Iodine deficiency is well documented as a preventable cause of mental retardation, and salt iodination is a proven cost-effective remedy. Although a minute quantity of iodine ensures a person’s iodine adequacy, iodine deficiency remains a major public health problem. In a review of Bank support for activities to help eliminate iodine deficiency disorders through salt iodination, using case studies for China, Indonesia, and Madagascar, Goh finds that:
- The consumption of iodized salt is an effective means of eliminating iodine deficiency disorders.
- Raising public awareness (for example, convincing poor people that goiter is preventable and creating demand for iodized salt) is not enough. Governments must also ensure easy access to iodized salt.
- The edible salt industry needs both the right incentives and effective monitoring and enforcement. Production must be monitored because the quality of iodination matters, and distribution and retail sales must be monitored because consumers cannot readily differentiate between iodized and noniodized salt.
- Incentives for maximizing compliance with salt iodination policies must be tailored to the structure of a country’s salt industry.
Of the three programs examined, those in China and Madagascar had clearly positive outcomes; the one in Indonesia did not. Experience suggests that a positive outcome is more likely when the means of production is concentrated either understate control or through a limited number of large producers and when an accountability framework is in place before a project is financed.
The Chinese edible salt industry is centrally controlled, its distribution network monopolistic, its production structure province specific. Madagascar’s salt industry is competitive, but six large producers supply 80 percent of national salt consumption. In Indonesia most of the salt supply comes from a multitude of small, competing salt farmers, making it difficult to develop an effective accountability framework.
In initiating and supporting programs to eliminate micronutrient deficiencies, the Bank can help most by providing critical financial resources; helping to diagnose a country’s incentive structures and to ensure an effective framework is in place before financing a project; promoting intersectoral dialogue; and calling top-level political attention to the cause.
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