Achieving Universal Salt Iodization Goal in Georgia by 2005

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Achieving Universal Salt Iodization Goal in
Georgia by 2005
Recommendations for 2004-2005 Action Plan
Ms. Tamar Lobjanidze Deputy Head, Public Health
Department
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What is the Goal

• The action plan targets to outline essential
  steps and activities for achievement of the
  virtual elimination of IDD through attainment of
  Universal Salt Iodization in Georgia by end 2005
• Objectives
• 1. Increasing HH consumption of adequately
  iodized salt to gt 90 by end 2005
• 2. Decreasing goitre prevalence among children lt
  35 by end 2005 for sustainable elimination of
  IDD lt 5 by 2007

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International Criteria for Sustainable
elimination of IDD to be Met?

• SALT IODIZATION
• National needs for iodized salt supplies met by
  production/import
• gt 95 of imported supplies to be iodized
• HH consumption of adequately iodized salt gt 90

Status in Georgia gt 100
Status in Georgia gt 90
Status in Georgia 67
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International Criteria for Sustainable
elimination of IDD to be Met?

• SALT IODIZATION
• IS checked at import, wholesale retail levels
  by titration
• Iodized Salt checked at HH by titration or testing

Checked by State Standardization and Sanitary
Departments (2). Database to be more consolidated
HH Surveys performed in 1999 2003, not routinely
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International Criteria for Sustainable
elimination of IDD to be Met?

• Population Iodine Status
• Median Urinary Concentration should be at least
  100 mcg/dl, with less than 20 of values below 50
  mcg/dl
• The most recent monitoring data (national or
  regional) should have been collected in the last
  2 years

Status in Georgia Not continuous data available
Not regularly collected, last in 2002 following
Lipiodol distribution Data mostly mixed up with
referral
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Status of the National Programme 10 Criteria for
Programme Success

• 1. Functional effective multi-sectoral committee
  for IDD Programme coordination state, private,
  media, NGOs
• 2. Evidence of political commitment to USI and
  IDD Elimination

Status Existent since 1996, to be renewed
Status High Commitment from Government
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Status of the National Programme 10 Criteria for
Programme Success

• 3. Appointment of a responsible executive officer
  for the IDD elimination programme
• 4. Legislation or regulations on USI (ideally
  covering salt for both human and animal
  consumption)

Status National Centre for Nutrition
Status Available, Law covering both human
livestock, submitted to Parliament in 2003
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Status of the National Programme 10 Criteria for
Programme Success

• 5. Assessment Reassessment of IDD Progress,
  Access to Labs for Urine and Salt Testing
  
• 6. Information-education programme on IDD

Status Labs Available, quality and coordination
to be improved
Status Supported since 1998, but a research
based strategy to be developed
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Status of the National Programme 10 Criteria for
Programme Success

• 7. Cooperation with Salt Industry to Maintain
  Quality
• 7. Regular laboratory data on urinary iodine in
  school-aged children with appropriate sampling
  for higher risk areas

Status To be built and strengthened
Status No systemic approach, financial
Constraints, needs to be prioritized
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Status of the National Programme 10 Criteria for
Programme Success

• 9. Regular data on salt iodine at import, retail
  household levels
• 10. A database for monitoring procedures for salt
  content urinary iodine, neonatal TSH, with
  mandatory public reporting

Status Available from import (Dept. of
Standardisation), retail/wholesale (Sanitary
Surveillance), HH survey data
Status Data available at sectoral institutions
partners responsible for each specific point of
monitoring chain (Sanitary, Standardization, SDS,
PHD, NCN, Customs), need for data reconciliation
under single database
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4 Key Directions of the 2004-2005 Action Plan
3. Information-Education Support
1. Legislation for Quality Control Quality
Assurance
HH Consumption of Iodized Salt gt 90
2. Monitoring and Disease Surveillance
4. Multi-sectoral Partnership and Private Sector
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Component 1Legislation Regulations

• Objective
• Establishment of a strong legislative and
  administrative framework for ensuring attainment
  of USI Goals by end 2005
• banning import and sale of non-iodized salt other
  than under exceptional provisions, introducing
  sanctions regulative norms, QC systems at each
  level, etc.

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Component 1Legislation Regulations
Recommended Activities
Cabinet of Ministers, MLHSA (Sectoral Ministries,
Private Sector, NGOs, UNICF)

• Establishment of effective functional
  co-ordination committee/task force - July 2004
• Finalisation of the 2004-2005 Action Plan for USI
  by the Inter-agency Co-ordination Committee/Task
  Force - July-August 2004
• Revision of the existing legislation (including
  standards for iodized salt for human and animal
  consumption) and submission to the Parliament

Inter-agency Co-ordination Committee/Task Force
Inter-agency Co-ordination Committee/Task
Force Health Social Affairs Commitete if the
Parliament
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Component 1Legislation Regulations
Recommended Activities
Parliament of Georgia

• Adoption of the Draft Law by Parliament of
  Georgia - 2004 Autumn Sessions
• Revision of the registration systems on iodized
  salt import, refinement of QC system and the
  procedures (coding, testing, sanctions, etc.)
  Following adoption of the draft law, by end 2004
• Capacity building for staff from Customs, State
  Standards and Sanitary Surveillance Departments,
  (Training, International exprince sharing,
  Seminars, etc.) - Before end 2004

Inter-agency Co-ordination Committee/Task Force
Sectoral Ministries - Finance, Economy, MLHSA,
etc.
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Component 1Legislation Regulations
Recommended Activities
Sectoral Ministry Department - Customs, Sanitary,
Standardisation

• Establishment of unified database on import,
  quality control of iodised salt and ensuring
  functioning of the system by IT equipment - end
  2004
• Incorporation of iodised salt consumption
  indicators within HH surveys (test kits) - 2005
• Revision of the MoU on Establishment of Salt
  Iodization/Re-iodization Chain

Statistics Department, Ministry of Economy
Interagency Committee MoLHSA, MOH Adjara, UNICEF
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Component 2 Impact Assessment Disease
Surveillance

• Objectives
• Establishment of reliable monitoring systems and
  data base on IDD prevalence in Georgia
  disaggregated by location, age gender
• ensure continuous availability of UIE goitre
  prevalence data through a representative sample
  of the population

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Component 2 Impact Assessment Disease
Surveillance

• Revision of state standards for monitoring and
  surveillance and medical statistics reports -
  August September 2004
• Establishment and Launching of regional level
  infrastructures for IDD surveillance - before end
  2004
• Procurement of UIE test kits lab equipment if
  required, upgrading technical facilities of
  regional and central IODD centres - October 2004
  February 2005

NCN, PHD, NCDC and Medical Statistics, (UNICEF)
MLHSA (UNICEF, World Bank, USAID, PHC Sector)
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Component 2 Impact Assessment Disease
Surveillance

• Revision of the guidelines for health care
  providers on prevention, diagnostics treatment
  of IDD, printing and provision of training -
  August-December 2004
• Scholl based cross-sectoral survey representative
  on sub-national level detecting prevalence of
  UIE and goitre among school aged children - 2005
• Considering possibility for using regional
  reference labs for UIE testing for quality
  assurance in CEE/CIS - 2005

MoHLSA, PHD, NCN (UNICEF, World Bank, USAID,
Other PHC System Donors)
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Component 3 Information-Education Support

• Objectives
• Increasing awareness of the population on IDD and
  benefits of the iodized salt for prevention of
  IDD through design and implementation of
  research-based communication strategy
• Multisectoral involvement - media, education
  system , private sector, children and youth, etc.

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Component 3 Information-Education Support

• Development of a communication strategy under
  leadership of interagency co-ordination committee
  for various target audience - August 2004
• Legislative/executive authorities
• population Maternal and Child Health Focus
• Youth
• Health
• Education
• Private Sector

Ministry of LHSA Charitable Foundation
SOCO UNICEF (NGOs, Child and Youth Parliament,
Salt Importers, Ministry of Education)
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Component 3 Information-Education Support

• Development/printing of printed IEC materials
  (posters, brochures, billboards) and distribution
  among health education facilitieis, private
  sectors - October 2004 - May 2005
• Development of TV/Radp spots and promotion of
  iodized salt consumption through avrious Media
  programmes (Talk-Show, Culinaryprogrammes) -
  October 2004 - May 2005
• Training of Media representatives on health
  promotion issues including IDD prevention -
  October- November 2004

TV/Radio Corporation Ministry of LHSA Charitable
Foundation SOCO UNICEF (NGOs, Child and Youth
Parliament, Salt Importers, Ministry of
Education)
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Component 3 Information-Education Support

• Innovative activities - Contest on Child Stories
  on IDD/USI, 1 minute videos - January-September
  2005
• Introduction of School Day for Conbating IDD
  among pre-school and secondary school facilitieis
  (salt testing, information support) -
  September-December 2004
• Supprot to private sctor for promotion of
  iodizeds salt promotion (Special quality
  sertificate, dissemination of information
  materials) - 2004-2005

TV/Radio Corporation Ministry of LHSA Charitable
Foundation SOCO UNICEF (NGOs, Child and Youth
Parliament, Salt Importers, Ministry of
Education)
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Component 4Multi-sectoral Partnership Role of
Private Sector

• Multi-sectoral to be mainly referring to
  components 1-3
• Private Sector
• Improving participation and involvement of salt
  industry/importers within the national IDD/USI
  efforts.

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Component 4Multi-Sectoral Partnership and
Private Sector

• Major salt importers joining the National IDD
  Council/TF - July-August 2004
• Meeting/w-shop for salt importers on IDD/USI.
  Involvement of major food producers for advocacy
  and consensus building on utilization of iodized
  salt for food production
• Involvement in design of the IDD/USI
  Communication campaign, Distribution of IEC
  materials provided by national ICC Committee in
  line with salt distribution channels

National IDD Committee (Ministry of LHSA,
education, Finance, Economy SOCO Founation NGO
Networks Youth organizations
All major salt importers Major
Food Producers