lack of consistent commitment due topolitical struggles in the North. In spite of quite strong legislation and some attemptsat enforcement, monitoring, planning and household salt availability remainproblematic.

In spite of being a country importing all its salt, the Maldives has clearly not yetdeveloped a strong program, as reflected by lack of progress in many programmaticelements, and low household coverage. Stronger advocacy efforts, directed towardpolitical leaders, importers, and the general public may be increasing, and may helpmove the program forward.

IV. Conclusions and Comments on Report Conclusions

The report draws conclusions for each of the major attributes, commenting in somedepth on production and supply, household use and advocacy. It is clear that in spiteof legislation, most countries have difficulty establishing an adequate system forenforcement, either because of political sensitivity, lack of staff for inspection, or lackof commitment in general. In section 13.2 the authors comment on differences inrequirements between countries in the region. Since several countries import salt(often from other countries in the region) greater regional cooperation, thoughdifficult, would improve the programs.

86


It is also clear, as noted by the evaluators, that there are not serious problems withsupply or capacity to produce iodized salt. Countries producing their own salt haveadequate facilities to meet iodization demands. Countries importing salt either havethe capacity to iodize, or in theory, can demand adequately iodized salt from thesupplier. Thus, as concluded by the authors, increased demand, particularly from'areas of greatest need' could be met by existing production or import facilities.Although there is limited information in the report, with minimal enforcement inplace, increasing demand may result in increasing 'counterfeiting' (as observed inIndonesia), making monitoring at various levels increasingly important. To date,there does not appear to be a problem with equipment or equipment maintenance,although there are issues of quality control for most countries.

Four of the seven countries have achieved remarkable household coverage with saltwith at least some iodine. The implication of achieving such high coverage is that inspite of weak enforcement, limitations in political commitment, and other constraints,a transition has been made from predominantly non-iodized salt to predominantlyiodized salt. It appears that the trend in household coverage is continuing to rise, andthat attention is now being given to improving consistency of iodine content. Inaddition, in some countries (notably Nepal) there appears to be a gradual movementtoward preference for a higher quality of salt, and this should make quality controleasier in the upcoming years. For Pakistan and Sri Lanka, increased politicalcommitment might vastly improve the situation, since other elements of the programare there. For the Maldives, most program elements are weak, and this is clearlyreflected in low household coverage.

IEC and advocacy efforts in all countries has been good. The evaluators concludethat these efforts have been important in generating both political commitment anddemand, and that the combination, at least in South Asia, has been necessary. Thisreviewer would agree with this conclusion, noting that in several instances it has beennecessary to increase educational efforts due to rumors and subsequent concern fromthe public. Attempting to simply bring in iodization without building awareness inconsumers could have had poor results.

The authors note that measurement of impact has been somewhat sporadic in mostcountries, without a systematic plan for monitoring urinary iodine or goiter. Whilethis may be true, it does reflect the fact that countries placed their priority onproduction (with some quality assurance during production) and achieving adequatehousehold coverage—something most countries in the region have achieved. Sincemost data suggest that adequate coverage with adequately iodized salt will result inreduction in IDD, this approach was appropriate. Now with program maturation,countries may be able to concentrate on a) identifying areas being missed; b)improving quality assurance and reducing variability in salt iodine content, and c)measuring progress in biologic and clinical indicators.

Finally, regarding sustainability, it is clear that programs are not so mature thatexternal funding can be dramatically decreased—in fact, in this reviewer's opinion,significant reduction in external support at this point would be disastrous. Theauthors mention supplies of potassium iodate, but equivocate on how this supplyshould be assured. It is likely that external support will be needed for several more

ROSA Report No. ***

years for potassium iodate alone, since most countries would have difficultiesincreasing salt prices to reflect this expense. Since most countries do not have strongretail or household monitoring systems, and do not have adequate enforcementmechanisms in place, any pressure on producers to lower prices might result in loweriodization levels which might be undetected.

In summary, this evaluation provides comprehensive information about 7 countries inSouth Asia on the progress of salt iodization. Countries have made substantialprogress in building strong foundations for their programs through enacting oflegislation and development of regulations; by establishing adequate iodizationcapacity; and by building awareness among politicians and in the general public. Thishas resulted in high household coverage in most countries, with salt that has someiodine. Most countries have also begun to develop monitoring systems concentratingon monitoring during production or importation, and this has resulted in a growingability to identify unacceptable variability in salt iodine content. In addition, periodicmonitoring has helped identify geographic areas where iodized salt is not available,and has provided some data on progress with reduction in HDD. This progress is mostencouraging.

Countries have generally made less progress in becoming self-sufficient for programfinancial needs. Most continue to rely on UNICEF for potassium iodate and supportfor many other program elements. Several countries have been unable to sustain oreven develop adequate political commitment to move their programs ahead.However, in most countries, attention to advocacy directed at the private sector hashad positive results. Thus for the region, significant progress has been made, withmost countries concentrating their early efforts correctly on establishing iodizationcapacity and getting iodized salt out to the public. The challenge ahead is to maintainthe political commitment, improve overall salt quality, and move toward financialsustainability.

V. Brief Comments on the Evaluation Format, Attributes and Weighting

This evaluation method appears to be very successful in guiding assessment of eachprogram element, and then including an objective way of scoring countries. Theattributes are well chosen, and the criteria for each, comprehensive. The weightsgiven to each criterion seem appropriate, as do the weights assigned to the attributesthemselves.

Some of the attributes could be combined, or organized differently. Legislation couldinclude enforcement. Monitoring for production could be broadened to include allmonitoring, and thus would include both household coverage and biologic and clinicalimpact assessment. Differentiating between inputs, processes, outputs and outcomesis sometimes confusing (mostly because of terminology), and it may be easier todifferentiate program elements by those relating to product, those relating to process,and those relating to impact (progress). However, no categorization avoids someconfusion when the details are reviewed.

88


This evaluation served two purposes: one to evaluate the progress for each countryprogram, and another to evaluate UNICEF's input. In some areas of the report, thesetwo goals seem confused particularly the section on finance, which concentrates onUNICEF input.

The report might be strengthened by imposing a bit more consistency in thediscussions for each country for each section. For example, it is difficult to tease outthe exact iodized salt production capacity, actual production, and % iodized in thesupply section. The tables included in the text help a great deal, but again could bemore consistent across countries, recognizing that in many instances the data availableare in different forms.

The evaluation process is very successful in developing an understanding of theoverall program elements rather than simply relying on progress in elimination (asmeasured by biologic or clinical indicators) or relying on achieving high householdcoverage. Earlier country assessments tended to classify countries as havingsucceeded or not in elimination efforts, but did not go into the same depth on reviewof critical program elements. This evaluation format very successfully provides themechanism for such a comprehensive review.

ROSA Report No. ***

Appendix D:

Re: Recommending Upper Limits for Iodine ContentElectronic correspondence from Frits van der Haar to Amy Oilman in response to

query about existence of new studies on iodine induced hyperthyroidism

I realize I forgot to say that since the mid point this decade there has been a blizzardof thyroidology publications on IIH but none of them specifically answered yourquestion.

To be direct, your inquiry is the classic case of "Simple question, complicatedanswer". There is NO level of iodine in salt that provides complete protection againstsome increase in the incidence of IIH in a previously iodine-deficient population.Even in Switzerland, where the staged increases in iodine additions to salt have beenvery small and over a long time period, there was an increase in IIH incidence in theearly 1990s in the year when the iodine supply was increased from 90 ug/day to therecommended 150 ug/day. Subsequently there has been a steady decrease in theincidence of this disorder.

Thus in decisions about upper (and lower) levels of iodine addition to salt, thereALWAYS is the need for trading-off the induced risk of higher IIH incidence againstthe derived benefit of EDD prevention. The experts state that in iodine-deficientpopulations the benefits of IDD correction far outweigh the risks. While this is notmeant to encourage acceptance of "any" level of salt iodization, it emphasizes the factthat whatever levels are chosen in the salt supply, countries have to always expect,and accept, a certain incidence of side-effects.

The last official recommendation on salt iodine levels is of the 1996WHO/UNICEF/ICCIDD consultation. This document often is cited as saying that theiodine concentration at production SHOULD be between 20 and 40 mg/kg. Instead,the recommendation is that required iodine levels in salt at production should bechosen in harmony with the country salt supply situation, and be based on data frommonitoring urinary iodine levels in the population.

Therefore, the final answer on your simple question is "It depends". Factors toconsider by national authorities are:- the amount of iodine intake from other sources;- the quality of raw salt;- the conditions in the salt supply lines to the consumers;- the time lag between production and consumption;- typical dietary and food preparation practices;- whether iodized salt is used also in processing of other foods, and/or by

animals (as a source of food supply to the population); and- the amount of (iodized) salt intake.

Some scenarios are reasonable, such as the assumption that if raw salt quality (lowimpurity) and packaging are adequate (sealed polyethylene plastic), a loss factor ofapprox. 20% between production and households can be expected. The other90


assumption that approx. 20% ON AVERAGE is lost in food preparation is alsoreasonable for populations where cooking is the main food preparation method.Finally, the level of discretionary salt intake usually is somewhere between 5 and 10gram per person per day in most countries, and averaging 7 grams (Note that theWHO/UNICEF/ICCIDD report makes the common mistake of equating salt supplyestimates from salt producers (10/g/capita/day) with average salt consumption!).

I hope all this is helpful in arriving at some clarity in your discussions. The importantinference, I submit, is that the assurance of quality (adequate procedures andconditions at salt iodization processing, packaging quality, FIFO in trade/distribution,conservation/promotion at market sales), and up-to-date information from populationiodine status monitoring are two key prerequisites for effective HDD eliminationprograms based on salt iodization - with minimal risk of side-effects. If I am allowedto say so, maybe the discussion can be turned that way, rather than seeking for amagic number. And as to choosing the number, the final decision is the country's -despite talk about "harmonization" all laws still are national.

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1997,1997,1997,1997,1997,1997,1997,1997,1997,1997,1997,I9'J7,1997.1997,1997,1997,1997.1997.1997,1997,1997.1997.1997,1997,1997,1997,1997,1997.

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1997. BBS, Statistics Div1997,1997.1997,1997,1997,1997,1997,

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1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.19971997.19971997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.1997.

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MIS, Progolir Palhtiy, 1997, BBS. Slalislics Div.. MoP, Bangladesh, 1997MIS, Progotir I'alhey, 1997, BBS, Statistics Div . MoP, Bangladesh. 1997.MIS, Progolir Palhoy, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Piogolii Palhny. 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Piogolir Palhey, 1997, BBS, Slalislics Div., MoP. Bangladesh. 1997.MIS, Piogotii Palhoy, 1997, BBS, Slalistics Div.. MoP. Bangladesh. 1997.MIS. Progolir Palhey, 1997, BBS, Slalislics Div., MoP, Bangladesh. 1997.MIS, Progolii Palhey, 1997, BBS. Slalistics Div., MoP, Bangladesh, 1997.MIS, Piogotir Palhoy, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Progotir Pathey, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Progotir Palhny, 1997, BBS, Slalistics Div., MoP, Bangladesh, 1997.MIS, Progolii Palhoy, 1997, BBS, Slalislics Div., MoP. Bangladesh, 1997.MIS, Progotir Patlioy, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Progolir Palhey, 1997, BBS, Slalistios Div.. MoP, Bangladesh, 1997.MIS, Progolir Pathey, 1997, BBS, Slalistics Div., MoP, Bangladesh, 1997.MIS, Progolii Palhey, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Piogolii Palhoy, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Progolir Palhey, 1997, BBS, Stalislics Div., MoP, Bangladesh, 1997.MIS, Progolir Palhey, 1997, BBS, Stalislics Div., MoP, Bangladesh, 1997.MIS, Piogolii Palhey, 1997, BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Progolii Palhoy, 1997, BBS, Slalislios Div., MoP. Bangladesh. 1997.MIS. Progotii Palhoy, 1997. BBS, Slalislics Div., MoP, Bangladesh, 1997.MIS, Progotii Pathey, 1997, BBS, Slalislics Div., MoP. Bangladesh. 1997.MIS, Progolir Palhey, 1997, BBS, Statistics Div., MoP, Bangladesh, 1997.MIS, Progotii Pathey, 1997, BBS, Stalislics Div., MoP, Bangladesh. 1997.MIS, Progolii Palhey, 1997, BBS. Statistics Div., MoP, Bangladesh, 1997.MIS, Progolir Pathey, 1997. BBS, Statistics Div.. MoP, Bangladesh. 1997.MIS, Piogolir Pathey, 1997, BBS. Statistics Div., MoP. Bangladesh. 1997.MIS, Progotii Pallley, 1997. BBS, Stalislics Div.. MoP, Bangladesh, 1997.MIS, Progotir Palhey, 1997. BBS, Slalistics Div., MoP, Bangladesh, 1997MIS, Progolir Pathoy, 1997, BBS, Statistics Div., MoP. Bangladesh. 1997MIS, Progotir Palhey, 1997, BBS, Statistics Div , MoP, Bangladesh. 1997.MIS, Progolir Palhoy, 1997, BBS, Slalistics Div.. MoP, Bangladesh, 1997.MIS, Piogolii Pathey, 1997, BBS, Statistics Div.. MoP, Bangladesh, 1997.Second Quarterly Repoil ol Ihe Health Monitoring System, Moll, Bhutan, 1997.Second Quaileily Repoil o[ Iho I leallh Monitoring System, MoH, Bhutan, 1997.Second Quaiteily Ropoil of the Health Monitoring System. MoH. Bluilan, 1997.Second Quaileily Report of Ihe I leallh Monitoring System. Mol I, Bhutan, 1997.Second Quaitoily Ropoit ol Iho I leallh Monitoring System, Mol I, Bhutan, 1997.

100 Second Quaileily Repoil of the I leallh Monitoring System, Mol I, Bhutan, 1997.

81 Second Quaileily Ropoil of Ihe Health Monitoring System, MoH. Bhutan, 1997.100 Second Quaileily Repoit of Ihe Health Monitoring System, MoH. Bhutan, 1997.98 Second Quaiteily Bepoit of Ihe I leallh Monitoring System, MoH, Bhutan, 1997.93 Second Quaitoily Repoil of Ihe Health Monitoring System, Mot I, Bhutan, 1997.

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80 Second Quarleily Report of the Health Monitoring System, MoH, Bhutan, 1997.

89 Second Quarterly Report ol Iho Health Monitoring System. MoH, Bhutan. 1997.92 Second Quarterly Report ol the Health Monitoring System, MoH. Bhutan, 1997.91 Second Quarleily Report ol the Health Monitoring System, MoH, Bhutan. 1997.15 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW. India, 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP. DGHS, MoHFW, India. 1997.98 Monitoring ol Iodised Salt reports. NIDDCP, DGHS. MoHFW, India, 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India. 1997.51 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW. India, 1997.88 Monitoring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW, India, 1997.94 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.98 Monitoring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW, India, 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP. DGHS, MoHFW, India, 1997.99 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.98 Monitoring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW, India, 1997.

100 Monitoring ol Iodised Salt reports. NIDDCP, DGHS, MoHFW. India. 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.99 Monitoring ol Iodised Salt reports, NIDDCP. DGHS, MoHFW, India, 1997.

106 Monitoring ol lodiujd Salt reports, NIDDCP. DGI IS. Mul IFW. India. 1997.89 Monitoring ol Iodised Salt reports, NIDDCP. DGHS, MoHFW. India. 1997.51 Monitoring ol Iodised Salt reports, NIDDCP. DGHS. MoHFW. India. 1997.98 Monitoring ol Iodised Salt reports. NIDDCP. DGHS. MoHFW. India. 1997.68 Monitoring ol Iodised Salt reports, tllDDCP. DGHS. MoHFW. India. 1997.95 Monitoring of Iodised Salt reports, NIDDCP. DGHS, MoHFW, India. 1997.11 Monitoring ol Iodised Sail reports. NIDDCP. DGHS, MoHFW. India. 1997.94 Monitoring ol Iodised Sail reports. NIDDCP. DGHS. MoHFW. India. 1997.78 Monitoring ol Iodised Sail reports, NIDDCP, DGHS, MoHFW. India. 1997.

100 Monitoring ol Iodised Salt reports. NIDDCP, DGHS, MoHFW. India. 1997.99 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW. India. 1997.

100 Monitoring of Iodised Salt reports, NIDDCP. DGHS, MoHFW, India. 1997.100 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.48 Monitoring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW. India. 1997.99 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW. India, 1997.

100 Monitoring of Iodised Salt reports, NIDDCP, DGHS. MoHFW. India. 1997.100 Monitoring ol Iodised Salt reports. NIDDCP, DGHS. MoHFW. India. 1997.100 Monitoring of Iodised Sail reports. NIDDCP. DGHS, MoHFW, India, 1997.88 Monitoring of Iodised Salt reports, NIDDCP, DGHS. MoHFW, India, 1997.

100 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW. India, 1997.97 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.

101 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.99 Monitoring of Iodised Salt reports, NIDDCP. DGHS, MoHFW. India, 1997.96 Monitoring ol Iodised Salt reports, NIDDCP. DGHS. MoHFW. India, 1997.

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I fttf tint' in USl f\'aliMli(m u»tl tit ii\>tla\f Chilillnfit

Karhi-anglongNoithCachar HillsKaiimgnnjCacharJamnagarRajkotSurendranagarBhavnagarAmreliJunagailiBanas-kantliaSahar-kanthaMahesanaGandhinagarAlimedahadKhedaPanch-malmlsVadodaraBhaiuchSuialValsaclTho-dangsArnhalaKuiuksholiaKailhalRohlakMahendragarhIlissarClianihaKangra1 lamirpurUnaBilaspurMandiKulluSolanSirmaurBangalore RuralChikmagalurDakshin KannadKodaguShimogaUtlar KannadGwaliorShahdolRallam

100 Moniloiinij of Iodised Sail lepnits. NIDDCP, DGHS. MollFW. India, 1997.98 Monitoring of lodisod Salt reports, NIODCP, DGHS. MoilFW, India, 1997.

100 Monitoring ol lodisod Sail reports, NIDDCP. DGHS. MollFW, India. 1997.100 Monitoring ol Iodised Salt reports, MIDDCP, DGHS, MoHFW. India. 1997.95 Monitoring ol Iodised Sail reports. NIDDCP, DGHS. MoHFW. India. 1997.73 Monitoring ol lodisod Salt reports, MIDDCP, DGHS, MoHFW, India. 1997.93 Monitoring of lodisod Salt reports. NIDDCP, DGHS, MoHFW, India, 1997.76 Monitoring ol Iodised Salt ropoils, MIDDCP, DGHS, MoHFW, India. 1997.70 Monitoring of Iodised Sail repoits, NIDDCP, DGHS, MoHFW. India. 1997.90 Monitoring of Iodised Salt reports. NIDDCP, DGHS, MoHFW, India, 1997.93 Monitoring of Iodised Salt reports. NIDDCP, DGHS, MoHFW, India, 1997.

100 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.97 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.85 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW. India. 1997.97 Monitoring ol Iodised Salt reports, NIDDCP. DGHS, MoHFW, India, 1997.96 Monitoring of Iodised Sail reports, NIDDCP, DGHS, MoHFW, India. 1997.81 Monitoring ol Iodised Sail reports, NIDDCP, DGHS, MoHFW, India, 1997.92 Monitoring of Iodised Sail reports, NIDDCP, DGHS, MoHFW, India, 1997.90 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.73 Monitoring ol lodisod Salt reports. NIDDCP, DGHS, MollFW. India. 1997.69 Monitoring ol Iodised Salt ropoils, NIDDCP, DGHS. MoHFW. India. 1997.60 Monitoring of Iodised Salt reports. NIDDCP, DGI IS, MoHFW. India, 1997.99 Monitoring of Iodised Salt reports. NIDDCP, DGHS. MollFW. India, 1997.98 Monitoring ol Iodised Salt reports. MIDDCP, DGI IS, MoHFW. India. 1997.97 Monitoring ol Iodised Salt ropoils, MIDDCP, DGHS. Mol IFW, India. 1997.82 Monitoring ol Iodised Salt lepoits. NIDDCP. DGHS. MoHFW, India. 1997.86 Monitoring ol Iodised Salt repoits, NIDDCP, DGHS. MoHFW, India, 1997.

100 Monitoring ol Iodised Sail repoits. MIDDCP, DGHS. MoHFW. India. 1997.99 Monitoring ol Iodised Salt reports, MIDDCP, DGI IS, Mol IFW, India, 1997

100 Monitoring ol Iodised Salt reports, MIDDCP, DGHS, MoHFW, India. 1997.100 Monitoring of Iodised Salt repoits, MIDDCP. DGHS. MoHFW. India. 1997.99 Monitoring of Iodised Salt lepoits. MIDDCP. DGHS. MoHFW, India. 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India. 1997.100 Monitoring ol Iodised Salt reports, MIDDCP, DGHS. MoHFW. India, 1997.99 Monitoring ol Iodised Salt reports, MIDDCP, DGHS, MoHFW, India, 199765 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW. India, 1997.100 Monitoring ol Iodised Sail leporls, NIDDCP, DGHS, MoHFW. India. 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW, India, 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.100 Monitoring ol Iodised Salt reports. MIDDCP. DGI IS. MoHFW. India, 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.99 Monitoring ol Iodised Salt reports. NIDDCP, DGHS, MoHFW, India, 1997.99 Monitoring ol Iodised Salt repoits. NIDDCP. DGHS, MoHFW, India, 1997.

100 Moniloring ol Iodised Salt reports, MIDDCP. DGHS, Mol IFW, India. 1997.

i./n h. //./UK./,. I.I j../in-./ia(l i,,.- ./.nil byi-t'unliy/iliarii-lj'ia-uit: in IISI cvnlMiliun ainl In ui-itnlt: CliilJInJ'u

IndiaIn, inIndiaIndiaIndiaIndiaIndiaIndiaIlidla

IndiaIndiaIndiaIndiaIndiaIndiaIndiaIndiaIndi.iInduIndiaIndiahull.,IndiaIndiaIndiaIndiaIndiaInduImliaIndiaIndiaIndiaIndiaIndiaIndiaIndiaIndiaIndiaIndiaIndiaImliaIndiaIndiaIndiaIndiaIndia

Madliya PiadurJiMadliya HrudoshMailliya PfadusllMaharashliaMaharashliaMahaiashliaMaharaahlraMuliarashtraMaliarashlraMaharashlraMahaiashtraMaliarashlraMaharashlraMaliarashlraMaliarashlraMaliarashlraMaharashliaM.iliaiashlraMali. tiasl iliaMaharashliaManipurManipurManipurManipurManipurManipurManipurManipurMi>jhalayaMuijhalayaMucjhalayaMcghalayaMiAiramMi/oramMiAiramSikkimSikkimSiKkimSikkimWusl BengalWust BengalWust BengalWcisl BengalWusl BunijalWust BengalWusl Bengal

DharVidishaBaslarThaneHalnagiriNaslukDhulaJalgaonSalaraAurangabadJalnaNandedLalurBuldanaAntravatiYavalmalWarilhaNaypurBhandaruGadchiroliSenapaliTamemjlongCluiiauhandpurChandulThoutialBishnupurImphalUklmilEast Khasi HillsWest Khasi HillsEast Garo HillsWast Garo HillsAizawlLungleiChhimluipuiNorth

. EastSouthWestKoch-hiharJalpaiguriDarjilingWest DinajpurNadiaPuruliyaBiibhum

100 Monitoring ol lodisod Sail reports. NIDDCP. DGHS. MoHFW. India. 199799 Monitoring ol Iodised Sail reports, NIDDCP, DGHS, MoHFW, India. 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP. DGHS, MoHFW. India. 1997.100 Monitoring ol Iodised Salt reports. NIDDCP. DGHS, MoHFW, India. 1997.100 Moniloiiny ol Iodised Salt repents. NIDDCP. DGHS. MuliFW, India, 1997.100 Monitoring of Iodised Salt reports. NIDDCP, DGHS, MollFW, India, 1997.100 Monitoring of Iodised Salt reports. NIDDCP, DGHS. MoHFW. India, 1997.100 Monitoring of Iodised Salt repoits, NIDDCP, DGHS. MoHFW, India. 1997.100 Monitoring of Iodised Sail reports, NIDDCP. DGHS, MoHFW, India, 1997.100 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.100 Monitoring ol Iodised Sail repoils, NIDDCP, DGHS, MoHFW, India, 1997.100 Monitoring ol Iodised Salt reports. NIDDCP, DGHS, MoHFW, India, 1997.100 Monitoring ol lodisod Sail repoits. NIDDCP, DGHS, MoHFW, India, 1997.100 Monitoring ol Iodised Salt repoits, NIDDCP. DGHS, MoHFW, India, 1997.100 Moniloring ol Iodised Sail repoils, NIDDCP, DGI IS, MoHFW, India, 1997.100 Monitoring ol Iodised Salt repoits, NIDDCP, DGI IS, MoHFW, India, 1997.100 Moniloring of Iodised Salt ropoits. NIDDCP, DGI IS. MoHFW, India. 1997.100 Moniloring of Iodised Salt ropoils, NIDDCP, DGI IS, MoHFW, Imlia, 1997.100 Monitoring ol lodisod Sail lopoils, NIDDCP, DGHS, MoHFW, India, 1997.100 Moniloring ol Iodised Sail repoils, NIDDCP, DGHS, Mol IFW, Imlia, 1997.100 Monitoring ol Iodised Sail repoits, NIDDCP, DGHS, Mol IFW, India, 1997.100 Monitoring of lodisod Salt repoils, NIDDCP, DGHS, MollFW. India. 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, Mol IFW, India, 1997.100 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India. 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India. 1997.100 Monitoring of Iodised Salt repoits, NIDDCP, DGHS, MoHFW. India, 1997.100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW, India. 1997.100 Moniloring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW. India. 1997.100 Moniloring ol Iodised Sail reports, NIDDCP, DGHS, MoHFW, India. 1997.99 Moniloring ol Iodised Salt reports, NIDDCP, DGHS. MoHFW. India, 1997.

100 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India. 1997.96 Moniloring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India. 1997.

100 Moniloring ol lodisod Salt reports, NIDDCP, DGHS, MoHFW. India. 1997.99 Monitoring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW. India. 1997.

100 Moniloring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.92 Moniloring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, Imlia. 1997.92 Moniloring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW. India. 1997.98 Moniloring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.97 Moniloring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, Imlia. 1997.70 Moniloring of Iodised Salt repoits, NIDDCP. DGHS, MoHFW, India, 1997.76 Moniloring ol Iodised Salt reports, NIDDCP. DGHS. MoHFW. India, 1997.78 Monitoring of Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.70 Moniloring of lodisod Salt reports, NIDDCP, DGHS, MoHFW. India, 1997.70 Monitoring of Iodised Salt repoits, NIDDCP. DGHS, MoHFW, India, 1997.92 Moniloring ol Iodised Salt reports, NIDDCP, DGHS, MoHFW, India, 1997.76 Moniloring of Iodised Sail repoits, NIDDCP. DGHS, MoHFW. India. 1997.

.\l-l'fn.in 1: ll:'t<u-li,J.tii*liir,li,ili,,!.,-,t.u,,l'V,;>uian/<liai-iflfiirusriH USI milualiim <uul n> iîrfnre ChiMlnfii

014620152-101015240.10152407015240201524050152408015241 1015241401524030152406015240901524100152413

01 586

0158601

0158(303

0158601

0 1 5860 J01144

MaldivesNopalNo mlNo mlIII' Ul

(Jo mlNo mlNo mlNopalNopalNopalNopalNepalNepal

Pakistan

Pakistan

Pakistan

Pakistan

PakistanSii 1 anka

Eastern MounlainConlial MountainWosloin MounlainEastern MillCenlial 1 liltWeslomllillMill Western HillFar-Western MillEastern TeiaiCenlial TeraiWestern TeraiMid Western TeraiFar-Western Terai

Punjali

NWFP

Balochistan

Sinilh

6692918694939094939894919690

2

2

5

2

2-

2<1

18

3<1

19

1646

1997 Statistical Yearbook ol the Customs Department. Maldives, 1997.Family Health Survey, 1996, Family Health Div., DolHS. MoH, Nepal; New Era; DHS, 19Family Health Suivoy. 1996, Family Meallli Div., DolHS, MoH, Nepal. New Era; DHS, 19Family Health Survey, 1996, Family Meallli Div.. DolHS, MoH, Nepal, New Era; DHS, 19Family Health Survey, 1996, Family Health Div., DolHS. MoH, Nepal; New Era; DHS. 19Family Health Survey. 1996. Family Health Div., DolHS, MoH. Nepal; New Era; DHS, 19Family Health Survey, 1996, Family Health Div., DolHS, MoH, Nepal; New Era; DHS. 19Family Health Survey, 1996, Family Health Div., DolHS, MoH. Nepal; New Era; DHS, 19Family Health Survey, 1996, Family Health Div.. DolHS, MoH. Nepal; New Era; DHS, 19Family Health Survey, 1996, Family Health Div., DolHS, MoH, Nepal, New Era; DHS. 19Family Health Survey, 1996, Family Health Div., DolHS, MoH, Nepal; New Era; DHS, 19Family Health Survey, 1996, Family Health Div.. DolHS, MoH, Nepal; New Era; DHS, 19Family Health Survey, 1996, Family Health Div., DolHS. MoH, Nepal; New Era; DHS. 19Family Health Survey, 1996, Family Health Div., DolHS, MoH, Nepal; New Era; DHS, 191996 Appraisal ol IDD Control Programme, UNICEF and Nutrition Section,Planning and Development Div.. Pakistan, 1996.1996 Appraisal ol IDD Control Programme, UNICEF and Nutrition Section,Planning and Development Div.. Pakistan, 1996.1996 Appraisal o( IDD Control Programme, UNICEF and Nutrition Section,Planning and Development Div., Pakistan, 1996.1996 Appraisal of IDD Control Programme. UNICEF and Nutrition Section.Planning and Development Div.. Pakistan, 1996.1996 Appraisal ol IDD Control Programme, UNICEF and Nutrition Section.Planning and Development Div., Pakistan, 1996.Survey ol vitamin A status and selected mid-decade goals, 1995, MF1I, Mot I. Sii Lanka.

'•-"•'1 iwu.1^ r*-*->•* f-f^t IKV-:

Appendix F

Attribute scores compared to maximum possible -Bangladesh

,/\f </<r J?

J</• /& *° ^ c/ ^^ X #p^ / J#

Attribute scores compared to maximum possible - Bhutan

i_

Attribute scores compared to maximum possible - India

• MAX• PandavDvd Haar• Greaves• Houston• Haxton

99

Attribute scores compared to maximum possible -Maldives

vS /* X Sj& '/ •^ */s

#// *f&/

• MAX

• PandavDvd Haar• Greaves• H o u s to nH H a xto n

Attributes scores compared to maximum possible -Nepal

^

•V <$" •!$X X S&

i& tip

• MAX

• PandavDvd Haar• Greaves• HoustonB H a xto n

Attribute scores compared to maximum possible -Pakistan

&

• MAX• PandavDvd HaarHGreaves• HoustonBHaxton

inn

Attr ibute scores compared to maximum possible -Sri Lanka

• MAX• PandavDvd Haar• Greaves• Houston• Haxton

101

$

COUNTRY: GREAVES - BANGLADESH .-'.";- • :

ATTRIBUTE1 Appropriate legislation

and regulations

CRITERIAnational in scope

applies to all edible salt, including salt(or animalsprescribes concentrations or iodine atproduction, retail and nousenoid level

specifies requirements tor pacxagingand labelling

POINTS

55

5

4

a

1

3

2 1

prescribes monitoring procedures | | 4 | | |soec:ties responsibilities for'nspection

.1

specifies penalties 'or violations | 5 | j

0 WEIGHTS0.15

0.10

0.15

0.15

SCORE0.75

0.50

0.60

0.45

| 0:0 | 030

1

2 Enforcementprocscures

3 Suomy at loaiseasail

a Monitoring system ;orioaisea salt at aroductionlevsi

5 Availaoility of ioaised saltat housenoid level

5 IEC activities

7 Monitoring of 100

8 National planning andcoordinating mecnanisms

9 Sustamaoiliry

infringements identified1

successful orosacutions | 1 | I 1 1 0

sufficient capacity ;o ôaise ail ediblesaltactual salt supply of iocised sailsufficient for needspercentage of sail effectively 'catsaa

5

"4

1I

0.15 O.SO

0.10 | 0.50

ATTRIBUTEWEICiHTS

FINALSCORE

t .OO | 420 1 0.130 | 0.5« |

0.60

0.401.00

0.50

0.00

I

0.50 | 0.080 0.048 |

1j 0.20

plan for monitoring (internal andexternal)

guidelines forprocadures

regular reportseffective supervision, including reviewof trainingevidence of follow-upaction

plan for monitoring at retail andhousenoid levelmomtonng system in place anaoperating regularlypercentage of households usingadequately iodised salt

effective advocacy addressed to a)policy makers, b) salt manufacturers,c) public and opinion leaders

emphasizes 100 and role of iociseasaltsupport to training and trainingmaterials

4

|

J

3 1-)

1

_j

4

4

*

1

3

3

recognition of USI as a component otan 100 elimination programmeplan for systematic monitonng ofurinary iodinelaooratones for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of ICOstatus by thyroid size and function at

3

*

reports or outcomes | 1 i I 1 '.

estaolisnment of nign-'evei

evidence of effective committeeactioncomprehensive national plan of action

5 !ii -*

2

0

a

0.20

0.50

1.00

0.30

2.40

1.00 | 4.20 | 0.140 0.538 ii

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

O.SO

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.1S

| 0.15

assured funding (Ihrougn compinationot external, internal and intrinsicsources)

4

1.00

0.50

0.30

0.600.40

0.20

2.50

0.40

1.20

2.40

Joo I

1.50

O.SO

0.90

3.20

0.80

0.00

1.25

0.00

0.152.20

0.120 0.312 |1

0.150 i 0.500

0.120 |

0.080

0.384

0.<75 |———————— - - !

I0.20

0.30

0.40

1.00

o.60

0.40

1.50

0.60

1.50

3.70 | 0.030

2.40

o.ao

1

•3225

COUNTRY: GREAVES -BHUTAN

ATTRIBUTE

regulations

aroceaures

salt

CRITERIA

applies to all adibla sail, including saltfor animalspresences concentrations at :ca:ne ataroduction, retail and household level

soectiss requirements ror nacKagingand laoeilinqpresences monitoring proceduresspecifies responsibilities for inspection

scecifies penalties for violations

s

3

1 1

4

i

1 3

3

1 ,

J

t

I

t

I

CRITERIAWEIGHTS

o.is

0.10 .

O.lj

0.15

1 i I 0.200.15

! 4 . i | I i o.io

i 3

SCORE0.73

0.40

0.73

0.20

0.300.45

0.40'.co i 3.35

ATTRIBUTEWEIGHTS

o.:-o

FINAL

0.473

0.30

succassrui orosecuticns | | , -, , | | | 0 40

sail

sufficient for needspercentage of salt srfectiveiy 'odisea a

, !4.

!

|1 i

L

1.30

'.201 .00 | 3.00 O.G80 024 :

0.20 0.30

0.20 0.30

0.60 I 3.00

I.-O i -».50 1 0.140 j 0.3JJ |

4 \iciiitonng svstam rcr:ccised sail at production'avei

1

|5 Availarjiiitv ot iodised salt

at housenold level

5 iSO acavities

17 Monitoring of 100

8 National planning and-oordinating mecnanisms

pian rcr monitonng linternai anaexternal)

guidelines :orprocecures

regular reoortseffective supervision, mcfucing reviewof trainingevidence of foilow-upaction

plan ;or monitonng at retail andhousencld levelmonitonng system in place andoperating regularlypercentage ot households usingadeauatelv iodised salt


emphasizes 100 and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan IOO elimination programmeplan for systematic monitonng ofunnary iodinelaooratones for measunng unnaryiodine, with equipment and trained staff

plan for periodic assessment of 100status by thyroid size and funcscn atpeculation levelreoorts or outcomes

estaolisnment of high-level mteragencycommitteeevidence of •jrfectrve committee action

comprehensive national plan ot action

1

5

5

5

5

5

•*

4

1

4

1

4

4

4

4

4

1 3

i 3

1

1

1

\

2 1

1

|

1

I

1

|

1

|

j

1

0

0

1j

1

0.20

0.20

| 0.20I 0.20

0.20

| 1.CO

I 0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.15 1130

0.30

0.20 1

0.40

1 .00 1

0.30

0.30

| 0.600.30

0.60

I 3.50

[ 0.50

1.50

2.40

4.40

2.50

1.00

1.20

4.70

0.30

0.00

1.25

0.00

0.302.35 |

1.20

1.20

1.20

330 I

0.120

0.150

0.120

0.030 |

o.oao i

0.432

0.560 |

0.534

0.138 |

') 211 \

3 Sustamaoiiity assured funding (tnrouqn comomanonof external, internal and intnnsicsources)political commitment 3

4

I

0.150

| 040

1.00

2.40

2.00440 0.100 0440

| 3331

COUNTRY: GREAVES - INDIA

ATTRIBUTE1 ADproonats legislation

and regulations

procedures

3 Sucsiy of icoisedsalt


applies to all eaible salt, including sailfor animals

prasc.-ioes concentrations or .odine atproduction, retail and housenold level

specifies requirements ror packagingand laoelling

POINTS

*

a

1 ,-

a

presences monitoring prccecuras | | ispecifies responsibilities ror jinspection |specifies penalties ror violations |

*

1 3

3

- I

2 1 0

i

J

successful orosecutions | i .'

sufficient capacity to iocise ait eoipfesaltactual sail suopty ot lociseo saltsurficient for needspercentage of salt effectively iodised

5

|

4

3 |

I

CRITERIAWEIGHTS

0.15

0.10

j.;s

0.15

0.200.15

0 10. •JO

SCORE0.60

0.30

0.75

0.30

0.30O.iO

0.40

ATTRIBUTEWEIGHTS

-1.05 | 0.13Q

FINALSCORE

0.527 i

1o.so 1.30

0.40 1 O.-tO'.00 J 2.20 1 0.030 | 0.173 !

1

1

0.20

0.20

o.ao

t.oo

o.ao

1.30 I1

j '.'JO ! 3.iO 1 0.1 .10 1 9.3C4 !

4 Monitoring system roriodised salt at production'avel

i

5 Avaiiaoiiity of icdisec sailat Household level

S !£C activities

plan ror monitoring (internal andexternal)

guiaeiines rorprocedures

regular reportseffective supervision, including reviewof trainingevidence of :oilow-upaction

I I

o

3

1 3

1

•7

2

1

plan :or monitoring at retail andhousenold levelmonitoring system in place andoperating regularlypercentage or households usingadequately iodised sait

J

4

3

effective advocacy addressed t'o a)policy makers, b) salt manufacturers,c) public and opinion leaders

emphasizes IOO and role of iodisedsaltsupport to training and trainingmaterials

3

4

J.

7 Monitoring of ICO recognition of USI as a component ofan IDO elimination programmeplan for systematic momtonng ofunnar/ iodineaooratortes ;or measuring urinaryoaine. with equipment and trainedstaffpian ror penocic assessment of SCOstatus Sy thyroid size and 'uncion atpooulation levelreports ot outcomes |

1

1

3

3

' 1 1 |

0.20

0.20

i 0.200.20

0.20

( 1.00

O.SO

0.50

0.600.40

0.40

2.50 i 0.120 | 0.312

0.10

0.30

0.60

1.00

0.40

0.90

2.40

3.70 0.150 0.555 |

0.50

0.20

0.30

| 1.00

2.50

0.30

1.20

4.50 | 0.120 | 0.540

10

0

0.20

0.25

0.25

0.15

0.30

0.00

0.75

0.00

1 | I 0.15 I 0.15 || 1.00 | 1-50 | Q.G30 i 0 :20 |


9 Susramaoiiity

estaciisnmem or tiign-iaveiinteraqancv committeeeviaanca or effective cammicreeactioncomorenensive national sian Qf Jc::cn

ass urea funding ithrougn comomatianof external, internal and intrinsicsources)

-

3

3

°

0.30

0.30

0.40

1.00

O.tiO

1.20

0.00

1.20

2.40

1.30

ocao 3.: 32

COUNTRY: GREAVES • MALDIVES

ATTRIBUTE

and regulations

procedures

3 Succiy or loc-isecsail

CRITERIA

applies 10 all edible salt, including saltfor animalspresences concantranons or iodine at^reduction, retail and housenold level

specifies requirements for pacxagingand laceHingpresences monitoring proceduresspecifies responsioilities :ornsoection

POINTSS 4 3 2 1

i\ 1 1

specifies penalties tor violations | | |

00

0

•3

°

1 )0

1 i 0

successful prosecutions ! i 1 1 1J

0

.

sufficient caoaciry to iodise ail eoibiesaltactual aait suopiy or iodised saltsufficient for needspercentage of salt effectively icoisea 1

0

1

CRITERIAWEIGHTS

0.15

0.10

0.15

0.15

uo0.15

O.IO1.30

SCORE000

0,00

0.00

o.co

o.co0.00

0.000.00

ATTRIBUTEWEIGHTS

FINALSCORE

0.120 j J.CCO

OdO

O.-iOt .JO

0.00

0.00o.co o.ceo 0.030 |

10.20

0.20

O.oO

1.00 |

0.00

0.20

0.60

0.30 | 0.140 j 0.112

la Monitoring system roriccisea salt at productionlevel

5 Avaifaciiity of ioaised saltat household level

5 1EC activities

7 Monrtonng or 100

3 National planning andcoordinating rnechanisms

pian tor monitoring (internal anaexternal)

guidelines ;orprocedures

regular reports |effective supervision, inducing reviewof trainingevidence or roiiow-upaction

i i i

0

0

0.20

0.20

1 0 | 0.20

1 °

0

plan for monitoring at retail andhousenold levelmonitoring system in placa andoperating regularlypercentage of housenolds usingadeduately iodised salt

00

0

effective advocacy addressed :o a)policy makers, b) salt manufacturers,c) public and opinion leaders

emphasizes 100 and role of ioaisedsaltsupport to training and trainingmaterials

- 2

2

2

recognition of USI as a component ofan 100 elimination programmeplan for systematic monitoring ofurinary iodinelaooratones for measuring unnaryiodine, with equipment and trainedstaffpian for periodic assessment at ICOstatus by thyroid size and function atpeculation level

4

11

0

0

0

0.20

0.20

0.00

0.00

0.000.00

0.00

t.OO | 0.00 0.120 o

O.IO

0.30

0.50

0.00

0.00

0.00

1.00 | 0.00 | 0.150 0.000 j

0.50

0.20

0.30

1.00

1.00

0.40

0.50

2.00 0.120 0.2*0

0.20

0.25

0.25

0.15

recoils of outcomes | | | ; 1 1 1 1 0.15 |

estaoiisnment or hign-ievelmeraqencv committeeevidence of effective committeeactioncomprehensive national oian at action I

|

1! i

• ! I! ! : !

1. I 0

0

0.30

0.00

0.00

0.00

Q.!5t.OO I 0.95

0.30

0.20

0.40

| '00 |

0.00

0.00

1.20

Io.cao | oo"6 |

1 20 | 0.080 | <).75ti 1

9 oustainaoility assured tunamg (tnrougn comomationat external, internal and intrinsicsources)political commitment

3

1 i

O.dO

0401.00

1.30

0.402.20 0.100 0220

COUNTRY: _GREAVES • NEPAL -- . :

ATTRIBUTE

and relations

procedures

sail

1

ioaised salt at productionlevel

at household isvel

-.

7 Monitoring of ICO i

fL

1

!

I

P

r

CRITERIA

apqiias to all adiola salt, inducing salttor animals |

prescribes concentranons of iodine at Iproduction, retail and househcid i«v»i

1specifies requirements for packaging 1and labelling |

POINTS

5 4J

3

3

3

i

prescribes monitoring procedures | I isoecifies resoonsibiiities forinspectionsoeenes penalties ror violations 1

I

I !

2

\

t

1

0

0

— CRITERIAWEIGHTS

o.ts

O.iO

0.15

0.15

I 2 | | I 0.20

-

1 1

0.15

| 0 | O.iO| 1.00

infringements identified ""

successful prosecutions • | " I i 1

(

O.dO

| 0 1 O.JO

SCOREOoO

0.30

O.JS

0.00

040

0.20

ATTRIBUTEWEIGHTS

I

0 CO i

FINAL_ _ _ SCORE

2.0o | 0.130 | o?57

0.50

| 0.00| 1 00 | 0.30 j J.080

surficient capacity to iodise all sdibiesaltac.ual salt suooiy of iodised saltsufficient for needspercentage of salt effectively iodised

4

3

3

Ipian ror monitoring (internal andexternal)

guidelines forprocedures

regular reoorts Ieffective supervision, including review 1of training |evidence of follow-upaction

4

4

3

3

3

plan ;or monitoring at retail andhousehold levelmonitoring system in place andoperating regularlypercentage of housenolds using 1adeauately iodised salt |

33

3

effective advocacy addressed to a) 5policy makers, b) salt manufacturers,c) public and opinion leaders

smpnasizes 100 and role of iodisedsaltsupport to training and training•natenals

4

J.

ecogmtion of USI as a component ofin 100 elimination orogrammelan for systematic monitoring ofrinary iodine

aporatones for measuring •jrmaryDdine. with equioment and trainedtarflan for periodic assessment of '.CO 1talus ay thyroid size and function at Iopulation level {

^

4

sports cf outcomes | | I 3 I

2

I

0.20

0.20

I 0.60

| 1.00

0.60

0.30

3.00

440

| 0.048

I 0.140 | 0.5H I1

0.20

0.20

0.200.20

0.20

1.00

O.SO

0.30

0.30O.SO

0.60

3.40 | 0.120 | Q.403

0.10

0.30

0.60

1.00

0.30

0.90

1.30

3.00 0.150 0.4SO

0.50

0.20

0.30

[ t.oo

2.50

0.80

1.20

4.50 0.120 | 0.54O

0

0.20

• 0.25

0.25

0.15

i | 1 O .TS |

coordinating mechanisms ireac

9 Sustainabihry a0

3(

staonsnment of hign-ievelteraqency committeevidenca of effective committee 1crion 1jmprenensivn national plan •;[ icricn

3

1

i

ssured funding (througn comomationexternal, internal and mtnnsic

3UrC93)

I

-I 1

1

o

0.30

0.00

1.00

0.30

0.43

| 100 ! 2.55 I 0.080 | 0.204 |

0.30

0.20

0.40

j 1.00

0.90

0.30

O.dO

2.00 0.080 |

I0.60 1.20

0.16

COUNTRY: GREAVES - PAKISTAN

ATTRIBUTEt Appropriate legislation

and regulations

2 :irifOrC3rrentprocedures

3 Succiy or iodisedsalt


aoplies to all edible salt, including saltfor animalspresences concentrations of iodine atproduction, retail and household level

specifies reauiremants ror 3acKag:ngand lacellingpresences monitoring proceduressoec:ties responsibilities ;ornsoectionspecifies penalties for violations

-.. .. POINT'5

5 4 33

3

3

2

I 1 22

1 1

1 0

0

1 o

infringements ;dentifiea

successful arosacutions |i

1 1 )

.sufficient capacity to iodise ail ediblesailactual salt supaly of iodised sailsurficsm far needspercentage of salt effectively iodised

ai

I0

CRITERIAWEIGHTS

0.15

0.10

O. :s

J.15

O.JO0.15

SCORE0.4S

0.30

0.4S

oca

0.40

0.20

0 1 0 ! 0.001 00 1.30

ATTRIBUTEWEIGHTS

0.130

RNALSCORE

0.247 |

0.50

0.40

0.50

0.001.00 I 050 O.C30 i 0.043 j

10.20 | 0.30

0.20

0.60

i 00 I

0.40

0.00

1.20 |

-

0.140 | 3.133

4 Mcnironng system rorRaised salt at production:evei

[5 Availaoiiity of iodised saltat household level

6 lEC activities

7 Monitonng of ICO

I

3 National planning andcoorainatmg mecnanisms

9 5u3tamaoility

pian ,-or monitoring (internal anoexternal)

guidelines rorprocedures

regular reoonseffective supervision, including reviewof 'rainingevidence of roilow-upaction

plan ror monitonng at retail andhousehold levelmonitoring system in placa andoperating regularlypercentage of households usingadeouately iodised salt

affective advocacy addressed to a)policy makers, b) salt manufacturers.c) public and opinion leaders

emphasizes IOO and rale of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan IOO elimination programmeplan for systematic monitoring ofurinary iodinelaooratones for measuring unnaryiodine, with equipment and trainedstaffplan for periodic assessment of ICOstatus py thyroid 5129 and function atpopulation levelreoorts 3f outcomes

estaolishment of high-levelnteragencv comrrufieeevidence of effective committeeactioncomprehensive national plan of action

assured funding (through combinationof external, internal and intnnsiccourcasipolitical commitment i

4

4

4

4

-

1

3

3

I 3

I 3

3

3

3 I

3

T I

,

1

1

<

1

!

II

I

0

0

a

I

I

O.-O

0.20

| 0.200.20

0.20

1.00

o.io

0.30

0.50

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.20

0.30

0.20

O.-O

1.CO |

0.50

0.401.00

0.50

0.50

| 0.501 0.50

0.20

| 2.50

0.20

0.30

0.60

1.10

2.00

0.80

1.20

4.00

0.30

O.CO

0.75

O.CO

O.CO1.55

1.20

0.90

1.20

3.20

1.30

1.203.00

0.120

0.150

0.120

0.080 |

0.080 |

i

0.100

I 0.312

3. -55

0.430

0.124

0254

0200

COUNTRY: GREAVES - SRI LANKA


and regulations

2 enforcementprocedures

3 Suopiy of ;oaisedsalt

4 Monitoring system roriodised salt at productionlevel

5 Availaoility of iodised saltat nousenoid !evel

6 IEC activities


aooiies to all ndiSle sail, including 331for animalspresences concentrations or ioaina atproduction, retail and household level

specifies requirements 'or pacxagingand laoeiling

POINTS

S5

5

|

4 3

4

Iprsscnoas monitoring procedures | ] 4 |specifies responsioihties forinscection |

4

soeefies penalties for violations | j 4 |

2

-

1 0- CRITERIA

WEIGHTS0.1S

| 0.10

0. '3

0.15

SCOREo.rs

0.50

0.30

O.sO

| | | -),20 | o.ao0.15 1 0.50

ATTRIBUTEWEIGHTS

I | | | 0.10 | 0.40

infringements identified 3

successful orosec'Jtions | | | | 2 1

FINALSCORE

| 1.00 | 3.3a | 0.130 j 0.514

0.50 1.30

j | 040 | 0.30

sufficient caoaory to ioaise ail ecibiesaltactual salt supply of iodised saltsufficient ror neeaspercentage of salt affectively :oaisea

33

I

| 100 | 2.50 | 0080 I 0.2C8

0.20

0.20

0

pian ror monitoring (internal anaexternal)


regular reportsaffective supervision, inducing reviewof trainingevidence of foilow-upaction

!|

1

1

1

0

0

plan for monitoring at retail anahousehold levelmonitoring system in place ardooerating regularlypercentage of householcs usingadequately iodised salt

1

11


empnasizes 100 and roie of ioaisadsaltsupport to training and trainingmaterials

7 Monitoring of IDO recognition of USI as a component ofan IDO elimination programmeplan for systematic monitoring ofurinary iodineaooratones for measuring urinaryodine. with equipment and trainedstaffpian ror oencoic assessment of ICOstatus Sy thyroid size ana "unction atpeculation level

4

3

4

2

1

O.oO

0.50

0.50

0.00

1.00 | 1.20 | 0.140 0.1 S31

J.20

0.20

0.200.20

0.20

0.20

0.20

0.000.20

0.00

1.00 0.60 0.120 0.072

0.10

0.30

O.SO

| 1.00

0.50

0.20

0.30

•(_ 1.00 |

0.10

0.30

0.50

1.00 | 0.150 | 0.150

1.00

0.80

0.90

2.70 0.120 | 0.32-s

0

0

0.20

0.25

0.25

0.15

0.30

0.00

0.25

0.00

onnrK if n,,lrw™« | | | | | | 0 1 0.15 ] 0-00

0.080 | Q.C8J j


9 Sustamaoility

estaolisnmant of hign-ieveiinreragency committeeevidence of rjrfectrve committeeactioncomorenensive national îan or action

assured funding (through comomationof external, internal and intrinsicsources! ,._,

2

1

1

1

0.30

0.30

0.40

1.00

0.60

040

O.JO

0.30

0.30

1.40

O.tiO

o.ao

0.030 0.1121

I ———— ~ . : • . - . ''COUNTRY: HAXTON - BANGLADESHi| ATTRIBUTE

1 Aopropriate legislationand regulations

1!11

J2 fnforcementprocedures

11i1i|3 Supciy or :odisedi salt

1t|i

,4 Vionnonng sysiam for1 iodised sail ai productioni leveli

1

5 Availapility of iodised salt| at household level

ii

6 IEC activities

!

7 Monitoring of IOO

|

j1

1

3 National planning anacoordinating mecnamsms

CRITERIAnational m sccoe

applies to ail edible salt, including saltfor animalsprescribes concentrations of 'Odma atproduction, retail and household level

specifies requirements ;or pacKagingand labelling

"OIMTS

53

3

4

-1

3

3

|

2 1

prescribes monitoring procedures ! 1 I ispecifies responsibilities torinspectionspecifies penalties tor violations

1 I

f 1 1 1 1

0CRITERIAWEIGHTS

0.15

0.10

0.15

0.15

SCORE0.7S

0.50

0.45

0.50

0 | 0-0 I 0.000

1}

imnngements identified

successful prosecutions3 1 '

1 1 1 'J

sufficient cacacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for leedspercentage of salt effectively looisea

o

1 2

0

pian rar monitoring (internal andexternal)

guidelines :orprocedures

'

4

regular reports | | .1effective supervision, including review jof training |evidence of roilow-upaction

1

0.15 O C O

ATTRIBUTEWEIGHTS

0.10 | 0.00 |

FINALSCORE

j t.OO | 2.30 | O.:20 | 0.299

10.60 1.30

|

0.40 | 000 . !| T.OO I 130 1080 i d.'-u

0.20

0.20

O.aO

i i.oo

0.40

0.00

t.OO | '40 | 0.14Q 0.1961

0.10

0.20

1 1 °-20

1

0

plan for monitoring at retail andhousehold levelmonitoring system in place andoperating regularlypercentage of households usingadequately iodised salt

44

3

affective advocacy addressed to a)policy makers, b) salt manufacturers,c) public and opinion leaders

empnasizas 100 and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan 100 elimination programme •plan for systematic monitoring ofurinary iodinelacoratcnes for measunng unnaryiooine, with equipment and trainedstaffplan for periodic assessment of 1CDstatus py thyroid size and function atpeculation level

3

4

1

2

1

1

2

2

0.20

0.20

1.00

0.30

0.30

0.800.20

o.co

2.50 0.120 0.312

0.10

0.30

0.60

0.40

1.20

1.30

1.00 1 3.40

0.50

0.20

0.30

1.00

0.50

0.20

0.60

1.30

0.20

0.25

0.25

0.15

reports of outcomes i | i 3 j | | | 0. T5 |

estaoiisnment of hign-ievei jnteragencv committee 1evidence of effective committee 1action Icomprenensrve national plan or action

5 1| |

|

| 1

3 Sustamaoility assured funding (throuqn comDinationof external, internal and mtnnsicsources)political commitmant | j |

3

1 1 1

I

0 I

0

o.ao

0.50

1.25

0.20

0.45

1.00 | 3.30 |

0.150 0.510 |

0.120 | 0.155

0.030 | 0.254

0.30

0.20

0.40

1.50

0.00

O.CO

| :.;o | i.50 |

0.50

0.40

1.00

1.30

0.402.20

0.030 |f

0.100

a: 2

0220

COUNTRY: HAXTON - BHUTAN ' ". ' '"' '-.?'y

ATTRIBUTE

and regulations

procedures

sail

4 Monitoring system ;oriodised salt at productionlevel

at household level

6 IEC activities

'

7 Monitoring of 100

iI

'

CRITERIA

applies to all edible salt, including safor animals

presences concentrations ot icaine aproduction, retail and household leva

specifies requirements for packagingand labelling

POINTS

5

t

5

4

I t

I 4

3

prescribes monitoring proceaures | | |specities respansioiiities forinspection

4

1scecfies oenaities for violations | I i |

2

1

t

1

1

1

0

infringements identified 4

successful orcsecutions | | 1 3 ~"i ——— I I

sufficient capacity to iodise ail ediblesalt

sufficient for needspercentage of salt affectively iodised

4

4

1 -

|

external)


regular reportseffective supervision, including reviewof trainingevidence of foilow-upaction

"

4

* 13

3

plan for momtonng at retail andhousehold levelmonitoring system in place andoperating regularlypercentage of housenolds usingadequately iodised salt

4

33

effective aoVocacy addressed to a)policy makers, b) salt manufacturers,c) public and opinion leaders

emphasizes IDO and role of iodisedsaltsupport to training and trainingmatenals

3

4

13

ecogmtion of USI as a component ofjn IDO elimination programmejian for systematic monitoring orjrinary iodine

aooratones for measuring unnan/odine. -with equipment and trainedtarflan tor periodic assessment of :CD itatus by tnyroia size and function atooulation ievel

5

4

3

3

- CRITERIAWEIGHTS

o.ts

0.10

0.15

0.15

0200.15

| 0.10

1.00

0.60

| 0 -10

SCORE0.75

0.40

0.75

0.60

0.40

O.SO

) 0.40

| 3.30

2.40

I 1.20

ATTRIBUTE RNAL

0.130 | 0.507 i

1 LOO | 3.80 | 0.080 i Q"238

0.20

0.20

0.60

1.00

0.30

2.40

1.00 | 420 i 0.140 j 0.538 i|

0.20

0.20

0.200.20

0.20

1.00

0.30

0.30

0.800.50

0.60

3.50 0.120 0.432

0.10

0.30

O.SO

1.00 |

0.30

0.90

2.40

3.60 | 0.150 0.540

0.50

0.20

0.30

1.00

2.50

0.80

0.90

4.20 | 0.120 0.504

0.20

0.25

0.25

0.15

eoons of outcomes | j ! 3 1 i 1 1 0.15

coordinating mecnanisms ieac

0

3

staoiisnment or hign-ievelueraqency committeevidence of effective committeeciionomorenenaive national olan ot 3C:cn i

0

|

ssurad funding (through comomationf external, intarnal and intrinsicources)

1

4

3

3

L

1.00

0.75

1.00

0.45

0.451.00 I 3.65 | 0.080 | 0.292

0.30

0.30

0.40

1.00

1.50

0.90

1.60

4.00 0.080 |

i0.60 1.80

0.32

COUNTRY: HAXTON-INOIA " ' • • - . - • •

ATTRIBUTE1 Aoorooriata legislation

and regulations

2 inrorcememprocedures

3 Supply or iodisedsalt

CRITERIAnational tn scope

applies to all edible salt, including saltfor animalsprescribes concentrations ot iodine atproduction, retail and household level

specifies requirements tor pacxagingand labellingprescribes monitoring proceduresspecifies responsibilities forinspectionsoeeties penalties for violations

pniKiTS

5

infringements identified

successful prosecutions

44

3

3

2

2

2

3 .

t1

! 2 !

0

-

I I !

sufficient capacity to iodise ail eaiblesalt . .actual sail supply of iodised saltsufficient for needspercentage ot sail effectively loosed

a

4

3

CRITERIAWEIGHTS

0.15

0.10

o.is

0.15

o.:o0.15

0.101.00

SCORE0.30

0.20

0.4S

0.20

JSO0.30

0.202.55

ATTRIBUTEWEIGHTS

0.130

FINALSCORE

0.345

0.60

O.-iQ1 00

1.20

3. -to1.50 O.G80 0.:23

0.20

0.20

0.50

1.00 • |

1.00

0.30

1.30

3.50 0.140 0.504

4 Monitoring system roriodised salt at productionlevel

15 Availapility or iodised saltat household level

6 IEC activities

7 Monitoring of IDO

1i

3 National planning andcoordinating mechanisms

9 Sustatnapility

pian ror momtcnng înternal anaexternal)


regular reoonseffective supervision, including reviewof trainingevidence of foilow-upaction

pian tor moniionng at retail anahousehold levelmonitonng system in place andoperating rsguiarrypercentage of households usingadequately iodised salt

effective advocacy addressed to a)policy makers, b) salt manufacturers.c) public and opinion leaders

emphasizes ICO and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan IDO elimination programmepian for systematic monitoring ofunnary iodineiacoratones for measuring urinaryiodine, with equipment and trainedstaffpian for periodic assessment of ICDstatus &y thyroid size and function atpopulation levelreports or outcomes

estaolisnment ot hign-ievelimeraqencv committeeevidence of affective committeeactioncomorenensrve national plan of action

assured funding (through combinationof external, internal and intrinsiclourceslpolitical commitment

5

1

4

4

4

4

4

• 4

1

I

j

•» 1

3

33

3

3

3

3

-1

^ 13

i

1

|

1

1

2

I

1

I

i

1

' |

—4

J.20

0.20

0.200.20

0.20

I 1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.20

0.30

0.30

3.40

1.00

0.50

0.40

t.OO

0.30

0.30

0.600.60

0.50

| 3.20

0.40

0.90

2.40

3.70

2.00

0.30

1.20

•• 4.00

0.30

0.75

1.25

0.45

0.453.70

0.90

0.90

0.30

2.50 |

i.ao

1.60

3.40

| 0.120

0.150

0.120

0.080 |

0.080 j

1

0.100

0.384

0.555

1

0.480

0295

0.2C8

0.340

COUNTRY: _HAXTON - MALDIVES " • "r.1, ;'T •, ;• -- ,C -

ATTRIBUTE

and regulations

2 ^nrarcsmentprocedures

3 Sucoiy of ioaiseasait

iodised salt at productionlevel

at housanold level

•

CRITERIA

aoonas to all edible salt, including sailfor animals

prascnoas concentrations or looina atproduction, retail and household 'evel

specifies requirements for pacxagingand labellingprescribes monitoring proceduresspecifies responsibilities forinspectionspecifies penalties ror violations |

infringements identified ' ~

s 4 ) 31

1

1 1

1 1

2

|

1

1

1

00

0

0

0

— CRITERIAWEIGHTS

0.15

0.10

0.15

1 °-'3

0 | 0.200 0.15

| 0 | 0.10

1

1

sufficient caoacity ;o looisa ail edible ~sailactual salt supply of iodised saltsufficient for needspercentage of salt affectively iccised

11

0

j 1 00

0.50

I 0 | 0.40

1

0

0

1 °

external)


regular reportseffective supervision, including reviewof training

action

1

0

0

00

0

plan for monitoring at retail andhousehold leva!monitoring system in place andoperating regularlypercentage of households usingadequately iodised salt

00

0

L

policy makers, b) salt manufacturers,c) public and opinion leaders

emphasizes IDD and role of iodisedsalt

nateriais

3

3

2

£

ftFis

spT-

ecagnition of USI as a component ofn IOD elimination programmelan for systematic monitoring otnnary iodineaooratonas for measuring urinaryJdine. with equipment and trainedfafflan for periodic assessment at ICCtatus by thyroid size and function atooulation levelloans of outcomes

1~~o "

0

0

0

| 1.00

0.20

0.20

O.dO

| l.CO

O20

0.20

0.200.20

0.20

1.00

0.10

0.30

O.SO

1.00 |

O50

0.20

0.30

1.00 |

O20 "

0.25

0.25

0.15

0.00

0.00

0.00

o.co

0 00o.co

I o.co

•— — —— — —— — —— —

ATTRIBUTE

1

0.00 | 0.730 ——

~ o~co

1 o.oc1 o.oo

0.00

0.00

0.00

I o.co

oco

o.co

0.000.00

0.00

0.00

0.00

0.00

0.00

0.00

7!so

0.50

0.60

2.70

0.00

0.00 .

0.00

0.00

I 1 I 1 1 3 1 0.15 | 0.00 |1 -co I

ccorcinating mecnanisms in9

ac:

staolisnment of high-iaveiteraqencv committee/idanca ot affective committee:tionjmpranansiva national plan at ac:on

1 0 1

0

0

Lotsc

surad funding (tnrougn camoinationexternal, internal and intrinsicureas)

0

0.30

0.30

0.40

1.00

0.60

—— - —— ' ———— — —

J ________1 o.oao- ———————————— _

1 0.1 -10

FINAL1 SCOR

"1 ocoo— —

1 o.coo— - .—

i 0

0.120 | 0

0.150

0.120

o.oco

0.324

0.00 | 0.080 | OCCO

0.00

0.00

0.00

0.00

0.00

0.080 | r>

\

J

1J

1

COUNTPV: ' HAXTON - NEPAL - • - . . ' • • • .


ana regulations

2 enforcement,procedures

J3 Sucpiy or iocisedsalt

4 Monitoring iystam torioaised salt at productionlevel

5 Availaoility ot iodised saltat household level

6 IEC activities

7 Monitoring of IDD

1


1I

3 ousiainaoility


applies to all edible salt, including salttor animalsarescnbes concentrations of ioaine atproduction, retail and household level

specifies reauiremants for packagingand labellingpresences monitoring proceduresspecifies responsibilities tornsoectionspecifies Penalties ror violations

POINTS

So

5

4

4

3 2 t

I 1 3 1 |3

1 3 i |

0

0

CRITERIAWEIGHTS

0.15

0.10

0.15

0.15

| 0.20

infringements lOentified 0

0.15

SCORE0.75

0.50

0.60

0.00

0 600.45

J. 10 | 0.30

ATTRIBUTEWEIGHTS

FINALSCORE

1.00 | 3.20 | 0.120 | 0.413 \

0.60 0.00

successful prosecutions | | | | | | 0 I 0.40 | CWO

sufficient capacity to iodise ail ediblesaltactual sail suppiy oi iodised saltsufficient for needspercentage of salt erfsc:rvely ioaisea

4

pian ;cr monitoring (internal anaexternal)


regular reports |effactrve supervision, including reviewof trainingevidence of follow-upaction

plan for monitonng at retail andhousehold levelmonitoring system in place andcoerating regularlypercentage of households usingadequately iodised salt


emphasizes ICO and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan 100 elimination programmeplan for systematic monitonng ofurinary iodinelaooratones -or measuring urinaryiodine, with equipment and trainedstartplan for periodic assessment of 100status by thyroid size and function atpoouiation level

4

4

1 3 13

3

33

2

3

3

3

*

1

2

3

reports of outcomes 1 ! i Z

estaoiisnmeni ot hign-ievelinteragency committeeevidence ot erfectrve committeeactioncomprenensiva national plan ot action

3

1|

11

°a

assured funding (through combinationot external, internal and intrinsic

political commitment

1

1 1 1 1 ! I I

1.00 | 0.00 | 0.080

0.20

0.20

0.50

1. 00

0.30

0.40

0.50

1.30 0.1-10

0.000

0.252

0.20

0.20

0.200.20

0.20

1.00

0.30

3.80 .

0.600.20

0.50

3.00 0.120

0.10

0.30

0.50

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.15

0.30

0.90

1.20

2.40

1.50

0.60

0.90

3.00

0.30

0.75

1.00

0.45

0.451.00 |' 3. 45

0.150

0.120

0.080

0.20 I 0.90

0.30

0.40

o.oo

0.00

1.00 1 '130

0.60

0.40

1.00

0.60

1.201.80

0.080

0.100

0.36

0.360

0.2SO

0276

0 'J72 |

1 180

[2 Eirorcamsntprocacures

COUNTRY: HAXTON - ft

ATTRIBUTE1 .ADoroonais lagislation

and regulations

LKISTAN • ".'.-•••*~ •?:''••%•-?;••..-;<•;•."'-.

CRITERIAnational in scope ~ —————— " ——

<W ioa !u all aaioie salt, including saltfor animals

production, retail and household level

and labelling

nsoectionueu.li»3 uanauias for violations |

5

__[

4

4

1

1

1 3

J

3

_..3 !

1 2

1

i

1 1

0

_

CRITERIAWEIGHTS

0.15

0.10

O.:s

0.15

a-° 10.13

0.10

SCORE0.30

0.10

0.60

0.45

0.600.45

1.00 2.30

O.oO

0.00O.CO lo.oao ~j o!ooo"

Supply or iodisedsalt

~UIIII..BIII kuuctury 10 looisa all ediblesalt•jc.uai sail supply of iooisea saitsufficient for needspercentage ot salt effectively -odisea

5

10

0.20

0.20

0.60

1.00

1.CO

0.20

0.00

1.20 j 0.163


pian for monitoring (internal andexternal)

procedures

regular reportseffective supervision, including reviewof trainingevidence of follow-upaction—————— ———— - ————— ———

•

4

3

33

2

0.20

0.20

0.200.20

0.20

1.00

0.80

0.60

0.60

0.40

3.00 0.120

__

0~3S

at household levelsed salt

.plan for monitoring at retail andhousehold levelmonitoring system in place andoperating regularly -percentaga of households usingadequately iodised salt

n• 3

2

-

0.10

0.30

0.60

1.00

0.30

0.90

1.20

2.40

— • — - — — -—— _

0.150

__

0.360

erfectivB advocacy addressed to a)policy makers, b) salt manufacturers,c) public and opinion leaders

[em ~~salt

materials

4

3

0.50

0.20

0.30

2.00

O.SO

1.20

1.00 3.aoMonitoring of IDO recognition of US! as a component of

an IDD elimination programmeplan for systematic monitoring oturinary iodine

odine. with equipment and trainedstaffplan for aenoaic assessment cf ICOstatus by thyroid size and function atpopulation level

3

I

4

|

3

3

3 I I I I

I

0.20

0.25

0.25

0.15

0.15i.:o |

0.80

0.75

1.25

0.45

0.45 |3.70 |

j 0.120

————————————

o.cao |

J 0.455

• —

1.236

8 National planning anacoordinating mecnamsms

9 Sustainaoility

estaolisnmem of hign-ieveiinteragency committeeevidence of effective committeeactionccmornnansrvu national ;:an ot .ic:cn

—————————— • —— - —————— , ...

assured funding (throuqn comomationof external, internal and inmnjicsources)

1

1

T 13

1

1

0.30

0.30

040

1.00

0.60

1.20

0.90

0.40

2.50

0.60

._

"O.G30

— — - — — .

-•" ' i

02

COUNTRY: HAXTON -SR 'LANKA ' • ''••:" ' •• '•ATTRIBUTE

1 Appropriate legislationand regulations

2 Enforcementprocedures

3 Supply ot ionisedsalt


applies to all edible salt, including salt(or animalspresences concentrations of iodine atproduction, retail and household level

specifies requirements tor packagingano 'abellinqpresences monitoring proceduresspecifies responsibilities :orinspectionspecifies penalties for violations

POINTS

s 4 3

3

33

2

2

1

i

3 1

00

0

CRITERIAWEIGHTS

o.ts

0.10

0.15

0.15

1 0.20


successful arosecutians 1 1

sufficient cacacity to iodise ail ecibiesaltactual sait suoply or iodised saltsufficient for needspercaniage of salt 9rfsc::veiy icdisea

a

:)

J.15

0.101.00

0.60

i o ! 040

t

'

:.00

SCORE0.00

0.00

0.30

0.45

JSO0.45

0.302.10

0.00

0.000.00

ATTRIBUTEWEIGHTS

0.130

FINALSCORE

0.273

o.oao 0.000

0.20

0.20

0 30

; 00

1.00

0.20

0.50

1.30 0.140 0.252

4 Monitoring system toriodised salt at productionlevel

5 Availability of iodised saltat household level

S lEC activities

7 Monitoring of IDD


3 Sustainaonity

pian ror monitoring (internal andexternal!


regular reportseffective supervision, including reviewof trainingevidence or follow-upaction

plan for monitoring at retail andhousehold levelmonitonng system in place andoperating regularlypercentage of households usingadequately iodised salt



recognition of USI as a component ofan IDO elimination programmeplan for systematic monitoring ofurinary iodinelaboratones for measuring urinaryiodine, with equipment and trainedstaffplan ;or periodic assessment of 100status by thyroid size and function atpeculation levelreports ot outcomes

estaoiisnmem of hign-ievelinteraqencv committeeevidence of effective committeeactioncomorenensive national plan of ac:;cn

assured funding (througn comoinationof external, internal and intrinsic•5OurC93>

political commitment

3

3

3

.

3

7

1

J

Q

! o0

0

00

0.

0

0

0

0

0

0

020

0.20

0.200.20

0.20

1.00

0.10

0.30

0.50

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25»

0.15

0.'51.GO

0.20

0.30

0.40

1.00

0.50

0.401.00

O.GO

0.00

0.000.00

0.00

0.00

0.00

0.00

1.20

1.20

1.50

0.50

0.90

3.00

0.20

0.00

0.75

0.00

O.CO0.95

0.00

O.CO

O.CO

0.00

0.00

0.000.00

0.120

0.150

0.120

0.080

0.080

0.100

o

. 0.180

0.360

0.075

I1

0000

COUNTRY: _van der HAAR • BANGLADESH


and regulations

procedures

salt


at household level

5 IEC activities

'•

fi1ie

5

'


applies to all edible salt, including salor animalsprescribes concentrations at iodine aproduction, retail and household lave

specifies requirements for packagingand labelling

prescribes monitoring aroceduresspecifies responsibilities torinspectionspecifies penalties for violations

POINTS

55

t

3

4

4

3

3

3

3

2

• •

t

1

0

I *


successful orosecutions

2

1 0

sufficient capacity to iodise all ediblesaltactual salt supply of iooised saltsufficient for needspercentage of sail effectively iodised

3

\

4

4

. . . .plan for monitoring (internal andexternal)


regular reoonseffective supervision. mc:uding reviewof trainingevidence of follow-upaction

0

4

2Z

0

plan for monitoring at retail andhousehold levelmonitoring system in pace andoperating regularlypercentage of nousenolds usingadequately iodised salt

3

31



b

; 5

3

ecognition of USI as a component ofin 100 elimination programme)lan far systematic monitoring ofjnnary iodineaooratones for measuring urinaryodine. with equipment and trainedtafflan for periodic assessment of :00tatus by thyroid size and function atoouianon level

5

4

eoorts of outcomes | t

3

3

3 1 t

13 National planning and ecoordinating mecnanisms ir

eac

0

staolisnment or hign-ieveiiteraqency committeevidence of ^rfective committeectionorrpren«n3ivrt national cian or action

5

ssured funding (througn compmationexternal, internal ind 'mnn-jw:

4

I

- CRITERIAWEIGHTS

O.I5

0.10

0.15

0.15

0.200.15

0.101.00

SCORE0.7S

0.40

0.45

0.45

0.00

0.45

0.50

3.00

ATTRIBUTEWEIGHTS

0.130

FINAL

0.390

0.60

O.-lOt.OO

1.20

0001.20 0.080 0.096

0.20

0.20

O.oO

| 1 JO

1.00

• 0.30

2.40

420 | O.I4Q i 0.533

0.20

0.20

0.200.20

0.20

t.OO

1.00

0.80

0.4Q0.40

0.00

2.60 0.120 | 0.312

o.to

0.30

O.SO

1.00

0.30

0.30

1.80

2.40 0.1 SO 0.360

0.50

0.20

0.30

1.00

' 2.50

1.00

0.90

4.40 ' •0.120' 0.523

I

0.20

0.25

0.25

0.15

0.15

1.00

0.75

1.00

0.45

0.45| ! CO | 355 | }.080 I 02-32

0

0.30

0.30

•J.40

1.00

1.50

0.30

000

1.80 0.080 | 0 :44

I0.60 2.40

COUNTRY: van dor HAAR • BHUTAN


and ragulanons


3 Supply of lodiseasalt



6 I EC activities

7 Monitoring of IDD


9 SustamaDility


applies to all edible salt, including salttor animalsprescribes concentrations of iodine atproduction, retail and household level

specifies requirements tor packagingand labellingprescribes monitoring proceduresspecifies responsioilities forinspectionspecifies penalties tor violations


POINTS

5

5

5

5

5

successful prosecutions |

44

3

4

I 3

sufficient capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage of salt effectively iodised


guioelmes forprocedures



5

5

4

0

5

5


emphasizes IDD and role of iodisedsalt ' > ' • : - - ' • .support to training and trainingmaterials

recognition of USI as a component ofan IDD elimination programmeplan for systematic monitonng ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of IDCstatus by thyroid size and function atpopulation level

3

5

3

5

a

i4

i

4

4

4

1

2

2

-.

1

!

0

2

estaolishment of high-levelinteragency committeeevidence of effective commmeeaction

3

5

comprehensive national plan of action I 5 1 r

assured funding (through comoinationof external, internal and intrinsic

5

5 1

WEIGHTS015

0.10

0.15

0.15

0.200.15

0.101.00

0.60

0.401.00

0.20

0.20

O.SO

1.00

SCORE0.60

0.50

0.75

0.30

. 0.40

0.75

0.503.80

2.40

1.203.60

1.00

1.00

2.40

440

ATTRIBUTEWEIGHTS

0.130

0.080

0.140

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20 .

0.30

1 .00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.30

0.40

1.00

O.SO

040

1.00

1.00

0.80

0.800.80

0.40

3.80

0.50

1.50

2.40

4.40

1 .00 .

1.20

4.70

1.00

1.25

1 .00

0.60

0.754.50

1.50

1.50

2.00

5.00

3.00

2.005.00

0.120

FINALSCORE

0494

0.288

0.616

0.456

0.150

. - . • • . - '

0.120

0.080 f

O.S60

.. -

0.564

0.368

0.080

0.100

i

0 4

0.500

COUNTRY: _v«n <ter HAAR . INDIA

ATTRIBUTE

and regulations

2 Enforcement• procedures

3 Suooiy of iodiseasail

4 Mcnitonng system roriodised salt at productionlevel

at household level

CRITERIA 5 4 1national in scope " —— " — j — ——

applies to all edible salt, including salt —— ——for animals

prescribes concentrations of iodine at 5production, retail and household level

specifies requirements for packaging ~ ——— — 3"and labellingpresences monitoring procedures ——specifies responsibilities for 5" ——— ——insoectionspecifies penalties for violations 5 ——

infringements identified ~~~ ——— — J~

successful prosecutions | j

sufficient capacity to iodise ail ediblesalt _,actual salt supply of iodised salt ~j~~sufficient for needspercentage of salt effectively iodised

plan .or monitoring (internal and 4exiernai)

guidelines for ~ — 3 —procedures

regular reports i i ~~ ~~effective supervision, including review 1of trainingevidence of follow-up " '" 'action

household level . .momtonng system in place andoperating regularlypercentage pf households using """"adequately iodised salt

effectiva advocacy addressea to a) 5 "policy makers, b) salt manufa«jrers,c) public and opinion leaders

smphasizes IDO and role of iocised 5saltsupport to training and training • 3 •naterials

.

aFu1,icsD

5

t

ecognition ol USI as a component of 5 I ~n 100 elimination programme Ilan for systematic monitoring of 3nnary iodineiooratones for measuring unnary 5>dine. with equipment and trainedtaffan for periodic assessment of !CD 3atus by thyroid size and function atooulation level

— ——— ——— ——— CRITERIA2 1 0 WEIGHTS

0.15

o.to

0.15

0.1S

: | 0.200.15

0.10

SCORE0.60

0.40

0.75

0.45

0.400.75

0.50| 1.00 | 3. 85

0.60

2 j 0-401.00

0.20

0.20

2 0.60

| 1.20

0.20

0.20

2 | | 0.202 0.20

0 0.20

1.00

~ aTo

0.301

2 O.SO

[ 1.00

O50

0.20

0.30

| 1.00

0.20

0.2S

0.25

0.15

ports o f outcomes | i 1 3 1 1 1 1 015

.National planning ana ecoordinating mechanisms in

e-accc

itaoiisnment of nign-ievei jteragencv committeetdence of affective committee )tion 1morenensive naiional alan •-,( ic::on i 1 '

1 i 1

I '-so |

1.30

0.802.60

0.30

0.60

1.20

2.30

0.30

0.60

0400.40

0.00

2.20

0.30

0.30

1.20

1.80

2.50

1.00

0.90

4.40

1.00

0.75

1.25

0.45

0.453.90

ATTRIBUTEWEIGHTS^

-

0.130

— ——— - — • —— — _

0.080

- —— - —————— ~

FINA_ _ SCOR

0.501

-" —

0203

— i i.

0.140 i 0354

• ————— ————— _

•

0.120

0.150 |

0.120 |

—

0.254

0.270 1

0.523

0080 | 0.312

I °'30 !! 0.30

1 O.-iO

1.2G

0.60

0.40

| 100 | 2.20 I

at50

PO

sured funding (ihrougn comomation 3external, internal and intrinsicureas)lineal cornrnitmtjnt i t ! i

O.SO

i I I o-»o

I 30

1. 60

'3.0SO | o : 76

1

E_

COUNTRY: v»n d«r HAAR - MALDIVES


and regulations


3 Supply of iodisedsal:


5 Availaoility of iodised saltat household level

6 IEC activities

7 Monitoring of IDO


9 SustamaOiiity


applies to all edible salt, including saltfor animalsprescribes concentrations of iodine atproduction, retail and household level

specifies requirements tor packagingand labellingprescribes monitoring proceduresspecifies responsibilities torinspectionspecifies penalties for violations

POINTS

5




plan for monitoring (internal anaexternal)

guidelines torprocedures





recognition of USI as a component ofan IDO elimination programmeplan for systematic monitoring olurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of !GOstatus by thyroid size and function atpopulation levelreports of outcomes

4 33

4

2 1

1

1

1

0

0

0

0

0

0

0

0

5

establishment of high-level

evidence of effective committee

comprehensive national plan ot acrion

3

|

2

2

assured funding (through combinationof external, internal and intrinsicsourcesi

| 1

0

0

00

0

___

Q0

0

0

0

0

0

0

u0

1

___ 0

CRITERIAWEIGHTS

015

0.10

U 15

0 15

0200.15

0.101 00

060

040t.OO

0.20

0.20

0.60

1.00

020

0.20

0.2C0.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.30

040

t.OO

0.60

0 40

1.00

SCORE045

0.00

000

0.00

0.000.15

0.00060

0.60

0.000.60

o.ao

0.20

0.00

ATTRIBUTEWEIGHTS

0 130

0.080

1.00 | 0.140

0.00

0.00

0.000.00

0.00

0.00

0.00

0.00

0.00

0.00

1.50

1.00

0.60 .

3.10

0.00

1 (Too

0.00

0.00

0.000.00

0.00

0.00

0.30

0.80

0.60

0.00

0.60

FINALSCORE

0 078

0.048

0.14

0.120

0.150

0.120

0.080

0.080

0.100

0

0.000

0.372

O.C64

0060

COUNTRY: v»n d« HAAR - NEPAL • ' ' ~-:'"'- • • - .


and regulations

2 Enrorcementprocedures

3 Supply of iQOisedsalt

4 Monitoring system :oriodised salt at productionlevel

5 Availaoiiity oi iodised saltat household level -

6 IEC activities

7 Monitoring of IDO


3 Sustainaoilitv


applies to all edible salt, including saltlor animalsprescribes concentrations of loama atproduction, retail and housenold level

specifies requirements for packagingand labellingprescribes monitoring proceduresspecifies responsibilities forinsoectionspecifies penalties for violations



sufficient capacity to locise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage ot salt effectively ipoisea



regular reoortseffective supervision, including reviewof trainingevidence of follow-upaction

plan for monitonng at retail andhousehold levelmonitoring system in place andoperating regularlypercentage of households usingadequately iodised sail

POINTS

S5

4

4

3

3

5

4

3

3

2 1

tt

3

0

0

0

0

2O

3

3

effective advocacy addressed to. a)policy makers, b) salt manufacturers,c) public and opinion leaders


3

5

3

recognition of USI as a component ofan 100 elimination programmeplan for systematic monitoring ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment ot ICOstatus by thyroid size and function atpopulation levelreoorts of outcomes

estaalisnrnent of hign-ieveiinteraqencv committeeevidence ot effective committeeactioncomorenensive national aian or action

assured funding (through comomanonat external, internal jnd intrinsicsouroif)

5

5

___ 1

4

~

4 |

1

1

I

4

4

3

1

CRITERIAWEIGHTS

0.15

0.10

0.15

0.15

0.200.15

0.101.00

o.so

0.401.00

0.20

0.20

0.60

1.00

o.co

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.15

SCORE0.75

0~40

045

0.15

o.:o0.00

0.001.95

1.20

0.001.20

1.00

0.80

1.30

ATTRIBUTEWEIGHTS

0.130

o.oao

3.50 | 0.140

1.00

1.00

0.400.40

0.20

3.00

0.30

0.30

1.80

2.40

...2.50

1.00

0.90

4.40

1.00

1.25

1.00

O.SO

0.501.00 | 4.45

0.30

0.30

0.40

1.00

0.60

0.120

0.150

FINALSCORE

0.254

0.096

0.504

0.36

-.

0.360

0.120

0.080

0.528

0.355

1.20

0.90

0.40

2.50

2.40

(3.030 I ') 2

COUNTRY: van der HAAR - PAKISTAN


and regulations

2 Entorcementproceaures

2 Supply of loaisecsalt

1- Monitoring system icrioc:sea salt at productionlevel

5 Availaiility of iodised saltat household level

6 IEC activities

7 Monitoring of IDD



applies to all edible salt, including salttor animalsprescribes concentrations ot iodine atproduction, retail and household level

specifies requirements tor packagingand laDellmgprescribes monitoring proceduresspecifies responsibilities forinspectionspecifies penalties tor violations


successful orosecuttons

-• , . POIWTS

5 4

44

3

3

3

I

22

22

\ 2

1 0

C


3

2

CRITERIAWEIGHTS

0.15

0.10

0 .15

0.15

| 0.20

0.15

| 0.10| 1.00

0.60

0 40

1.00

SCORE0.30

040

0.60

045

| 040

0.30

0.202.65

ATTRIBUTEWEIGHTS

FINALSCORE

0.130 | 0.345

1.80

0001.80 0.080 0.144

0.20

0.20

0 I 0.60



regular reportseffective supervision, including reviewof trainingevidence of follow-uoaction



emphasizes IDO and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan IDO elimination programmeplan for systematic monitoring ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of IDOstatus by thyroid size and function atpeculation levelreports of outcomes

5

5

3

'

4

-

3

2

4

1 I

2

0

11

1.00

0.60

0.40

0.00

1.00 | 0140

0.20

0.20

0.200.20

0.20

• 0.30

0.80

0.40

0.80

0.00

1.00 | 2.80

0.10

0.30

0.50

1.00

0.50

0.20

0.30

1.00

-

1

1

0.20

0.25

0.25

0.15

\ 1 ' 1 0-15

estaolishment of high-levelinteraqency committeeevidence of effective committeeactioncomprenensive national plan of act.cn

j

|

3

9 Sustatnability assured funding (through combinationof external, internal and intrinsicsources)political Gommitrrwnt , t

1

i i

1

1

' I

| 1.00

0.30

0.30

O.SO

1.20

2.50

1.00

1.20

4.70

1.00

0.50

0.25

0.15

0.152.05

I

0.30

0.30

0.40

• CO

II

0.50

0 -iO1.00

0.90

0.30

0.40

1.60

1.20

0401.60

0 14

0.120 0.336

0.150

0.120

• 0.080 |

0.180

0.564

0.154

0030 |1

10100 |

—————— - ———— '" I

0 :23

0 160•? isi

~

COUNTRY: l_v»n derH>

ATTRIBUTE1 Aooropriata legislation

and regulation]


Suooly or iodisedsait

4 Monitoring system foriodised salt at productionlevel

Availability of iodised saltat household level"

5 IEC activities

<

3

n

Monitoring of 100 raPu

iost

stPC

National planning and escoordinating mechanisms int

ac

Sustainaoilif/ las'P'pot

UR-SRlUWkA^îic-'-îv :-•

CRITERIA 5 4 n

lor animals— — —— —— ————————— 4

production, retail and household level

and labelling

soeafies responsibilities for 5 ——— ——inspectionsnacihes penalties for violations 5 |

Impingements identified ——— 1 ——— ——— ———

lsuc.essfulprosecut.ons | (

— ——— ——— ——— CRITERIA2 1 0 WEIGHTS

0.13

0.10

i O.I 5

0.15

0 0.200.15

| 0.101.00

2 0.50

[ 0 0.401.00

SCORO.SO

0.40

0.30

0.45

0.000.75

0.503.00

1.20

0.001.20

surficient capacity to iodise ail eaible 1 ———————— 1 — i ——————————————————saltac.uai salt supply of iodised saitsufficient for needs

external)

procedures

re5Ularre00nS ——————— ——————————————

of training

action

—— _________

household level ^

operating regularlypercentage of households using "adequately iodised salt

aolicy makers, b) salt manufacturers.:) public and opinion leaders

alt

natenals———————— . ———— ——————

^cognition of USI as a component of S i ——— ——— ~n 100 elimination programme . |an tor systematic monitoring of ——— —nnary iodine

dine, with equipment and trainedaffan for periodic assessment of 100 "" — ——— —atus by thyroid size and function atoulation level

tablishment of hign-ievei ~~] ——— ' ——— ——— —eragencv committee |

ion•nprenensiwj national Bian or act;cn [. ___________ ____ I

ufDd funding (thrown corporation " ——— ——— ———— — J»xternal. internal and .ntnniicrcesi

0.20

2 0.20

1 O.SO

1.00

o.eo

0.40

0.60

| 1.50

0 0.20

0.20

1I 0 0.20

1 0.20

0 0.20

1.00

0.00

0.20

0.000.20

0.00

0.40

ATTRIBUTE FINALU —— WEIGHTS grnP.

| 0.130

o.oao— ——————

0.14Q

0.120

0.10

0.301

2 O.SO

1.00

0.30

0.30

1.20

1.80

0.50

0.20

0.301

1.00

2.50

1.00

0.30

3.80

0.150 |

0.120 |

0.20

0.251

0 0.25

0 0.15

1 1 0 1 0.15I 'I oo —— T

1 0.30

0 0.30

1 040

j 1 00

1.00

0.25

0.00

0.00

0.001.25

0.30

0.00

0.40

0.70

| 0.390

0,096 |

—— _

I 0.224

— . _

0.048

i •

0.270

0.4S6 |

—

0.080 | 0.100 |

0.030 |

Ia-30 1 20

• i-~

0.056

COUNTRY: HOUSTON - BANGLADESH


and regulations


3 Suooiy of looiseasalt

- Monitoring svs:em roriodised sal! a! productionlevel

5 AvailaDility of iodised saltat household level

6 IEC activities

7 Monitoring ot IDD

3 National panning andcoordinating mechanisms

9 Sustainability


applies to all edible salt, including saltlor animalsprescribes concentrations ot iodine atoroduclion. retail and household level

specifies requirements tor packagingand labellingprescribes monitoring proceduresspecifies responsioilities lorinspectionspecifies penalties tor violations

POINTS

5

S

s

5



sufficient capacity to iodise all ediblesal:actual salt supply ot iodised saltsufficient for needspercentage of salt effectively iooised

5

5

3

3

4

4

4

4

4

3

pian tor monitoring (internal andexternal)


regular reponseffective supervision, including reviewof trainingevidence of tollow-upaction



emphasizes IDO and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan IDO elimination programmeplan for systematic monitoring oturinary iodinelaboratones for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of 100status by thyroid size and function at

establishment of high-levelinteraqency committeeevidence of effective committeeactioncomprehensive national plan of action

D

5

•*

4

33

4

4

3

2 1

I

0

0

2

2

3

1

3

3

3

2

assured funding (tnrougn comomationof external, internal and intrinsicsources)political commitment

5

5

0

0

0

CRITERIAWEIGHTS

o.ts

0 10

0.15

0.15

0200.15

0.101.00

0.60

0 401 00

0.20

0.20

0.60

SCORE0.75

0.50

0.60

0.60

0.80

0.60

0.504.35

ATTRIBUTEWEIGHTS

0.130

3.00

0.00300 0.080

1.00

1.00

3.00

1 .00 | 5.00 0.140

FINALSCORE

0.566

C.240

C.7 •

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.30

0.40

1.00

0.60

0401.00

0.30

0.80

0.500.60

0.40

3.20

0.30

0.60

2.40

3.30

1.50

0.80

0.60

2.90

1.00

0.00

1.25

0.00

0.00

1.50

0.90

1.20

3.60

3.00

2.005.00

0.120 0.384

0.150

0.120

0.080 [

0.080

0.100

0.495

0.130

1238

0500

\2 enforcementprocedures

!3 Supply of iodisedsalt

p Monitoring system for _ _ . _ . . . _ . .iodised sait at production j external)

16 IEC activities

7 Monitoring of IDD

ATTRIBUTE RNAL

J!il!£»2s__ SCORE

•1.15


___40.60

| 1.00

3.00

4.60 o.oao 0.363sufficient capacity to iodise all edible "saltac.uai sail suoply of iodised saltsufficient for needsportsmage ot salt effectively iodised

— ————— - ——————— ———————

5

4

4

0.20

0.20

0.60

1. 00

1.00

0.80

2.40

4.20

————— - —————

0.140

_

0.588 |

V of iodised saltold level

plan for monitoring at retail andhousehold levelmuniranng system in place andoperating regularlyyeiuemage Or Households usingadequately iodised sail

5

3

4

0.10

0.30

0.60

1.00

0.50

1.50

2.40

4.40

— — — — — — —— __

0.150

-

O.S60


emphasizes luu and role of iodisedsalt

materials——————— . ——— . ———————

5

5

5

0.50

0.20

0.30

1.00

2.50

1.00

1.50

5.00

——

0.120

1

o.soorecognition of USI as a component oTan IOO elimination programme

urinary iodinelaliuraioriBs ;or measuring urinaryiodine, with equiomem and trainedstaff

status by thyroid size and function at:oouiation levelreports of outcomes [

3

5

I

1

. I

0

0.20

0.25

0.25

0.15

0.151.00 |

1.00

0.25

1.25

0.00

0.152.S5 0.080 |

.

0.212 I

0.30

0.30

0.40

1.50

1.50

1.60

—Jrni ni —— "1 1

— -~ — r- — i

1 060

L l1 n .in

1 loo ~r. —

COUNTRY: HOUSTON -INDIA


and regulations


3 Supply of iodisedsalt

- Monitoring system ;oriodised sail at productionlevel

5 Availaailiry of iodised saltat household level

6 IEC activities

7 Monitoring of IDO

CRITERIA


specifies reouirements for packagingand labellingprescribes monitoring proceduresspecifies responsibilities torinsoectionspecifies oenalties tor violations

DOIMTS

5

s

5

5


sufficient caoacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage of salt effectively iodised

0

4

I

-

33

3

2

2

I

1 0

•?

3

4



regular reoonseffective supervision, including reviewof trainingevidence of follow-upaction

•-

4

3 |

4 |

3

2



emphasizes IDD and role of iodisedsaltsupport to training and trainingmaterials

recognition of US 1 as a component ofan IOO elimination programmeplan for systematic monitoring ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of IDDstatus by thyroid size and function atpopulation levelreoons of outcomes


establishment of hign-levelnteragency committeeevidence of effective committee 1action |comprehensive national plan of action

3

5

5

3

5

4

4

4

I

3

9 Sustainability assured funding (through combinationof external, internal and intrinsicsources)political commitment |

3

I

I

3 I

3

I I

I 3

- CRITERIAWEIGHTS

0.15

0 10

0.15

0.15

0.200.15

| 0.10| 1.00

0.60

| 040

SCORE045

0.30

0.75

0.75

0.40

0.60

050375

ATTRIBUTEWEIGHTS

] 0.130

FINALSCORE

048S

3.00

| 0.80| 1.00 | 380I 0080 0.304

0.20

0.20

O.SO

1.00

1. 00

0.80

1.30

3.50 0.140 0.504

C.20

0.20

0.200.20

0.20

1.00

0.80

0.80

0.800.60

0.40

3.40

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0

0

0.20

0.25

0.25 .

0.15

C | 0.15

I

|

1.00

0.30

0.30

040

1.00 |

0.50

0401.00

0.40

1.20

2.40

4.00

2.50

1.00

1.50

5.00

1.00

0.00

1.25

0.00

0.002.25

1.50

0.90

1.20

3.60

3.00

1.20420

0.120 0.408-

0.150 0.600

0.120

0.080

0.080

i

0.100

0.600

0.130

0.238

0420

COUNTRYr _HOUSTON - MALDIVES

13Suop ly of loaiseasalt

sufficient capacity to iodise all aaiblesaltactual salt supply of iodised saltsufficient for needspercentage of salt effectively :oflisec~ — • —— - ——————— _

21

0 0.20

0.20

O.SO

1.00

0.00

0.20

1.20

1.40 0.140

. .1

0 - 9 3

S Availability of ioaised saat houssnold level

6 IEC activities

7 Monitoring of 100

coordinating rrec.lanisms i

;

[action

t plan for monitoring at retail andhousehold levelmonitoring system m place andooerating regularlypercentage of households usingadequately iodised salt


emphasizes 100 and role of iodisedsalt

materials

recognition of USI as a component ofan 100 elimination programmeplan for systematic monitoring ofurinary iodineaooratones for measuring unnaryodina. with equipment and trainedstaffplan far periodic assessment of ICOstatus by thyroid size ana function atjooulatton level

i

0 0.20

| 1.00

3

00

3

2

4

eporrs of outcomes . j " —

sstablisnmem of nign-ievei "nteraqencv committeevidenca of effective committeection

omprenensive national plan of action

9 Sustainaoility a0

3

4

2

1

1

0

0.10

0.30

O.SO

| 1.00

0.00

0.00

0.00

0.00

1.30

1.80

0.120

- — — - — — ———— _

0.150

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

1 I I 0.15| 1 00

Lssurea funding (tnrougn comoinanon I s~] ~~~ ~1 external, internal and intrinsicources) j j

0.30

0.30

0.40

1.00

O.SO

1.00

1.00

0.90

2.90

0.80

0.25

0.00

0.15

0.151.35

0.60

0.60

1.60

2.80

3.00 ~T

—— •— —— —

"0.120

•~— -^ — .

0080

Q080

3

0.270

" •

0.343

o ;ca |

0224

COUNTRY: HOUSTON • NEPAL

ATTRIBUTE1 Approoriate legislation

and regulations




5 Avaiiaoility of iodised saltat household level

6 IEC activities

7 Monitoring of IDD


9 SustainaDility

CRITERIAnational m scope

applies to all edible salt, including saltlor animalsprescribes concentrations ot iodine atproduction, retail and household level

specifies requirements for packagingand labellingprescribes monitoring proceduresspecifies responsibilities forinspectionspecifies penalties for violations



POINTS

5

5

4

4

sufficient capacity to iodise all ediblesaltactual salt supply ot iodised saltsufficient for needspercentage of salt effectively iodised

o

5

4


guidelines :orprocedures

regular reportseffective supervision, including reviewof trainingeviaence at toilow-upaction




recognition of US! as a component ofan 100 elimination programmeplan for systematic monitoring ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of 100status by thyroid size and function atpopulation levelreports of outcomes

3

5

5

5

5

5

5

establishment of high-levelinteragency committeeevidence of effective committeeactioncomprehensive national plan ot action

assured funding (through combinationot external, internal and intrinsicsources)political commitment

5

5

**

-

4

4

3

3

33

3

3

3

22

2

2

2

2

I

1

0

0

\ \

0

1- 1

1

CRITERIAWEIGHTS

0 15

0 10

0.15

0 15

0.200 15

0.101.00

0.60

0.401 00

SCORE0.30

0.30

0.60

000

060

O.J5

0.202.45

3.00

0.40340

0.20

0.20

0.50

1.00

1.CO

0.80

3.00

430

ATTRIBUTEWEIGHTS

0.130

0.080

FINALSCORE

0.319

0.272

0.140 0.572

0.20

0.20

0.200.20

0.20

0.30

1.00

1.000.50

0.80

1 .00 4.20

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.30

0.40

1.00

0.50

0 40

1 00

0.40

0.90

2.40

3.70

2.50

1.00

1.50

5.00

1.00

0.00

1.25

0.30

0.302.85

1.50

0.50

1.20

3.30

3.00

1.604.60

0.120

0.150

0.120

0.080

0080

0 100

0.504

0.555

0.600

-

0.223

0254

rj4SO

Ki

COUNTRY: HOUSTON -PAKISTAN ' "• •..-..;:?. ;;


and regulations


3 Sucoiy of iodisedsail

4 iMcnironng system roriodised salt at productionlevel

5 Avaiiaoility of iodised saltat household level

6 1 EC activities

7 Monitoring of IDO


0 Sujtainaoilitv


applies to all edible salt, including saltfor animalsprescribes concentrations of iodine atproduction, retail and household level

specifies requirements tor packagingand labellingprescribes monitoring proceduresspecifies responsibilities fornsoectionsoecifies penalties for violations

POINTS

5

5

5

infnngements identified


sufficient capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage of salt erfectively locised

pian ror monitoring (internal andexternal)



plan for monitoring at retail andhousehold levelmonitonng system in place andoperating regularlypercentage of households usingadequately iodised salt



recognition of USI as a component ofan 100 elimination programmeplan for systematic monitoring ofurinary iodinelaboratories for measuring unnan/iodine, with equipment and trainedstaffplan for periodic assessment of 100status by thyroid size and function atcopulation levelreoorts of outcomes

establisnment of hign-ievelinteraqency committeeevidence of effective committeeactioncomorqnensive national plan of action

assured funding (through comoinationof external, internal and intrinsicsourcesloolitic:]! commitment

5

4

4

4

5

5

5

5

4

4

4

3

33

3

3

3

2 1 0

10

3

3

I0

-i

2

2

2

11

1

1

'

0

WEIGHTS0.1S

0.10

0.13

0.15

0.200.15

0.101.00

0.60

0.401.00

0.20

0.20

0.60

1.00

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.20

0.40

1.00

0.80

0 40

SCORE0.45

0.30

0.60

0.75

1 000.45

0.303.85

0.60

0.000.60

0.60

0.20

0.00

0.80

1.00

0.40

0.400.80

0.40

3.00

0.20

0.30

0.60

1.10

2.00

1.00

1.20

4.20

1.00

0.25

1.25

0.00

Q.152.65

ATTRIBUTEWEIGHTS

0.130

0.080

RNALSCORE

1501

:.04s

0.140 0.112

0.120

0.150

0.120

1.50

1.20

1.20

3.90

3.00

0 30

0.080 |

I

0.36

3.165

3.504

0,212

;312

COUNTRY: HOUSTON - SRI LANKA in


and regulations

2 Emorcemantprocedures

3 Supply ot locisedsail

4 Monitoring system toriodised sal; at productionlevel

5 Availability of iooisea saltat household level

6 IEC activities

7 Monitoring of IDD


9 Sustamaoility


applies to all edible salt, including saltor animalsarescnBes concentrations ot iodine atoroduction. retail and household level

specifies requirements lor packagingand labellingprescribes monitoring oroceouresspecifies responsibilities for

specifies penalties tor violations

ntringements identified


suttaen; capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage of salt effectively ioaisea

plan tor mcnitonng (internal anaexternal)

guioennes torprocedures

regular recortseffective supervision, including reviewot trainingevidence of tollow-uoaction

plan for monitoring at retail andhousehold levelmonitoring system in piace andoperating regularlypercentage of households usingadequately iodised salt

effective advocacy adoressed to a)policy makers, b) salt manufacturers,c) public and opinion leaders

emphasizes IDD and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan 100 elimination programmeplan for systematic monrtonng of

laboratories tor measunng urinaryiodine, with equipment and trainedstaffplan for periodic assessment of 100status by thyroid size and function atpopulation level

establishment ot hign-ievelinteragency committeeevidence of effective committeeactioncomprenensive national plan ot acion

POINTS

55

5

55

_LJ

0

4 3

3

1

2

__

3 1

1 0

3

5

5

4

3

.

4

2

2

_

1

11

____

1

1

0

0

0

0

0

0

0

0

u

assured funding (througn combinationot external, internal and intrinsicsources)

4

CRITERIAWEIGHTS

0.15

0.10

0.15

0 15

0200.15

0 101.00

0.60

040

SCORE

0.30

0.30

0.75

1.00

0.73

0.504.35

3.00

1.20

ATTRIBUTEWEIGHTS

0.130

FINALSCORE

0.566

100 | 420 | 0.080

0.20

0.20

0.60

1.00

0.50

0.40

1.20

2.20

0.20

0.20

0.200.20

0.20

1.00

0.00

0.000.20

0.00

0.20

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

025

0.25

0.15

0.151.00.

0.30

0.30

0.40

1 00

060

0401.00

0.30

0.60

0.90

1.00

0.90

3.90

0.00

0.00

• 0.00

.uu

0.30

1.60

2.20

0803.20

0.140

0.120

0.150

0.120

0.080

| 0080

0 100

0.336

0.308

0.024

0.135

0.463

0 - 7 5

I

0.3202413

COUNTRY: PANDAV- BANGLADESH _ . . : • ; . : : : .

ATTRIBUTE1 Aoorooriata legislation

and regulations


3 Supply of loaiseasait


5 Avaiiacility of iodised saltar Household level

6 IEC activities

7 Monitoring of 100


applies to all adibla salt, including saltlor animalsprescribes concentrations of iodine atproduction, retail and household level



POINTS

55

55

5

successful prosecutions |


55



5

regular reports |effective supervision, including reviewof trainingevidence of follow-upaction



emphasizes 100 and rola of iodisedsaltsupport to training and trainingmaterials

5

5

5

4

4

4

4

4

recognition o.f USI as a component ofan 100 elimination programmeplan for systematic monitoring ofunnary iodinelaboratories for measuring urinaryicdina. with equipment and trainedstaffplan for periodic assessment of ICOstatus by thyroid size and function atpopulation levelreports of outcomes 1

5

5

5

5

5 1 1

3

3

3

3

33

2 1 0

0

0

2

3

1

a National planning andcoordinating mechanisms

estaolishmam of hign-lavelnteraqency committeeevidence of effective committeeactioncomprehensive national plan st action

5

9 Susiainaoility assurad funding (through combinationof extarnal, internal and intrinsicsourcos)nnlitirfi! i-nmmitm«a«»

3

3

3

1

CRITERIAWEIGHTS

0.15

0.10

0.15

0.15

oco0.15

0.101.00

O.SO

0.401.00

0.20

0.20

O.oO

1.00

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60 _

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.30

040

1.00

0.60

SCORE0.75

0.30

050

0.45

1.000.75

0.504.35

0.00

0.000.00

1.00

1.00

2.40

4.40

0.50

1.00

0.600.60

0.40

•3.20

0.50

1.50

2.40

4.40

2.00

1.00

0.90

3.90

1.00

1.25

1.25

0.75

075 I5.00 f

1.50

0.90

t.20

3.60

3.00

ATTRIBUTEWEIGHTS

0.130

0.080

RNALSCORE

0 566

0.000

0.140

0.120

!0.616 |

|

0.384

0.150

0.120 |

0.080 |

0.660

0.463

0.400 |

i

0080 0288

COUNTRY: PANOAV - BHUTAN


and regulations


3 Supoiy ot iodisedsal:

- Monitoring system toriodised salt at productionlevel

5 Avaiiaoiiity of iodised saltat household level

6 I EC activities

7 Monitoring of IDD


9 SustainaDility

CRITERIAnational in scops

applies to all edible salt, including saltfor animalspresences concentrations of iodine atproduction, retail and household level




POIMTS

55

5

5

o3

5

5

5

sufficient capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage of salt effectively iodisea

3

5

4

•*

plan tor monitoring (internal anaexternal)


regular reportseffective supervision, including reviewof trainingeviasnce of follow-up - - .action



emphasizes IOO and role of iodisedsaltsupport to training and training

recognition of USI as a component ofan I DO elimination programmeplan for systematic monitoring ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of IOOstatus by thyroid size and function at

reports of outcomes


evidence ot effective committeeactioncomprehensive national plan of action

3

3

5

5

5

5

- 5

5

5

3

_J ________ . ______________

4

3

3

2 1 0

3

33

3

5

5

5

assured funding (througn comoinationof external, internal and intrinsicsources)political commitment

5

WEIGHTS0.15

0.10

0.15

0.15

0.200.15

0.101.00

0.60

0401.00

0.20

0.20

0.60

SCORE0.75

0.30

0.75

0.75

1.000.75

0.504.80

3.00

2.005.00

1.00

1.00

2.40

1.00 | 4.40

ATTRIBUTEWEIGHTS

0.130

0080

0.140

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

0.30

0.30

0.40

1.00

0.60

0.40

1 00

1.00

0.60

0.600.60

0.60

3.40

0.50

1.50

2.40

4.40

2.50

1.00

1.50

5.00'

1.00

1.25

1.25

0.75

0.755.00

1.50

1.50

2.00

0.120

0.150

0.080

5.00 | o oac

3.00

2.005.00 0.100

FINALSCORE

0624

0.400

O.S15

0.408 '

0.660

0.600

0.400

0500

COUNTRY: P AND AV- INDIA • .:'-•• ->^ . . • ' i/: -; ; •

ATTRIBUTE

and regulations


3 Suociy of iodisedsalt

4 Monitoring system ;oriodised salt at productionlevel

5 Availability of iodised salt,at Household level

6 IEC activities

7 Monitoring of IDD

B National planning and 5coordinating mechanisms i

f.ac

0

5

C

CRITERIA

applies to all edible salt, including safor animals

prescribes concentrations of iodine aproduction, retail and household leve

specifies requirements for packagingand labellingprescribes monitoring proceduresspecifies responsibilities forinsoectionspecifies penalties for violations



5

t

5

55

5

44

4

0

sufficient capacity to iodise ail ediblesailactual salt supply of iodised saltsufficient for needspercentage of salt effectively iccised

3

4

3

3

3

2 1 0

!

3

pian ror monitoring (internal anaexternal)



3

3

33

2

plan for monitoring at retail andhousehold Sevelmonitoring system in place andoperating regularlypercentage of households usingadequately iodised salt

3

4

4


emphasizes 100 and rale of iodisedsaltsupport to training and trainingmaterials

5

5

5

•

recognition of USI as a component ofan 100 elimination programme3lan for systematic monitoring ofjrinary iodineaboratories for measuring urinaryodine, with equipment and trained,taff3lan for periodic assessment of 100>tatus by thyroid size and function atlooulation leveleoons of outcomes '

5

5

3

5

CRITERIAWEIGHTS

O.IS

0.10

0.15

0.15

0.200.15

0.101.00

SCORE0.60

0.30

0.75

0.60

1.000.75

0.504.50

ATTRIBUTEWEIGHTS

0.130

FINAL

0.585

0.60

0.40| 1.00

3.00

1.204.20 0.080 0.336

0.20

0.20

0.60

1.00

1.00

0.30

1.30

3.30 0.140 0.504

0.20

0.20

0.200.20

0.20

• -i.oo

1.00

1.00

O.SO0.60

0.40

-• 3.SO 0.120 • 0.432

0.10

0.30

O.SO

• 1.00

0.50

1.20

2.40

4.10 0.150 0.615

0.50

0.20

0.30

1.00

2.50

1.00

1.50

5.00 0.120 0.600

0.20

0.25

0.25

0.15

5 1 I I i l l 0.15

staolisnment of high-leveliteraqencv committeevidence of effective committeectionomprenensive national sian of jc::<3n

5

•>

ssured funding (througn comomalionf external, internal and intrinsicources)3litical commtlmftm

3

3

1.00

1.25

1.25

0.75

0.75| 1.00 | 5.00

-

0.080 0.4001

0.30

0.30

040

| 1.00

1.50

0.90

1.50

400 aoao

0.60

n 4n

3.00

i fin

032

COUNTRY: PANOAV - MALDIVES


and regulations



I- Monitcnng system roriodised salt at productionlevel


5 I EC activities

7 Monitoring of IDD


9 Sustainability



specifies requirements tor packagingand labellingprescribes monitoring proceduresspecifies responsibilities forinspectionspecifies penalties for violations


successful orosecutions

POINTS

5 4

I

sufficient capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient tor needsPercentage of salt effectively looisea

3 2 1 00

0

0

0

c0

0

0

c

NOT A?PNO INFO

0

0

0

Dian ror rr.onitcnng (internal ar.aexternal!


regular reportseffective supervision, including reviewof trainingevidence of follow-uoaction

plan for monitoring at retail andhousehold levelmonitoring system in place andoperating regularlypercentage of housenolds usingadequately iodised salt


emphasizes IOD and role of iodisedsaltsupport to training and trainingmaterials

recognition of USI as a component ofan IDD elimination programmeplan for systematic monitonng ofurinary iodinelaboratories for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment of IOOstatus by thyroid size and function atpopulation level


evidence of effective comminseactioncomprehensive national plan ot action

I

3

3

I

c

0

00

0

00

0

0

0

0

0

0

I I 3

3

assured funding (through comomationof external, internal and intrinsicsources)political commitment

1

1

0

0

0

CRITERIAWEIGHTS

0 15

0 10

0.15

0 15

0.200.15

0.101 00

SCORE000

000

000

000

0.00000

0000.00

0.60 0.00

o JO ! o.oo1.00 |

C.20

0.20

0 SO

1.00

0.00

0.00

0.00

0.00

ATTRIBUTEWEIGHTS

0 130

0080

0.140

FINALSCORE

0.000

0.000

0

0.20

0.20

0.200.20

0.20

0.00

0.00

0.000.00

0.00

1.00 | 0.00

0.10

0.30

0.60

1.00

0.50

0.20

1.00

0.20

0.25

0.25

0.15

0.00

0.00

0.00

0.00

0.00

0.60

0.90

1.50

0.00

0.00

0.00

0.00

0.15 I 0.001.00

0.30

0.30

- 040

1.00

0.60

0401.00

0.00

0.00

0.00

1.20

1.20

0.60

000oso

0.120 o

0.150

0.120

0.080

OC30

0 100

0.000

0.180

0.000

'3.035

ooeo

COUNTHY:'-- PANDAV- NEPAL


and regulations



4 Monitoring systam toriocised salt at productionSavel

5 Availaoility of iocised saltat household level

6 IEC activities

7 Monitonng of IDD

8 National planning andcoordinating mecnamsms

9 Suslainaoility


applies to all edible salt, including saltor animalsprescribes concentrations of iodine atproduction, retail and household lavel

specifies requirements for packagingand labellingprescribes monitoring proceduresspecifies responsibilities for

specifies penalties for violations

POINTS

55

55

5

4

4

mnngements identified


sufficient capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage or salt effectively :odised

plan ;or monitonng (internal andextarnal)

guicaiines forprocedures

regular reportseffective supervision, including reviewof trainingevidence of follow-upaction • •

pian for monitoring at retail ana

monitoring system in place andoperating regularlypercentage of households usingadequately iodised salt



recognition of USI as a component ofan 100 elimination programmeplan for systematic monitoring of

laooratones for measuring urinaryiodine, with equipment and trainedstaffpian for periodic assessment at iCDstatus by thyroid size and function atpopulation levelreports of outcomes

estaoiisnment of hign-ievel

evidence of effective committeeactioncomprehensive national plan of action

assured funding (through comomationof external, internal and intrinsicsources)oahtical commitment

3

5

5

5

5

5

5

5

5

o

5

3

3

5

4

4

3

3

33

_

3

2

2

1 0

0

0

0

2

3

3

T

CRITERIAWEIGHTS

0.15

0.15

0.15

0.200.15

0.101.00

0.60

0.401.00

SCORE0.75

0.60

0.00

1.000.75

0.503.30

0.00

0.000.00

• 0.20

0.20

0.60

1.00

0.20

0.20

0.200.20

0.20

1.00

0.10

0.30

0.60

1.00

0.50

0.20

0.30

1.00

0.20

0.25

0.25

0.15

0.151.00

1.00

0.80

3.00

4.30

0.50

1.00

O.SO0.60

0.40

3.20

0.50

1.50

1.80

3.30

2.00

1.00

1.50

. 4.50

1.00

1.25

1.25

0.75

0.755.00

ATTRIBUTEWEIGHTS

0.130

0.080

0.140

0.120

0.150

0.120

0.080

0.30

0.30

0.40

1.00

0.60

0.40

1.50

0.90

1.20

3.60

3.00

1 20

0080

FINALSCORE

0.494

1

0000 I

1

0.572 |i

0.384 |

1

0.570

•

0.540

1400 i

1.238 |

1

rOiJNTnv- PANDAV - PAKISTAN ._ _ _

______ ATTRIBUTEi Aoproonate legislation n.

a

pp

s

s

2 Enforcement 'procedures

2 Supply of iodised s

- Monitoring system ;oriodisec sal! at ore-auction


6 IEC activities

7 Monitoring of IDD

8 National planning andcoordinating mechanism

————— • — — — ————9 SustamaDility

CRITERIAuional in scope

)piies to all edible salt, including salt

escribes concentrations ot iodine ateduction, retail and household level

jecities requirements tor packaging

Decides responsibilities tor

imngements identified

ufticient capacity to iodise all edible

ictual salt supply ot iodised salt

jercemage of salt effectively lOdissc

__ POINTS __

5

5

4

4

1

33

3

3

1

3

3

)ian for monitoring \internal andexternal)

guidelines torsrocedures

regular reports ___________effective supervision, including review

evidence of follow-upaction

"-

plan for monitoring at retail and

monitoring system in place and

percentage of households usingadequately iodised salt

' • • '


emphasizes IDD and rola of iodiseosaltsupport to training and trainingmaterials

5

-

4

3

recognition of USI as a component of

plan for systematic monitoring ofurinary iodineaboratones for measuring urinaryiodine, with equipment and trainedstaffplan for periodic assessment ot ICDstatus by thyroid size and function atpopulation level

5

5

5

5

reports of outcomes | 5 1 i

establishment of high-levels interagencv committee

evidence ot effective committee

comprehensive national plan ot actic

3

n

| 3

3

(assured funding (through comoinatiolot external, internal and intrinsic(sources)Ipolilical commitment

n 5

3

2

1

- '

—. —

2

• — '"•

i i -1__i. . •

—i ———

__ —_ - '—

1— -

3

i

1

- -

— ••

— '•

. i —

_ "•

_ '

_ • i""

rj_i i

_p___

~~o "

c 1i

I

- 1"

— —

— "

- —

~

. ••

. - —

_ .1 •••

p. -1 •

_ .. •

_ — •

_ - 1-

CRITERIAWEIGHTS

0 15

0.60

SCORE045

0.00

ATTRIBUTEWEIGHTS

0130 |

FINALSCORE

——— LOO ——————— OOC ——————— 0080 ——————— OUU^

0.20

0.20

1.00

0.10

Too

0.50

0.20

O30

Too

' 020

0.25

' 015

" "0.15" Too__ —— — — —

" O30

"' O30

~j Too

~ 060

~ O40~ 1.00

0.60

O.SC

2.50

0.20-

1.40

0.120 0.312

0.150 ' ' 0.210

2.00

1.00

090

3.90

1.00

1.25

" 075

" 0755.00

_ _

1~.50

~ O90

3. SO

3.00

1.20420

0.120 0.468

~r O.OBO | 0.400

0.080

0.100

| 0.288

0420

COUNTRY: _PANOAV - SRI LANKA "' - . .. .' .


and regulations

procedures

salt


5 Availaoility of iodised saltat household level

6 IEC activities

7 Monitoring of IDD

1

8 National planning and ecoordinating mechanisms i

9ac

0

s

CRITERIA

applies to all edible salt, including safor animalsprescnbes concentrations of iodine aproduction, retail and household leve

specifies requirements for pacKagmgand labellingprescribes monitoring proceduresspecifies responsioilities forinspectionspecifies penalties for violations

POINTS

S3

It

t

5-5

1 5

4 3

3

3

z

t

I

1 0

•infringements identified


0

3 I

sufficient capacity to iodise all ediblesaltactual salt supply of iodised saltsufficient for needspercentage of salt effectively iodisea

3

2

0

plan tor monitoring (internal andexternal)


regular reportseffective supervision, inducing reviewof trainingevidence of follow-upaction

0

0

CRITERIAWEIGHTS

0.15

0.10

0.15

0.15

| 0200.15

0.101.00

SCORE0.75

0.30

0.30

0.45

1.00o.7s

0.504.05

ATTRIBUTEWEIGHTS

0.130

FINAL

0.527

0.60

0.40| 1.00

3.00

1.204.20 0.080 0.336

0.20

0.20

0.60

1.00

0.60

0.40

0.00

1.00 0.140 I 0.14

0.20

0.20

0 | 0.200

0

plan for monitoring at retail andhousehold levelmonitoring system in pace andoperating regularlypercentage of households usingadequately iodised salt



.

5

5

ecognition of USI as a component ofan 100 elimination programme3lan for systematic monitonng ofjnnary iodineaooratones for measunng urinaryodine. with equipment and trained>taff •)ian for periodic assessment of 100tatus by thyroid size and function atooulation level

5

5

5

esorts of outcorres i

stablisnment of hign-ieveliteragency committeevidence of effective committeectionomprenensive national plan or .icicn

3

2

2

1

3

3 I

3

ssured funding (throuqn comomation1 external, internal and intrinsicources)

1

0.20

0.20

1.00

0.00

O.GO

0.000.00

0.00

0.00 0.120 0

0.10

0.30

0.50

1 1.00

0.20

0.50

0.60

1.40 0.150 | 0.210

0.50

0.20

0.30

r.oo

1.50

1.00

1.50

4.00 0.120 | 0.480

0.20

0.25

0.25

0.15

1.00

0.75

1.25

0.75

| 0.15 | 045j_ 1.00 | 420 | 0.080 | 0.336 |

0

0

0.30

0.30

0.40

1 00

0.00

000

1.20

1 20 0030 |I

0.60 060

0096

-

.-^. v -->.^« v . . •• i - - ••* i -;-J ., -J

Documents

Page 1 Date Time Login rvenu - Home page | UNICEF · Login rvenu CF-RAI-USAA-DB01-EV ... when iodized salt constituted only a small part of household ... making attempts at developing