Title: Sustained Elimination of Iodine Deficiency Disorders in CEE/CIS
1Sustained Elimination of Iodine Deficiency
Disorders in CEE/CIS Baltics
- Assessment of UNICEF Supported Communication
Activities
2Purpose
- Assess the status of IDD communication programs
- salt iodized / salt situation
- existing communication strategies
- media environment
- knowledge among the public
- stakeholder involvement
- Provide lessons learned and recommendations for
- role of communication within USI programs
- communication strategy design (including
messages) - using experience and expertise across countries
-
3The Countries
- Albania Kazakhstan Turkmenistan
- Georgia Kyrgyzstan Russia
- Moldova Tajikistan Ukraine
- Assessment conducted by Johns Hopkins Bloomberg
School of Public Health - Lisa Cobb
- Raisa Scriabine
4Presentation Structure
- Goals and Strategy
- Role of Communication
- Communication Framework
- Overview of Findings
- Findings from each framework element
- Supportive Environment
- Increasing Immediate Use
- Ensuring Sustained Use
- Recommendations by framework element
5UNICEF Supported Goal A Regional Priority
- Goal
- Sustainable elimination of IDD by 2005
- Measured by
- Household use of iodized salt (gt90)
- adequate iodine status (urinary iodine)
- Strategy
- Universal salt iodization by 2003
- All salt for human and animal consumption
- table or household salt
- salt for food processing
- animal salt
6Iodine Deficiency The Problem
7The network of connections are less dense
Iodine Sufficient Brain
Iodine Deficient Brain
Source From Legrand, 1967.
8The focus shifts to the brain
Science shows the real issue
9Role for Communication?
- Communication can change behavior at many levels
- Leaders (political medical)
- Communities
- Families
- Uses advocacy, education, information, marketing,
mobilization, and persuasion
10Iodized Salt From the Law to the Table
11Framework for IDD communication
- Aims to support the sustained production and use
of iodized salt - Multiple intervention points to achieve aim, from
legislation to household use - Each country puts emphasis on different elements
depending on their situation, but all elements
should be included
12Framework for IDD Communication
IDD Program Strategy
Supportive Environment Increasing Immediate
Use Ensuring Sustained Use
13Overview
- Congratulations to UNICEF staff! They should be
proud of their large role in changing the way
governments, salt producers, and populations
legislate, supply, and use iodized salt - Reaching UNICEF-supported goal to eliminate IDD
is important to all country offices. Staff
showed they are ready to move their programs
forward
14Overview (cont)
- The goal (sustained elimination of IDD by 2005)
is achievable in all of the countries visited,
but not at the current level of activity - Programs are creative, responsive to local needs
and desires, and carried out in collaboration
with local partners. Its time to take them to
scale everywhere
15Supportive Environment
Moldovan Legislation
16Supportive Environment - Overview
- Creating a supportive environment for sustained
elimination of IDD is UNICEFs strength and great
achievement - All country programs assessed had activities
designed to create a supportive legislative
environment - Level of success in creating legislation may have
more to do with country dynamics than
programmatic issues
17Supportive Environment - Overview
- Staff sometimes expressed disappointment that
legislation did not mandate USI - what they have
achieved so far is an accomplishment, however,
and they should continue advocacy for mandatory
legislation - Regulatory measures are necessary to enforce the
legislation that is in place
18Supportive Environment - Salt Situation
Salt Packaging from Albania
19Supportive Environment Overview (Salt Situation)
- Commercial salt trade across region regulated by
supply and demand - Many countries have problems with salt smuggling
and fake iodized salt - In every country, iodized salt is a market-based
product, and the market must sustain its
production with incentives (profits) and
regulation (legislation)
20Increasing Immediate Use
The Healthy Food Brand Kazakhstan
21Increasing Immediate Use - Overview
- In countries with communication plans, activities
designed to immediately increase use of IS
carried out in partnership with governments,
NGOs, and commercial partners - Most countys programs were designed to raise
awareness of IDD. Another approach is to market
or promote iodized salt
22Increasing Immediate Use - Overview
- Only a few countries included a marketing
perspective as a part of their strategy.
Kazakhstan was one of the few, with its Healthy
Food brand - Iodized salt is sold in the open market. When it
is promoted the messages compete with other
messages about food products good for health. IS
messages must be more powerful than others to be
remembered
23Increasing Immediate Use - Overview
- Little audience segmentation, without specific
messages targeted to the most vulnerable group
mothers-to-be - General iodized salt is good for your health
messages may not reach this group as powerfully
as a message on preventing brain damage in their
child
24Ensuring Sustained Use
School Curricula in Ukraine
25Ensuring Sustained Use - Overview
- Some country programs have large sustained use
components, with training of doctors and work
with school children as priority elements in
their strategy - Work with health works and school children is a
valuable, long-term strategy to ensure sustained
elimination of IDD (not a quick fix)
26Ensuring Sustained Use - Overview
- For this component, UNICEF support has focused on
educational and medical institutions. Sometimes
NGOs and community groups also actively engaged,
for example - Russia consumer groups played a dynamic role in
the program - Kyrgystan community leadership and village health
committees became forces in applying pressure on
retailers and producers to supply iodized salt
27Ensuring Sustained Use -Overview
- Producers of iodized salt will always be
responsible for providing and marketing iodized
salt to their customers - Some UNICEF country programs are working with the
salt producers actively, others less so - Salt producers have a role to play in legislation
and enforcement, increasing household use, and in
particular in ensuring there will always be
demand for iodized salt
28Iodized Salt From the Law to the Table
- Supportive Environment
- Advocacy for USI legislation
- Creation of IDD coalitions and monitoring bodies
- Engagement of IS producers in advocacy and IS
agenda
- Increasing ImmediateUse
- IS marketing to consumers
- Branding and packaging with IS producers
- Point of sale promotion
- Ensuring Sustained Use
- IS promotion by medical professionals
- IDD education and IS promotion in schools and
civil society groups - Engaging private sector salt production in
marketing
Adequate iodine nutrition
29Regional RecommendationsGeneral
- All country offices should develop communication
strategies tailored to their specific audiences
(leaders, private sector, communities, families)
within available resources - Communication plans should include objectives,
roles responsibilities, timelines, audiences,
message concepts, and relationship to overall USI
goal. - Development should be done through workshops
that bring together all IDD stakeholders in the
government, private sector, and civil society
30Regional RecommendationsGeneral
- All country officer should integrate
communication into the USI program.
Communication should not be seen in isolation
from USI programs, and communication officers and
program officers need to plan and coordinate
their work to reach the goal - UNICEF (at the regional level) should disseminate
lessons learned, successful methodologies,
messages and materials, toolkits, and strategies
among countries
31Regional RecommendationsSupportive Environment
- Advocate for strengthened mechanisms for
designing, implementing, and enforcing policy at
the national level. Not all countries have an IDD
coalition , and some are not adequately staffed,
or have low-level representation without
political impact - Where legislation is incomplete or absent,
continue advocacy for USI (as a priority) - Advocate and provide support for adequate
enforcement measures in legislation.
32Regional RecommendationsIncreasing Immediate Use
- Consider strategies that directly target
mothers-to-be (both pregnant women and women
likely to become pregnant sometime soon) - Focus on message that iodized salt prevents brain
damage. Messages that say iodized salt leads to
better health" are not memorable enough -
iodized salt must then compete with other
products offering better health - Use marketing strategies to harness the power of
families and individuals to drive IS use.
Develop tools such as point-of-sale promotion and
branding
33Regional RecommendationsEnsuring Sustained Use
- Engage health workers and teachers in delivery of
the iodized salt message. Train teachers and
health workers carefully to make sure they teach
the material correctly, with the right messages - Involve the salt industry in planning for
sustainable production and use of iodized salt
through their own marketing activities - Look at additional ways of engaging civil
society, such as involving womens and youth
groups, consumer groups, and teachers - Disseminate IDD messages through other programs
activities - UN agencies, NGOs, and international
organizations active in relevant health areas
34- Johns Hopkins Bloomberg School of Public Health
Center for Communication Programs - International Council for Control of Iodine
Deficiency Disorders