sustained elimination of iodine deficiency disorders in cee/cis & baltics assessment of unicef...
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Sustained Elimination of Iodine Deficiency Disorders in
CEE/CIS & Baltics
Assessment of UNICEF Supported Communication Activities
Purpose: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
The Countries
Albania Kazakhstan Turkmenistan
Georgia Kyrgyzstan Russia
Moldova Tajikistan Ukraine
Assessment conducted by Johns Hopkins Bloomberg School of Public Health:
Lisa Cobb
Raisa Scriabine
Presentation StructureGoals 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
UNICEF Supported Goal: A Regional Priority
Goal: Sustainable elimination of IDD by 2005
Measured by: Household use of iodized salt (>90%) 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
Iodine Deficiency: The Problem
At risk of At risk of mentalmentalImpairmentImpairment10-15% IQ loss10-15% IQ loss
GoiterGoiter
Cretinism Cretinism
The network of connections are less dense
The network of connections are less dense
Iodine Sufficient Brain
Iodine Deficient Brain
Source: From Legrand, 1967.Source: From Legrand, 1967.
Role for Communication?
Communication can change behavior at many levels: Leaders (political & medical) Communities Families
Uses advocacy, education, information, marketing, mobilization, and persuasion
The Market
Production of IS(table, food, animals)
Enforcement of Laws
Government Legislation
The Black Market
UniodizedSalt
The Household
Iodized Salt:From the
Law to the Table
Framework 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
Framework for IDD Communication
Supportive Environment
Increasing Immediate Use
Ensuring Sustained Use
IDD Program Strategy
Overview
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
Overview (con’t)
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. It’s time to take them to scale everywhere
Supportive Environment - Overview Creating a supportive environment for sustained
elimination of IDD is UNICEF’s 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
Supportive 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
Supportive 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)
Increasing 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 county’s programs were designed to raise awareness of IDD. Another approach is to market or promote iodized salt
Increasing 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
Increasing 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
Ensuring 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)
Ensuring 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
Ensuring 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
The Market
Production of IS
Enforcement of Laws
Government Legislation
The Black Market
UniodizedSalt
The Household
Iodized Salt:From the
Law to the Table
Supportive Environment•Advocacy for USI legislationCreation of IDD coalitions and monitoring bodiesEngagement of IS producers in advocacy and IS agenda
Increasing ImmediateUseIS marketing to consumersBranding and packaging with IS producersPoint of sale promotion
Adequate iodine nutrition
Ensuring Sustained UseIS promotion by medical professionalsIDD education and IS promotion in schools and civil society groupsEngaging private sector salt production in marketing
Regional Recommendations:General
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
Regional Recommendations:General
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
Regional Recommendations:Supportive 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.
Regional Recommendations:Increasing 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
Regional Recommendations:Ensuring 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 women’s 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