Sustained Elimination of Iodine Deficiency Disorders in CEE/CIS & Baltics Assessment of UNICEF Supported Communication Activities

Purpose: Assess the status of IDD communication programs: l salt iodized / salt situation l existing communication strategies l media environment l knowledge among the public l stakeholder involvement Provide lessons learned and recommendations for: l role of communication within USI programs l communication strategy design (including messages) l 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 Structure Goals and Strategy Role of Communication l Communication Framework Overview of Findings Findings from each framework element l Supportive Environment l Increasing Immediate Use l Ensuring Sustained Use Recommendations by framework element

UNICEF Supported Goal: A Regional Priority Goal: l Sustainable elimination of IDD by 2005 Measured by: l Household use of iodized salt (>90%) l adequate iodine status (urinary iodine) Strategy: l Universal salt iodization by 2003: l All salt for human and animal consumption l table or household salt l salt for food processing l animal salt

Iodine Deficiency: The Problem At risk of mental Impairment 10-15% IQ loss Goiter Cretinism

The network of connections are less dense Iodine Sufficient Brain Iodine Deficient Brain Source: From Legrand, 1967.

The focus shifts to the brain Science shows the real issue

Role for Communication? l Communication can change behavior at many levels: l Leaders (political & medical) l Communities l Families l Uses advocacy, education, information, marketing, mobilization, and persuasion

The Market Production of IS (table, food, animals) Enforcement of Laws Government Legislation The Black Market Uniodized Salt The Household Iodized Salt : From the Law to the Table

Framework for IDD communication l Aims to support the sustained production and use of iodized salt l Multiple intervention points to achieve aim, from legislation to household use l 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 l 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 l 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) l The goal (sustained elimination of IDD by 2005) is achievable in all of the countries visited, but not at the current level of activity l 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

Moldovan Legislation Supportive Environment

Supportive Environment - Overview l Creating a supportive environment for sustained elimination of IDD is UNICEF’s strength and great achievement l All country programs assessed had activities designed to create a supportive legislative environment l Level of success in creating legislation may have more to do with country dynamics than programmatic issues

Supportive Environment - Overview l 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 l Regulatory measures are necessary to enforce the legislation that is in place

Salt Packaging from Albania Supportive Environment - Salt Situation

Supportive Environment Overview (Salt Situation) l Commercial salt trade across region regulated by supply and demand l Many countries have problems with salt smuggling and “fake” iodized salt l In every country, iodized salt is a market-based product, and the market must sustain its production with incentives (profits) and regulation (legislation)

The Healthy Food Brand Kazakhstan Increasing Immediate Use

Increasing Immediate Use - Overview l In countries with communication plans, activities designed to immediately increase use of IS carried out in partnership with governments, NGOs, and commercial partners l Most county’s programs were designed to raise awareness of IDD. Another approach is to market or promote iodized salt

Increasing Immediate Use - Overview l 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 l 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 l Little audience segmentation, without specific messages targeted to the most vulnerable group: mothers-to-be l 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

School Curricula in Ukraine Ensuring Sustained Use

Ensuring Sustained Use - Overview l Some country programs have large sustained use components, with training of doctors and work with school children as priority elements in their strategy l 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 l For this component, UNICEF support has focused on educational and medical institutions. Sometimes NGOs and community groups also actively engaged, for example: l Russia consumer groups played a dynamic role in the program l Kyrgystan community leadership and village health committees became forces in applying pressure on retailers and producers to supply iodized salt

Ensuring Sustained Use - Overview l Producers of iodized salt will always be responsible for providing and marketing iodized salt to their customers l Some UNICEF country programs are working with the salt producers actively, others less so l 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 Uniodized Salt The Household Iodized 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 Adequate iodine nutrition 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

Regional Recommendations: General l All country offices should develop communication strategies tailored to their specific audiences (leaders, private sector, communities, families) within available resources l Communication plans should include objectives, roles& responsibilities, timelines, audiences, message concepts, and relationship to overall USI goal. l Development should be done through workshops that bring together all IDD stakeholders in the government, private sector, and civil society

Regional Recommendations: General l 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 l UNICEF (at the regional level) should disseminate lessons learned, successful methodologies, messages and materials, toolkits, and strategies among countries

Regional Recommendations: Supportive Environment l 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 l Where legislation is incomplete or absent, continue advocacy for USI (as a priority) l Advocate and provide support for adequate enforcement measures in legislation.

Regional Recommendations: Increasing Immediate Use l Consider strategies that directly target mothers-to-be (both pregnant women and women likely to become pregnant sometime soon) l 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 l 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 l 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 l Involve the salt industry in planning for sustainable production and use of iodized salt through their own marketing activities l Look at additional ways of engaging civil society, such as involving women’s and youth groups, consumer groups, and teachers l Disseminate IDD messages through other programs’ activities - UN agencies, NGOs, and international organizations active in relevant health areas

Johns Hopkins Bloomberg School of Public Health Center for Communication Programs International Council for Control of Iodine Deficiency Disorders