Report
National Consultation on
“Strengthening the Supply Chain of Iodized Salt through
National and State Level Activities”
Organized by
ICCIDD, Centre for Community Medicine, AIIMS & GAIN
New Delhi
27-28 April 2013
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Contents
S. No. Content Page No.
1 Background 3-4
2 Summary of the proceedings 5-23
3 Annexure 1: Agenda of the National Consultation Participants 24-25
4 Annexure 2: List of participants of the National Consultation 26-29
5 Annexure 3: Logic model for sustainable elimination of IDD in India 30-34
6 Annexure 4: Tool for state level situation analysis of supply chain of
adequately iodized salt
35-38
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1. Background
The coverage of adequately iodized salt at household level worldwide has shown remarkable progress
over last two decades with nearly 71% of households using adequately iodized salt. Seventy one per cent
of the households in India were consuming adequately iodized salt, with another 20% of the households
consuming salt with some iodine in it. Globally and in India also, we are within the grasping reach of the
target of greater than 90% household level coverage of adequately iodized salt of Universal Salt
Iodization (USI). However, the proverbial last stretch is the most difficult. A “final push” with
coordinated efforts from all stakeholders in mission mode is required to overcome this.
Analysis of the Coverage Evaluation Survey 2009 data clearly indicates that the urban-rural difference in
salt iodization still persists and the states with the lowest coverage are the ones showing substantial
reduction in coverage compared to the previous estimate in 2005-6. This reflects that the poor performing
states are likely to continue showing the least improvement or even worsening of coverage with
adequately iodized salt in coming years unless urgent actions are taken.
The monitoring of iodized salt can be delineated into three distinct components; the production end
monitoring (salt production facilities), supply chain monitoring (salt traders/wholesalers and retailers) and
consumer end monitoring (community and household level). The most neglected area of USI monitoring
in India is monitoring of supply chain of iodized salt. The supply chain stakeholders (including salt traders
and retailers and state level consumer end regulators) are the key determinants of quality of iodized salt
procured for supply to the state and its distribution within state.
Strengthening of supply chain of iodized salt with a focus on key states will be crucial for achieving USI
in India. In order to strengthen the supply chain of adequately iodized salt a number of interventions are
required to address the bottlenecks. These activities can be broadly divided into national and state level
activities. At state level activities targeted at regulators, policy makers, suppliers of iodized salt, civil
society and other stakeholders is required. At national level robust coordination amongst key partners is
needed to streamline the IDD program and keep USI high in the policy sphere.
A national consultation of important stakeholders was organized at New Delhi on 27-28 April 2013 to
develop strategies for strengthening the IDD control programme in general and supply chain of iodized
salt in particular. This consultation was a part of the project “Strengthening supply chain of iodized salt
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through national and state level activities” which is implemented by Indian Coalition for Control of Iodine
Deficiency Disorders (ICCIDD) with support from GAIN, the Global Alliance for Improved Nutrition
(GAIN).
This project aims to implement a cogent strategy through national and state level consultations and
activities in order to strengthen the supply chain of adequately iodized salt with focus on identified
priority states viz. Bihar, Uttar Pradesh, Gujarat, Rajasthan and Tamil Nadu. Objective of the project
is to strengthen the supply chain of edible salt in order to sustain and improve production and
availability of adequately iodized salt. Specific objectives of the project are to engage with key
stakeholders at national and state level to bring USI high in policy sphere; to strengthen supply of
adequately iodized salt; and to mainstream the Salt Management Information System. Activities of
the project will be facilitated by state level focal persons.
Agenda of the consultation and the list of participants are attached as Annexure 1 and Annexure 2.
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2. Summary of the Proceedings
Sitting (From Left to Right)- Dr. J Jeyaranjan, Mr. M A Ansari, Dr. Vikas Desai, Dr. M G Karmarkar,
Dr. Chandrakant S Pandav, Dr. S D Gupta, Dr. R. Sankar
Standing First Row (From Left to Right)- Dr. Pawan K Gupta, Mr. Rizwan Yusufali,
Dr. Richa Singh Pandey, Dr. M M Godbole, Dr. Kapil Yadav, Mr. Kumar Rajbhandari,
Mr. Raman Sankar
Standing Second Row (From Left to Right)- Dr. Rakesh Kumar, Mr. D S Dikshit,
Mr. Ranjan Kumar Jha, Mr. Vivek Ogra, Dr. Harshal R Salve, Dr. Arijit Chakrabarty,
Mr. Suvabrata Dey
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Saturday, the 27th April 2013
The National Consultation started with a welcome address by Dr. Chandrakant S Pandav, Professor
and Head, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi and
Regional Coordinator (South Asia), ICCIDD Global Network.
From Left to Right- Dr. M G Karmarkar, Dr S D Gupta, Dr. Chandrakant S Pandav
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2.1 Session 1- This session featured reflections by all participants on the current status of Iodine
Deficiency Disorders Control Programme and Universal Salt Iodization in India. Perspective of the
participants is summarized below as per 10 indicators proposed by WHO/Unicef/ICCIDD for
tracking progress towards sustainable elimination of IDD.
2.1.1 Presence of National multi-sector coalition:
There is an effective coalition at the national level.
There is a need to replicate the model of national coalition at the state level to carry forward
the agenda of USI and sustainable elimination of IDD at state level.
2.1.2. Political Commitment:
Presently, IDD control programme is a low priority area in the policy atmosphere.
There is a need to project IDD in terms of a child and maternal survival initiative and align
it with Reproductive and Child Health programmes (RCH) which is very high on policy
agenda.
Specific focus should be given to target the policy window in states. Salt producing states viz.
Gujarat, Rajasthan and Tamil Nadu needs special attention in terms of policy advocacy.
Ongoing health initiatives like Village Health and Nutrition Days (VHNDs) should be used to
promote iodized salt as has been done in Gujarat.
Introduction of iodized salt in government funded food programmes like Public Distribution
System (PDS) has been adopted by certain states and needs further push in other states.
Another critical issue identified was streamlining financial support for NIDDCP. State IDD
program officers have repeatedly highlighted the issue of inability to access NIDDCP funds in
timely and efficient manner. State level coordinators should review the financial support of
NIDDCP over last 5 years, identify bottlenecks in the same and suggest corrective actions.
The state level coordinator also needs to review the state NRHM PIP and identify areas of
intervention for strengthening IDD control activities in the state.
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2.1.3 Enactment of legislation and supportive regulations on universal salt iodization:
In India legislation for mandatory iodization of edible salt exist however the enforcement of
the same is not optimal.
There is a need to strengthen the enforcement of legislation with respect to mandatory salt
iodization at state and district level.
Understanding the dynamics of Food Safety and Standards Act with respect to enforce salt
iodization i.e. sampling methodology, periodicity of the sampling, action taken and feedback
mechanism is required. Uttar Pradesh presents a good model where Food Safety Officers
spend two days every six months in a district for checking salt iodization.
District Collectors could be important link in enforcing ban on sale of non-iodized salt at
district level and should be actively involved.
Participants also discussed the virtues of punitive and educative actions in ensuring
compliance with salt iodization regulations and agreed that type of action should be tailored
according to situation.
It was agreed that monitoring of salt during its transport, especially road transport which is a
neglected area, needs to be strengthened. Recent example of use of railway vigilance in
monitoring the quality of salt during rail transportation is a good measure and needs to be
further scaled up.
The MIS established at Salt Commissioner’s Office can be valuable tool in streamlining road
and rail monitoring of iodized salt movement from production centres.
2.1.4 Establishment of methods for assessment of progress in the elimination of IDD:
There is a need to revise the guidelines for survey under National Iodine Deficiency Disorders
Control Programme (NIDDCP) and align it with internationally recommended guidelines by
WHO/Unicef/ICCIDD. Current guidelines were last revised in year 2005 and are based on
historic district centric approach of the program. National Coalition and All India Institute of
Medical Sciences, New Delhi will approach Ministry of Health and Family Welfare to
consider revising the existing guidelines.
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Dr Vikas Desai also stressed upon need to revisit the grading of goiter used for
epidemiological surveys. Considering the feasibility at field level visible goiter may be more
appropriate indicator as compared to palpable goiter.
The progress of IDD program needs to be assessed regularly every three years. In India this is
not happening either at national or state level. The state level focal points should leverage with
state IDD cells and Directorate of Health to conduct IDD surveys regularly and assess IDD
progress at state level every three years.
2.1.5 Access to laboratories to provide accurate data on salt and urinary iodine levels:
It was stated by all participants that the access to laboratories has been deficient and has
adversely affected the monitoring of the programme.
State IDD cell should be encouraged to establish the IDD monitoring laboratories. There is a
need to take up the issue of training of laboratory personnel of IDD cell in states with National
Programme Officer of IDD. In the past, these activities were supported through WHO Grant
and training programmes were conducted every year.
There is a need to involve medical colleges in providing laboratory services for monitoring
IDD.
Establishment of six All India Institute of Medical Sciences in underserved areas of the
country provides an excellent opportunity to strengthen laboratory network in these states. It
was decided to request all new six AIIMS to consider establishing iodine monitoring
laboratory including facilities for both salt and urine iodine estimation. It was decided to issue
a letter of participation to these institutions. The regional reference laboratory at AIIMS can
provide them technical assistance and provide quality assurance for these new laboratories.
2.1.6 Establishment of a programme of education and social mobilization:
A robust programme of education and social mobilization is required to generate demand for
iodized salt.
Besides Accredited Social Health Activists (ASHAs), other personnel with more technical
expertise need to be involved in the programme.
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Unicef was requested to take lead in this and specifically design training modules for ASHA
workers for IDD.
Some participants also felt that use of Information Technology should be explored.
2.1.7 Routine availability of data on salt iodine content:
There is a need to provide routine data on salt iodine content at the household level.
The national and state level information is available from national Family Health Surveys.
However these are done using rapid test kits. At state level state IDD cells and ASHA workers
also collect and analyze household level salt samples. The state level coordinators should
collate these reports in coordination with state IDD cell.
It was also felt that data from retailers could be collected by a rapid national survey using
standard titration methodology for salt iodine estimation.
Concerns were also raised regarding the availability of salt testing Kits at state level. It was
decided that issue needs to be taken up with national and state IDD cells.
2.1.8 Routine availability of population-based data on urinary iodine:
Need of national and state specific surveys to collect the population data on urinary iodine
were stressed. Currently district level surveys on urinary iodine status are not being
conducted. State level urinary iodine surveys can be planned and funding support for the same
needs to be identified.
2.1.9 Demonstration of ongoing cooperation from the salt industry:
It was felt that salt industry has by and large been highly cooperative. There is a need to
applaud, appreciate, and highlight the corporate social responsibility (CSR) contribution of the
salt industry.
In salt producing states, small scale producers need to be engaged to optimize salt iodization
in this sector. In addition salt supply chain stakeholders need to be engaged to strengthen
monitoring of iodization level along the supply chain.
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2.1.10 Presence of a national database:
It was felt that there is a need to collate and analyze manual records at the national IDD
cell. A structured MIS similar to the office of the Salt Commissioner could be the solution
for this. Similar system can be established at State IDD cell in each state.
Other issues discussed during the session were as follows:
2.1.11 Strengthening the supply chain of adequately iodized salt: It was felt that a situation analysis of the supply chain of iodized salt should be conducted
in states and disseminated to a larger audience. A state specific action plan needs to be prepared based on the situation analysis. Capacity building among salt traders and producers should be carried out to ensure better
availability of adequately iodized salt.
2.1.12 Mainstreaming of Salt Management Information System (MIS): Need for mainstreaming for salt MIS for better monitoring of iodized salt supply situation
at production level was also stressed.
A logic model based on above deliberations has been presented as Annexure 3.
From Left to Right- Mr. Kumar Rajbhandari, Mr. Vivek Ogra, Mr. Suvabrata Dey,
Mr. Rizwan Yusufali, Dr. Arijit Chakrabarty, Mr. Ranjan Kumar Jha
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2.2 Session 2- In this session, presentations were made on the evolution of IDD control programme in
India and the national and state level coalitions for control of IDD and achievement of USI in India.
This was followed by presentation of the overview of the project “Strengthening the supply chain of
iodized salt through national and state level activities”.
2.2.1 Evolution of IDD control programme in India- Dr. Kapil Yadav, Assistant Professor,
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
Dr. Kapil Yadav making presentation
Iodine deficiency has been reported since time immemorial. References to goiter can be found in
ancient Indian and Chinese literature. In modern scientific literature, goiter was first reported from
Kashmir valley by McCarrison in 2005. Legendary Kangra Valley study which started in 1956,
conclusively proved the efficacy of salt iodization in control of IDD and lead to the launch of
National Goiter Control Programme (NCGP) in India in 1962. Control programme for iodine
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deficiency in India can be divided in four phases. Phase 1 (1956-1983) is underscored by scientific
research leading to institution of NCGP and supply of iodized salt to endemic districts. During this
period only 12 salt iodization plants were established with actual production of 0.2 million tons/year,
which was estimated to be 15% of the need. Due to area specific approach and recognition of IDD as
a mild cosmetic problem restricted to a particular region, NGCP remained a low priority health
programme. During Phase 2 (1983-2000), new scientific evidence that emerged both from across the
world and from India, showed significant impact of iodine deficiency on early brain development,
cognition and learning abilities of children. Evidence also emerged regarding very high prevalence of
neonatal hypothyroidism in some parts of the country. New evidence also established that the whole
country is prone to IDD. This led to programme being modified and renamed as National Iodine
Deficiency Disorders Control Programme in 1992 with increased focus on Universal Salt Iodization.
High political commitment, privatization of iodized salt production, and ban on sale of non-iodized
salt lead to increased production of iodized salt from 0.2 million tons in 1986 to 4.4 million tons in
2000 and an increase in household consumption of iodized salt. Third phase (2000-2005) is
characterized by lifting of ban on the sale of non-iodized salt for human consumption. This led to a
decline in iodized salt production to 4.1 million tons in 2003 and resulted in a major drop in the
household coverage of iodized salt. The lifting of ban spurred the scientific community in conducting
more research to generate scientifically valid information to address this challenge. A research
conducted by International Council for Control of Iodine Deficiency Disorder (ICCIDD) in seven
states during the period 2000-2006 reported that IDD remained endemic in these states. Intense
advocacy countering the claims made against the policy of Universal Salt Iodization was taken up
during this phase based on evidence generated by scientific study. Fourth phase (since 2005) started
with lifting of ban on sale of non-iodized salt. There was also an attempt among various stakeholders
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to develop partnership for sustained advocacy and pushing the agenda of sustainable elimination of
IDD by formation of National Coalition for Sustained Iodine Intake (NCSII). Efforts were also made
to engage small and medium scale salt producers in ensuring the quality of iodized salt. Various
innovative business models including introduction of iodized salt in Public Distribution System is
also being implemented to increase coverage with iodized salt. This multipronged approach with
supply and demand side intervention led to a quantum jump in the household coverage with
adequately iodized salt in India.
The role of AIIMS, New Delhi and ICCIDD was also stressed during this presentation. Mentorship
has played a key role in contribution of these institutions. Reaching the unreached, promotion of state
level activities, regular, reliable and representative national and state level scientific data, and
strengthening of monitoring and quality assurance was listed as key challenges for the future.
2.2.2 National and State level coalitions to promote sustainable elimination of IDD- Dr. Kapil
Yadav, Assistant Professor, Centre for Community Medicine, All India Institute of
Medical Sciences, New Delhi
National and state level coalitions are important for fostering collaborative action for promoting USI
in India. Coalitions are multi-sectoral body to coordinate & facilitate efforts towards achieving USI.
They act as a high level advocacy channel and are actively involved in streamlining communication
and professional discourse. National Coalition for Sustained Iodine Intake (NSCII), which was
established in 2006, has been playing a major role in steering the efforts for sustainable elimination of
IDD and achievement of USI in India. The secretariat of the NSCII is located at the South Asia
Regional Office of the ICCIDD Global Network and is funded by grants from coalition partners.
Successful example of National Coalition should be replicated at the state levels for effective
intervention to mainstream activities related to sustainable elimination of IDD and USI.
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2.2.3 Overview of the Project “Strengthening the supply chain of adequately iodized salt
through national and state level activities”- Dr. Rakesh Kumar, Senior Programme
Officer, Indian Coalition for Control of Iodine Deficiency Disorders
An analysis of USI situation in India was conducted by GAIN-Unicef using the parameters;
household coverage with adequately iodized salt and household using non iodized salt as per
Coverage Evaluation Survey (CES) 2009, number of child of under two years of age unprotected
from IDD and change in household coverage with adequately iodized salt in CES 2009 as
compared to third round of National Family Health Survey (NFHS-3). This analysis categorized 8
states viz. Uttar Pradesh, Bihar, Tamil Nadu, Rajasthan, West Bengal , Jharkhand, Chhattisgarh
and Karnataka as “make or break” states for achievement of USI in India. It was also felt that
intervention in supply chain of iodized salt is key to achieve USI. ICCIDD with support from
GAIN launched a project “Strengthening the supply chain of adequately iodized salt through
national and state level activities” in four “make or break” states Uttar Pradesh, Bihar, Tamil
Nadu, Rajasthan and another major salt producing state Gujarat. Aim of the project is to
implement a cogent strategy through national and state level consultations and activities in order
to strengthen the supply chain of adequately iodized salt with focus on identified priority states.
General objective of the project is to strengthen the supply chain of edible salt in order to sustain
and improve production and availability of adequately iodized salt. Specific objectives of the
project are to engage with key stakeholders at national and state level to bring USI high in policy
sphere; to strengthen supply of adequately iodized salt; and to mainstream the Salt Management
Information System. Specific activities of the project will include state specific analysis of supply
chain of iodized salt; sensitization of policy makers, salt traders and producers; dissemination of
findings of sensitization meetings; capacity building among salt traders by providing salt testing
kits; building capacity of iodized salt producers by providing tech know how; facilitating
formation of coalitions at state level; and strengthening of the regulatory environment. Expected
outputs of this project are sensitized stakeholders; USI high in the policy environment; optimal
functioning of the regulatory mechanism regarding salt iodization; comprehensive report on salt
supply situation; enhanced capacity of producers, traders and wholesalers to ensure quality of
iodized salt; a fully mainstreamed salt MIS that is functional and reporting in real time, and
increase in the availability of edible salt as per mandated standards in market as well as public
funded safety net programs of focused states. This project will be completed in next one year.
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2.3 Session 3- In this session, status of salt iodization in India was discussed. Presentations on
“Status of salt iodization in India with focus on five states viz. Gujarat, Tamil Nadu, Rajasthan, Bihar and
Uttar Pradesh” and “USI and small scale salt producers: Experience from India” was covered during this
session.
2.3.1. Status of salt iodization in India with focus on five states viz. Gujarat, Tamil Nadu, Rajasthan,
Bihar and Uttar Pradesh- Mr. M. A. Ansari, Salt Commissioner of India
Mr. M A Ansari making presentation
India is the second largest producer of iodized salt and third largest producer of common salt. In 2012-13 India
produced 24.5 million MT of common salt and 6.5 million MT of iodized salt. Gujarat, Rajasthan and Tamil
Nadu are major salt producing states. 56% of all the iodized salt produced in India is refined and 44% are
unrefined. India also exports 5 million MTs of salt. Of the total cost of iodized salt in India, 18% is the cost of
salt, 4% is the cost of iodization, 10% is the cost of packaging, 30% is the cost of transport and 38% is profit
margins. The household coverage with iodized salt in four priority states are less than national average of 71%
while in Gujarat it is 71.4%. In recent development, 10 salt up gradation plants have been established in
Rajasthan to improve the quality of iodized salt. Salt commissioner is also encouraging the merger of small
iodization units for better quality monitoring. State governments are also being requested to monitor the
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quality of iodized salt. Railway vigilance is also being activated and punitive action taken to check the
transport of sub-optimally iodized salt under the guise of iodized salt.
2.3.2 USI and small scale salt producers: Experience from India- Mr. Suvabrata Dey, National
Programme Manager, Salt Iodization, Micronutrient Initiative
Mr. Suvabrata Dey making presentation
Small scale salt producers produces nearly one third of the total salt produced in the country. 39% of
all the small scale salt producers are in Gujarat, 28% are in Rajasthan and 25% are in Tamil Nadu.
Micronutrient Initiative (MI) has been working with small scale salt producers for improving the
quality of iodized salt produced by them. In an analysis of quality of iodized salt among small scale
salt producers done by MI in 2012, 19.9% of the samples had iodine content less than 15 ppm, 43.3%
has iodine content between 15 and 30 ppm and 36.8% had iodine content more than 30 ppm. The
corresponding figures for Gujarat, Rajasthan and Tamil Nadu was 17.8%, 48.5% and 33.7%; 25%,
47.4% and 27.6%; and 20.1%, 33.1% and 46.8% respectively. Major challenges for the small scale
salt producers were lack of capacity, lack of effective monitoring and high price of potassium iodate.
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2.4 Session 4- During this session, situation analysis of USI in two key states, Uttar Pradesh and
Bihar was presented.
2.4.1 USI in Uttar Pradesh: Supply chain and role of Unicef- Dr. Richa Singh Pandey, Nutrition
Officer, Unicef, Uttar Pradesh
Dr. Richa Singh Pandey making her presentation
Uttar Pradesh (UP) is one of the poor performing states in terms of household coverage with adequately
iodized salt. The state saw a dip in household coverage of adequately iodized salt of 12% points between
NFHS-2 (1998-99) and NFHS-3 (2005-06). According to NFHS-3, the adequately iodized salt coverage was
36.4% and was significantly lower in marginalized sections of the society.
In UP, 84% of the edible salt is transported by rail. Ninety seven percent of the salt consumed in UP is
unloaded in 18 districts. Unicef mapped 202 wholesalers/retailers in these 18 districts and found that
procurement takes place from outside state sources (46%), within state (17%) and mixed (34%), 90.7% traders
procure salt through roadways and 58% procure it through the rail route (overlapping possible as multiple
responses), 1.9% salt traders are engaged in local packaging of salt, 73% supply is sent using tempos, with the
destination in 98% cases being the market. Reasons for selling unrefined salt were better margin (42%), easy to
sell (26%), affordability of customers (18%). Customers were reportedly asking for Iodized salt (83%) or
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branded salt (59%). Salt is not provided by the government under PDS at fair price shops (FPS). Study of
trend of availability of iodized salt in market in March-May 2011 suggests that 71.3% of the salt were
adequately iodized and 27.5% of the salt samples had some iodine in it.
Unicef is involved in promotion of salt iodization through demand generation, promoting monitoring
of salt consumption through salt testing labs at regional Home Science/ State Medical colleges,
sensitizing whole-salers/retailers and linking them to regional laboratories/state IDD laboratories,
creating an advocacy group and Promote availability of adequately iodized salt through PDS. Some
of the lessons learnt from activities of Unicef in UP are; non-punitive approach by the USI cells and
feedback certificate is instrumental in gaining the confidence and co-operation of salt traders on the
supply issues; punitive approach from Food Inspectors also works as it creates pressure on
wholesalers/retailers to demand better quality salt; established linkages with State government
stakeholders gives USI Cells better visibility and increases ownership of the programme. Demand
generation alone cannot improve consumption of adequately iodized salt, availability of adequately
iodized salt is equally important. In the absence of same, substandard salt also gets pushed to rural
markets on a credit basis.
2.4.2 Situation analysis of USI in Bihar- Dr. Arijit Chakrabarty, Associate, GAIN
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Dr. Arijit Chakrabarty making his presentation
A situation analysis of USI was conducted by Unicef-GAIN in Bihar. The edible salt requirements of Bihar are
estimated at about 5, 50,000 tons/year. Bihar procures salt from Gujarat-Marine and Rajasthan salt sources
and most of the quantity is transported by rail, though supplies by road are substantial from Rajasthan. The
situation analysis found that the Bihar State Health Society (BSHS) has been making good quality iodised salt
available to the Below Poverty Line (BPL) card holders through the PDS in Tirhut division in the first phase
and proposes to extend it to other Divisions. The BSHS and Programme Officer were also keen in ensuring
success of the USI programme in the state. Inquiries in Patna, Vaishali, Muzaffarpur and Nalanda districts of
the state showed that no loose salt was available in the market. All salt was sold in polythene pouches even in
the rural areas. Even the poorest households used iodised salt and all the samples checked using STK showed
adequate levels of Iodine.
However, there was no quality control mechanism for iodized salt in place within the State . While the only
food testing laboratory in the state was not handling iodised salt samples since September 2012, no salt testing
kits had been supplied to state-level agencies in the last two years. Neither Coordination Committee on IDD
neither existed at the state-level nor was the IDD Cell fully functional. There was no review of the
implementation of the programme in the districts conducted and no training/refresher courses had been held for
the district and block-level functionaries in the last 2-3 years. For want of STK, testing of salt samples at the
railway unloading points, road check-posts, wholesale and retail outlets was not being done. IEC activities
were almost no-existent, except for the observation of the Global IDD Day.
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2.4.3 Presentation of a tool for situation analysis of USI in selected states- Dr. Harshal Salve,
Senior Resident, Centre for Community Medicine, AIIMS, New Delhi
From Left to Right- Mr. Rizwan Yusufali, Dr. R. Sankar, Mr. Raman Sankar,
Dr. Chandrakant S Pandav
A tool to assess the situation of USI and IDD in different states was presented.
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Sunday, the 28th April 2013
2.5 Session 5- During this session a presentation was made on “Implementation of MIS in Salt Commissioner’s Office”.
2.5.1 Implementation of MIS in the Salt Commissioner of India Office- Mr. Vivek Ogra Director - Technology & Innovation, VBSOFT India Limited
Mr. Vivek Ogra making his presentation
Status of the Management Information System (MIS) installed in the offices of the Salt
Commissioner was presented. Objectives of the Salt MIS are real-time monitoring of salt iodization
in edible salt, to provide national Quality Compliance and assurance program, to provide real-time
decision support system and automated regulatory framework, to provide real-time weather
information to salt producers and national salt production planning and forecasting. Main usage of
MIS includes preparation of monthly statements, maintenance of quality assurance in iodization
process, land and lease management and knowledge management. Some of the important features of
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the MIS are; centralized system with secured authentication & authorization; user credentials and role
based access rights management; host of reporting facilities for authenticate user and management for
flawless and efficient administration processes; and mail utility for sending emails to various
stakeholders. Ahmedabad Regional office has 82 users, Mumbai Regional Office has 17 users,
Chennai Regional Office has 80 users, Jaipur Regional Office has 26 users and Kolkata Regional
Office has 1 user. 67 out of 94 factory offices were entering their monthly statements and 18 out of
26 Salt test laboratories are using MIS for their analysis report.
2.6 Session 6: During this session, proceedings of the discussions held on day 1 were presented by
Dr. Rakesh Kumar. A logic model for action based on the discussions on both days is presented in
Annexure 3. This was followed by presentation of modified tool for situation analysis of USI and
IDD in states by Dr. Kapil Yadav. The modified tool is presented in Annexure 4.
From Left to Right- Mrs. Gomathi Sankar, Dr. R. Sankar, Mr. Suvabrata Dey, Dr. M. M. Godbole,
Dr. J. Jeyaranjan
The consultation concluded by closing remarks from all participants.
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Annexure 1
Agenda of the National Consultation on “Strengthening supply chain of iodized salt through national and state level activities”
Saturday, 27th April 2013
Time. Agenda Responsible Person
10.00 AM – 10.15 AM Welcome Address Prof. Chandrakant S Pandav,
AIIMS- ICCIDD
Session 1
10.15 AM – 12.15 PM Opening remarks All participants
Session 2
12.15 PM- 12.45PM Evolution of Iodine Deficiency
Disorders program in India
Dr. Kapil Yadav, AIIMS-ICCIDD
12:45 PM – 12:55 PM National and State level Coalitions Dr. Kapil Yadav, AIIMS-ICCIDD
12.55 PM – 1.15 PM Brief overview of the Project titled
“Strengthening the supply chain of
adequately iodized salt through
National and State level activities”
Dr. Rakesh Kumar, ICCIDD
1:15 PM – 2:00 PM Lunch
Session 3
2:00 PM – 2.45 PM Status of salt iodization in India with
focus on five states viz. Gujarat, Tamil
Nadu, Rajasthan, Bihar and Uttar
Pradesh
Mr. M. A. An sari
Salt Commissioner of India
2.45 PM - 3.30 PM USI and small scale salt producers:
Experience from India
Mr. Suvabrata Dey, National Programme Manager, Salt Iodization, Micronutrient Initiative
3:30 PM – 4:00 PM Tea Break
Session 4
4:00 PM – 4:30 PM USI in Uttar Pradesh: Supply chain and
role of Unicef
Dr. Richa Singh Pandey, Nutrition Officer,
Unicef, Uttar Pradesh
4:30 PM -5:00 PM Situation analysis of USI in Bihar Dr. Arijit Chakrabarty, Associate, GAIN
5:00 PM- 6:00 PM Situation analysis of salt iodization in Dr. Harshal Salve, AIIMS
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five selected states
Sunday, 28th April 2013
Session 1
09.30 AM-11.00 AM Implementation of MIS in the Salt
Commissioner of India Office
Mr. Vivek Ogra, VBSOFT
11.00 AM - 11.15 AM Tea/ Coffee
Session 2
11.15 AM - 12.15 PM Summary of the proceedings of Day 1 Dr. Rakesh Kumar, ICCIDD
12.15 PM -1.00 PM Presentation of tool for Situation
analysis of Salt Iodization
Dr. Kapil Yadav, AIIMS-ICCIDD
1:00 – 1:30 PM Concluding remarks All participants
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Annexure 2
List of Participants
S. No. Name Designation Contact Details
1 Dr. M G Karmarkar President, ICCIDD
Address- Room No- 29Centre for Community MedicineOld OT BlockAIIMS, New Delhi-110029
E-mail- [email protected] No- 011-26588522Mobile No. - 9811857412
2 Dr. Chandrakant S Pandav
Professor & HeadCentre for Community Medicine
AIIMS, New Delhi&
Regional Coordinator (South Asia), ICCIDD
Address- Room No. 31 Centre for Community MedicineOld OT BlockAIIMS, New Delhi-110029
E-mail - [email protected] No. 011-26593553Mobile No. -9810038423
3 Dr. Rajan Sankar Country Manager & Regional Advisor (South Asia),
GAIN
Address- Suite 15AB, The Lodhi, Lodhi Road, New Delhi- 110 003
E-mail - [email protected] No. - 011- 43147575Mobile No. - 9717141110
4 Mr. M A Ansari Salt Commissioner of India
Address- Lavan Bhawan, 2-A, Lavan MargJhalana Doongri, Jaipur- 302004
E-mail - [email protected] No. - 0141-2709568Mobile No. - 9414073350
5Dr. Vikas Desai Secretary
Urban Health Society of India, Surat
Address- NIWCD premises, Kanaiyalal Desai Bhawan, Nandshankar Mahollo, Gopipura, Surat - 395001 (Gujarat)
E-mail- [email protected] No. - 9825117259
6 Dr. S. D. GuptaDirector
Institute of Health Management and Research, Jaipur
Address- 1, Prabhu Dayal Marg, Sanganer Airport, Jaipur - 302 011
E-mail- [email protected]
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Landline No- 0141-2791431-32Mobile No. – 9825117259
7 Dr. M. M. GodboleProfessor & Head
Department of EndocrinologySanjay Gandhi Post Graduate Institute of Medical Sciences,
Lucknow
Address- Raebareli Road, Lucknow- 226 014 (U P)
E-mail- [email protected] No- 0522 2668800Mobile No.- 9415014339
8 Dr. Richa Singh Pandey Nutrition OfficerUnicef Office for Uttar Pradesh
Address- 3/194, Vishal KhandGomti Nagar, Lucknow-226010Uttar Pradesh
E-mail- [email protected] No.- 0522- 2303151-52Mobile No. - 9839549005
9 Mr. Rizwan Yusufali
ManagerUSI Programmes, GAIN
Address- Suite 15AB, The Lodhi, Lodhi Road, New Delhi- 110 003
E-mail - [email protected] No. - 011- 43147575Mobile No. - 9910339298
10 Dr. Arijit Chakrabarty Associate, GAIN
Address- Suite 15AB, The Lodhi, Lodhi Road, New Delhi- 110 003
E-mail [email protected] No. - 011- 43147575Mobile No. - 9868501808
11 Mr. Suvabrata DeyNational Programme Manager, Salt
IodizationMicronutrient Initiative
Address- 11, Zamroodpur Community CenterKailash Colony ExtensionNew Delhi - 110 048; India
E-mail- [email protected] No.- 011 4686 2031Mobile No. 98102 13178
12 Mr. Ranjan Kumar Jha Micronutrient Initiative
Address- 11, Zamroodpur Community CenterKailash Colony ExtensionNew Delhi - 110 048; India
E-mail- [email protected] No.- 011 4686 2031Mobile No. 9810107783
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13 Mr. Vivek Ogra Director - Technology & InnovationVBSOFT India Limited
Address- 1001 Pinnacle Business Park, Corporate Road,Prahladnagar, Ahmedabad - 380015, Gujarat, India
E-mail- [email protected] No. 9824022997
14 Dr. Pawan Kumar Gupta Manager, Strategy Development Via Media Health
Address- Assotech-1, C-20/1/1A 2nd Floor, Sec - 62 Noida Uttar Pradesh, India
E-mail- [email protected] No.- 0120- 2400375Mobile No. - 9891344359
15 Mr. D S Dixit USI Cell
Motilal Nehru Medical College, Allahabad
Address- Allahabad, UP
Mobile No- 09450579694
16 Mr. Kumar RajbhandariDivisional Manager
Salt Division,Salt Trading Corporation Limited
Address- Divisional Manager,Salt Division, Salt Trading Corporation LimitedKalimati, Kathmandu, Nepal
E-mail- [email protected] No: 00977-1-4280432,Mobile Nepal: 00977-9851033303.Mobile India: 0091-9717003353
17 Dr. J. Jeyaranjan Director, Institute of Development Alternatives, Chennai
Address- M7C MIG Flats, Lattice Bridge Road, Thiruvanmiyur, Chennai – 600 041, Tamil Nadu
E-mail- [email protected] No. 044-24484803Mobile No- 9444371520
18 Dr. Kapil YadavAssistant Professor
Centre for Community Medicine AIIMS, New Delhi
Address- Room No-32, Centre for Community MedicineOld OT Block, AIIMSNew Delhi-110029
E-mail- [email protected] No. 011- 26593848Mobile No.- 9818420553
Senior Programme Officer
Address- Room No-28, Centre for Community MedicineOld OT Block, AIIMS
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19 Dr. Rakesh Kumar ICCIDD, New Delhi New Delhi-110029
E-mail- [email protected] No. 011- 26588522Mobile No.- 9810672953
20 Dr. Harshal SalveSenior Resident
Centre for Community Medicine AIIMS, New Delhi
Address- Room No-14, Centre for Community MedicineOld OT Block, AIIMSNew Delhi-110029
E-mail- [email protected] No. 011- 26593233Mobile No.- 9911253846
21 Dr. Rizwan SAJunior Resident
Centre for Community Medicine AIIMS, New Delhi
Address- Room No-14, Centre for Community MedicineOld OT Block, AIIMSNew Delhi-110029
E-mail- [email protected] No. 011- 26593233Mobile No.- 8447284098
22 Mr. Pritam Singh Tanwar ICCIDD, New Delhi
Address- Room No-30, Centre for Community MedicineOld OT Block, AIIMSNew Delhi-110029
E-mail- [email protected] No. 011- 26588522Mobile No.- 9810829103
23 Mr. Rajesh Lal Laboratory AssistantICCIDD, New Delhi
Address- Room No-29, Centre for Community MedicineOld OT Block, AIIMSNew Delhi-110029
E-mail- [email protected] No. 011- 26588522Mobile No.- 9810568829
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Annexure 3
Logic model for Sustainable Elimination of IDD in India
Immediate Outcome Output Input Activities Target Coordination in efforts
of all stakeholders for achieving USI at state level
USI high in policy agenda of the national and state governments
Alignment of IDD in RCH and NRHM
Formation of state level coalition for sustainable elimination of IDD
Introduction of iodized salt in Public Distribution System and other government funded food programmes
- Meeting of stakeholders
- Meeting with Health Secretary/Mission Director (NRHM) at national level to explore the alternate mechanism of funding of NIDDCP and alignment of IDD and RCH
- Meeting with Health Minister/Principal Secretary (Health)/ NRHM Mission director to sensitize them and advocate with them for strengthening of IDD cell and IDD laboratories in the state and explore the funding for state coalition
- Meeting with Civil Supplies Minister/Principal Secretary to sensitize them and advocate with them for inclusion of iodized salt in PDS
- Meeting with state representatives of partner agencies (Unicef/WHO/WFP/GAIN/MI) and enlist their support for the state level activities and formation of the coalition and explore funding for the coalition
Formation of state level coalition in five priority states i.e. Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
Separate budget for IDD in programme implementation plans (PIPs) of all state
Introduction of iodized salt in PDS in remaining priority states
Distribution of iodized salt in all VHNDs
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- Meeting with salt trader union/key salt traders in the state to sensitize them about IDD and USI
- Meeting with salt producers union/ key salt producers in salt producing states to sensitize them about IDD and USI
- Meeting with key media personalities/civil society organizations to sensitize them about IDD and USI
Drafting of terms of reference and
budgeting mechanism for the State Coalition
Meetings of state coalition
Strengthening of legislative framework and implementation of regulations regarding salt iodization
Active Involvement of district collectors in enforcement of salt iodization regulations
Active involvement of Food Safety Officers in enforcement of regulations regarding iodized salt
Involvement of railway authorities in preventing wrongful declaration of quality of salt transported
Meeting with district collectors to sensitize them about IDD and advocate with them for enforcement of salt iodization legislation
Meeting with Head of State Food Safety Authority to sensitize him and advocate with him for more effective implementation of Food Safety Laws
Meeting with railway authorities in states
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by railwaysEnsuring availability of adequately iodized salt at consumer level
Improvement in quality of iodized salt at production level
Procurement of adequately iodized salt by salt traders
Supply of salt testing kits to salt traders
Provision of technical know-how to iodized salt producers in salt producing states
Formation of a linkages between iodized salt traders and producers using good manufacturing practices
Monitoring of iodized salt quality by traders using salt testing kits
Better understanding of iodized salt supply issues at state level
A report on the situation analysis of iodized salt supply chain in Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
A dissemination meeting on iodized salt supply chain analysis in Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
State specific action plan for strengthening supply chain of adequately iodized salt in Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
Situation analysis of the iodized salt supply chain in Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
Dissemination of state level supply chain analysis through meeting of stakeholders in Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
Preparation of state specific action for strengthening supply chain of adequately iodized salt in Bihar, Uttar Pradesh, Gujarat, Tamil Nadu and Rajasthan
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Generation of robust and authentic data on IDD and coverage with adequately iodized salt at national and state level
Framing of revised guidelines for survey under NIDDCP , which is aligned with internationally recommended guidelines by WHO/Unicef/ICCIDD
Regular Procurement of STKs by state government
Availability of urinary iodine data at state and national level
Availability of routine data on salt iodine content at household level
A rapid survey of retailers for iodine content of retail salt
Regular supply of STKs to ASHAs
Meeting with Health Secretary/ National Programme Officer, IDD cell, Ministry of Health and Family Welfare Government of India for framing revised guidelines and funding mechanism for surveys under NIDDCP
State and national survey every five years
Testing of specific number of salt samples using Salt testing Kits and titration routinely
Testing of specific number of urine samples routinely
Improved access to laboratories to provide accurate data on urine and salt iodine levels
Strengthening of laboratory at State IDD cell
Involvement of six newly created AIIMS and other medical colleges in provision of laboratory services for IDD
Development of training manual for laboratory personnel
Meeting with National Programme Officer of IDD cell for organizing the training programme
Training of laboratory personnel of IDD cells in states
Communication with Directors of newly created AIIMS for establishment of IDD laboratory
Training of laboratory personnel of IDD cell of priority states
Establishment of IDD laboratory at all newly created AIIMS
Increased demand generation for iodized salt
A robust communication strategy for demand generation for iodized salt
Development of IEC manuals for various
Training of ASHAs/other functionaries in communication strategies for iodized salt
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Involvement of health and allied functionaries like ANM, ASHA, AWW in IEC for iodized salt
functionaries Meeting with district collector/health official for effective implementation of communication strategy
Effective collation and dissemination of data on IDD
Establishment of a MIS in the IDD Cell, MOHFW, Government of India
Meeting with Health Secretary/National Programme officer, IDD Cell for establishment of MIS in IDD cell
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Annexure 4
Situation Analysis of supply chain of adequately iodized salt
State of ________________
Domain Indicator/detail Source
Demographic Profile
(Descriptive profile of the state)
Total population (in millions) Total annual births Total number of pregnant women
annually Rural-Urban population percentage Number of districts/Blocks Number of Medical colleges Details of special focus group-
marginalized populations- Tribal population, remote/hilly areas
Census, 2011
Sample Registration Survey
Burden of IDD(both historic and current
status)
Total Goitre rate Urinary iodine level
- SAC -Pregnant women
Iodized salt coverage - Total - Desegregate (Rural/Urban, Socio-economic, Region/district wise)
State IDD cell - District levelNational and State level surveysPeer reviewed journalsExpertsOther sources
IDD Stakeholders list(compile a comprehensive list
with identification of key person in each
department/stakeholder group)
Compile list with contact details
Department of HealthState Food Safety AuthorityDepartment of Food and Civil
suppliesDepartment of WCDDepartment of Education- MDMDepartment of Information and
broadcastingSalt Commissioner s RepresentativeDistrict CollectorsPartner agenciesNon-governmental agencies
Key informants
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Professional associations- Public Health/Paedriatician/Obstetrician /Nutritionist/Endocrinologist
Medical CollegesSalt wholesalers/tradersMedia groups- electronic/print Experts – IDD, Nutrition, Public
HealthIDD Program at state level Total annual budget of IDD at State
- Central/state percentage IDD budget head allocation and
utilization (last five years)Details of IDD component of State
PIPProcurement of STKsTraining of ASHA for use of STKsDetails of remuneration for ASHA
(allocation/utilization)
Status of IDD Cell IDD Cell present/absent Staff in position Functional status last 5 years
- IDD surveys conducted- Details of survey conducted - Other activities
IDD laboratory- Staff in position- Equipment inventory- Total salt samples analyzed
Fund status (annual basis last five years with time line) - Amount sanctioned - Total amount received - Total expenditure incurred - Identify bottlenecks
Directorate of Health
Supply chain of Iodized salt
Salt producing state
Salt consuming/sourcing state
Total iodized salt requirement Total iodized salt supply Source state Mode of transport Type of salt- refined/unrefined Desegregate data from
sub-state/district level Price of salt
Procurement cost/landing cost/wholesaler/retailer cost
Salt Commissioner OfficeDepartment of Civil SuppliesWholesalers AssociationSalt Traders
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Availability of iodized salt in PDS- Type, cost, amount procured annually- Mechanism of procurement, suppliers of salt
Number of iodized salt wholesalers/traders
Total number of salt producers * Total salt production by type of salt Number refineries/small scale producers Status of production end monitoring - Total number of salt samples analyzed - percent sample conforming to standard -Details of punitive action taken
Monitoring of iodized salt State Food Authority - Number of Food Safety Officers - Total number of salt samples collected annually - Source of salt samples collected- Production/wholesaler/traders - Percentage confirming to the standards - Follow up action taken (Court case, punitive action)
Public Health laboratory- staff- equipment- Salt samples analyzed annually
Monitoring of salt procured in PDS, public health programs like MDM, ICDS, VHND
State Food Safety AuthorityPublic Health laboratoryState IDD Cell
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Programme indicators for tracking progress of
sustainable elimination of iodine deficiency disorders
Presence of a state multi-sector coalition
Demonstration of political commitment
Enactment of legislation and supportive regulations on universal salt iodization
Establishment of methods for assessment of progress in the elimination of IDD
Access to laboratories to provide accurate data on salt and urinary iodine levels and thyroid function
Establishment of a programme of education and social mobilization
Routine availability of data on salt iodine content, at the factory level at least monthly, and at the household level at least every five years
Routine availability of population-based data on urinary iodine every five years
Demonstration of ongoing cooperation from the salt industry
Presence of a state database for recording of results of regular monitoring procedures which include population-based household coverage and urinary iodine
Innovations USI CellIodized salt in VHND
Conduct SWOT (Strength, weakness, opportunity and threat) analysis of each identified broad domain
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