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

2. 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 > 90% by end 2005; 2. Decreasing goitre prevalence among children < 35% by end 2005 for sustainable elimination of IDD < 5% by 2007

3. International Criteria for Sustainable elimination of IDD to be Met? SALT IODIZATION National needs for iodized salt supplies met by production/import > 95% of imported supplies to be iodized HH consumption of adequately iodized salt > 90% Status in Georgia: > 100% Status in Georgia: > 90% Status in Georgia: 67%

4. 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 HH Surveys performed in 1999 & 2003, not routinely Checked by State Standardization and Sanitary Departments (2). Database to be more consolidated

5. 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

6. 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: High Commitment from Government Status: Existent since 1996, to be renewed

7. 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

8. 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

9. 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

10. 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: 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 Status: Available from import (Dept. of Standardisation), retail/wholesale (Sanitary Surveillance), HH – survey data

11. 4 Key Directions of the 2004- 2005 Action Plan HH Consumption of Iodized Salt > 90% 1. Legislation for Quality Control & Quality Assurance 2. Monitoring and Disease Surveillance 3. Information-Education Support 4. Multi-sectoral Partnership and Private Sector

12. Component 1 Legislation & 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.

13. Component 1 Legislation & Regulations Recommended Activities 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 Cabinet of Ministers, MLHSA (Sectoral Ministries, Private Sector, NGOs, UNICF) Inter-agency Co-ordination Committee/Task Force Health & Social Affairs Commitete if the Parliament

14. Component 1 Legislation & Regulations Recommended Activities 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 Parliament of Georgia Inter-agency Co-ordination Committee/Task Force Sectoral Ministries - Finance, Economy, MLHSA, etc.

15. Component 1 Legislation & Regulations Recommended Activities 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 Sectoral Ministry Department - Customs, Sanitary, Standardisation Statistics Department, Ministry of Economy Interagency Committee MoLHSA, MOH Adjara, UNICEF

16. 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

17. 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)

18. 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)

19. 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.

20. 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)

21. 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)

22. 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)

23. Component 4 Multi-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.

24. Component 4 Multi-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