Outcome%20:%20Political%20support%20from%20the%20PM

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The Turning Point of The Programme1983 Meeting
With The Prime Minister of India Mrs. Indira
Gandhi

• Outcome Political support from the PM
• Redefining IDD National developmental problem
• Strategy From District specific to
  Universal Salt Iodisation (USI)
• Solution Liberalization of production
  - Encouragement to private sector
• Prime Ministers 20-point Programme Goitre
  Elimination

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Progress since 1983 - 1

• 1984 Policy of Universal Salt Iodisation
• Private sector encouraged to produce
  iodised salt
• 1992 National Goitre Control Programme
  (NGCP) renamed as National IDD Control
  Programme (NIDDCP)
• 1995 Independent survey evaluation of USI
  in Madhya Pradesh New Delhi Sikkim

3
Progress since 1983 - 2

• 1997 Sale storage of common salt banned
• 1998-99 NFHS - 2 Survey on Household
  consumption of iodised salt
• 13th Sept. Ban on sale of common salt 2000
  lifted by the Central Government

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• Graph of progress of USI at a glance
• 1983-2000

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India Use of Iodised Salt National Family Health
Survey 2 (NFHS 2) 1998-1999

• 71 consuming salt with some iodine
• 49 use adequately iodised salt
• (recommended level of 15 ppm or more)
• 22 use inadequately iodized salt
• 29 use non-iodized salt

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The World In Which Policies Should Be Made
1) Health Problem/Issue
2) Information

Values
3) Institutional structure for
decision making
4) POLICIES
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World In Which Policies Should Be Made
Values
CORE VALUES (IDEOLOGIES) Gandhians Salt as a
icon of the freedom struggle SJM Globalization
Liberalization
BELIEFS Casual Assumptions Iodine Impurity
INTERESTS Iodine Import Loose Vs
Packaged Small Vs Big producers National Vs
Multinational
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Dr. Denish Moorthy, Ph.D. Student, Centre for
Community Medicine AIIMS, who has been
associated with Prof. Ramalingaswami since
1999 to take us through the events related to
role of values in health policy formulation
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Year 2000 Beyond

• May 2000
• Central Government decides to lift the ban on
  the sale of common salt
• May - Sept 2000
• Communication to elected representatives of
  Central State Govt. through meetings letters
• Proactive IEC in print electronic media on
  importance of IDD elimination Benefits of
  iodised salt
• Sept 2000
• - Government lifts the ban at the Central Level
• - States continue to have the ban

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Withdrawal of The Ban

• National Ban on sale of common salt for human
  consumption withdrawn
• - Government of India, 13th Sept. 2000
• Reason Given
• On point of principle, compulsions in the matter
  of individual choice in undesirable

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Current Scenario Of The Ban

• Andhra Pradesh Maharashtra - Partial ban
  continues
• Kerala - No ban (Status Quo)
• But recent (May 2001) statewide survey
• shows IDD as public Health problem
• Gujarat and Orissa Lifted the ban
• Orissa Restored the ban after 6 months

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Year 2000 Beyond

• Probable factors responsible for lifting of the
  ban
• PFA Legislation harassment
• Politics of liberalization
• Price difference and perceptions
• Principle of choice

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Core Values, Beliefs, Interests The Three Key
Players
Common Iodised Salt Manufacturers

Swadeshi Jagran Manch (SJM)

Gandhians
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Profile of Common Salt Manufacturers

• Statewise production
• Gujarat 73
• Tamil Nadu 13
• Rajasthan 9
• Sector wise production
• Private Sector 60
• Un-recognised Sector 28 (Half in Gujarat)
• Co-operatives 9
• Public Sector 3
• Category wise production
• Small - lt 10 acres 62
• Large - gt 100 acres 28
• Medium - 10 - 100 acres 10

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Profile of Iodised Salt Manufacturers

• Number of salt iodisation plants 964 (Year
  2000)
• State wise production
• Gujarat 61
• Rajasthan 13
• Tamil Nadu 9
• Refineries (Production of refined / vacuum
  iodised salt)
• Installed Capacity 25 lakh tons
• Iodised Salt Production 8 lakh tons (1998)
• Proportion of total production 8 /44 18
• Sector wise production
• Private 98
• Public 2

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Salt Manufacturers Traders
Repackers (Traders)
Salt manufacturers
Brand Imitation
Medium Large Scale
Small Scale
Poor Quality salt With Inadequate iodine
content
Question of quality and Adequate iodine content
of salt
Refined Free flowing Salt
Good Quality salt With Adequate iodine content
PFA Act Harassment
Problems with the PFA Act
No problems with the PFA Act
Petitioning elected representatives Lifting of
the ban
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Salt Manufacturers

• Past
• Availability of Technology Large and medium
  scale producers cutting into small scale
  producers market
• Cooperatives formed to assist the small producers
• Issues in PFA Act
• Issues in implementation of PFA Act
• Proposed plan of action
• Availability of Technology Innovative ways of
  Cooperation
• Issues in PFA Act
• Efforts to modify Act
• Monitoring of quality of iodised salt by the
  producers themselves
• Certification of product WTO ISO 9002

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Swadeshi Jagran Manch (SJM)

• Points related to ideology
• Globalization Multinational and large
  corporation angle to salt in India
• Perceptions about common iodised salt
• Price of iodised salt
• Liberalization Import of iodine a burden
  on economy!

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IDD Control Programme A National Effort - 1

• Contribution Made For Assessment Tracking
  Progress
• - By national institutions
• - With national support
• - By national scientists
• - Using national laboratory
  equipments

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IDD Control Programme A National Effort - 2

• Contribution Made For Control
• - Self Sufficiency in common salt production
• - Indigenous manufacture of salt
  iodisation plants accessories
• - Supported by national technical efforts
• - Conversion of iodine to potassium
  iodate done in India
• - Indigenous packaging
• - Import of Iodine
• (Iodines share of Total Indian Imports
  0.005)

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Perception about common salt iodised salt
Universal Salt Iodisation (USI) Legislation
PFA Iodised Salt Packaged Salt Refined
Salt High Priced salt
Crystal - in Jute Bags - 75 Kgs. /
100 kgs. Common salt Powdered - in
Polypacks - of ½ Kg / 1 kgs. iodised salt
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Cost Of Iodine For Salt Iodisation

• Total Production of
• Iodised salt in India
  44 Lakh tons
• Iodine Required for Salt
• Iodisation (30 mg I2 /Kg Salt ) 144
  Tons
• Price of iodine per ton Rs. 7.3 Lakhs
• (_at_ US15.5 / Kg)
• Total cost of Iodine required
• for salt Iodisation Rs. 10.5
  Crore

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Cost Of Iodine Per Person Per year

• Total cost of Iodine required for
• salt Iodisation Rs. 10.5 Crores
• Rs. 10.5 Crores for 100 Crores population
• Cost of iodine per person per year 10.5 paise

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Acts and Rules for Salt

• Salt is declared as an item of food under
  Essential Commodities Act, 1955
• State governments have been authorized to
  administer the Act for
• Fixing the prices of salt
• Its movement within their States, if necessary

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States/UTs Supplying Iodised Salt Fully/Partly
Through PDS - I
S.No. State / UT PDS selling price/ kg.
1. Maharashtra Rs. 2.90 DPAP areas Rs. 1.65 ITDP areas
2. Tripura Rs. 1.90
3. Lakshadweep Rs. 2.50
4. Assam Rs. 2.00 powdered Rs. 3.00 packed salt
5. Kerala Rs. 2.45 Crystal salt Rs. 4.65 Free Flow
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States/UTs Supplying Iodised Salt Fully/Partly
Through PDS - II
S.No. State / UT PDS selling price /kg.
6. Orissa Rs. 2.00
7. Rajasthan Rs. 3.25
8. Tamil Nadu Rs. 2.50
9. Delhi Rs. 2.50 Rs. 3.50 Refined free flow
10. Arunachal Pradesh Rs. 2.60
11. Gujarat Rs. 0.60
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Gandhian Movement

• Their Arguments
• Do we need universal salt iodisation?
• Why a compulsion for iodised salt?
• Salt An Icon of the Freedom Struggle
• Why not have a Choice?

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Do we need universal salt iodisation?

• IDD is a public health problem Therefore it
  requires public health solution
• The serious irreversible effects of IDD
  (stillbirths , abortion, neonatal mortality and
  mental handicap) are not obvious
• Prevention (Health Promotion specific
  protection public health approach)
• is better than
• Cure (early diagnosis and treatment, disability
  limitation, rehabilitation Clinical approach)

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Yes- A Worthwhile Investment in Health

• Cost per person per year of protection
  50 paise
• (less than a price of cup of tea!)
• Cost benefit ratio (only health effects) 13
• If benefits related to education
• (13 I.Q points) livestock
• (increased productivity yield of
• eggs, milk, wool, etc) included, then
• Cost benefit ratio 110
• (This work was conducted as part of the INCLEN
  Training of Dr. Pandav at McMaster University,
  Canada, 1990-1991)

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India Use of Iodised Salt National Family Health
Survey 2 (NFHS 2) 1998-1999 Socioeconomic
Status Use of Iodised Salt
Socio-economic status Non-iodised Salt () Inadequately Iodised Salt () Adequately Iodised Salt () Total ()
Low 36 28 36 100
Medium 28 22 50 100
High 13 9 78 100
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Scientists Point of View

• Improving beneficial components of diet does
  not increase iodine intake
• Dietary diversification does not increase iodine
  intake because
• Iodine deficiency is a disease of the soil
• Therefore the need for universal salt iodisation
• Most cost-effective, economical physiologically
  safe means of eliminating iodine deficiency is
  regular continuous consumption of adequately
  iodised salt
• Consumption of Iodised Salt A Healthy Habit

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Dr. Chandrakant S Pandav, Member, Clinical
Epidemiology Unit, Addl. Prof., Centre for
Community Medicine AIIMS, who spent his school
life at Aga Khan Palace, Pune where Mahatma
Gandhi was imprisoned during the Quit India
Movement To summarize The Case Study
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• I would be hard-hearted enough to let the sick
  die if you can tell me how to prevent others
  from falling sick
• - Mahatma Gandhi

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Lessons Learnt From NIDDCP

• Health Issues are Social,Political Economic
  Issues
• In the Formulation of Policy in a Democratic
  Environment, we require
• a) Identification of the health problem/issue
• b) Information to knowledge
• - Evidence based data
• - Effective efficient intervention to
  eliminate the problem

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Lessons Learnt From NIDDCP

• In the Formulation of Policy in a Democratic
  Environment, we also require
• a) Formal networks
• b) Informal networks
• c) Values Core values, beliefs, interests
• Implementation of policy based only one or two
  factors will
• a) Achieve less than optimum results
• b) Lead to a retrograde step as seen in the Case
  Study of NIDDCP

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World In Which Policies Should Be Made
1) Health Problem/Issue
2) Information
3) Values
4) Institutional structure for
decision making
5) POLICIES
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In Summary

• Iterative Loop Research Policy - Programme
• World In Which Policies Were Being Made
• World In Which Policies Should Be Made
• A Case Study of NIDDCP
• Lessons Learnt From the NIDDCP
• In Summary

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Thank You for Your Kind Attention!