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10 years of innovation

& partnership:
better nutrition for half
a billion people

Universal Salt Iodization:


India as a case study for optimizing
the production, distribution
and use of iodized salt
Catalyzing collaboration between salt producers, regional organizations, international agencies, government
officials and industry experts

INTRODUCTION adequately iodizing salt at just five US


cents per individual. About iodine deficiency
Universal Salt Iodization (USI)
Iodine is a trace mineral required for
With funding from The Bill and Melinda
Iodine is a trace mineral essential for healthy brain development and thyroid
Gates Foundation, the Global Alliance
human development and growth. Iodine function. While the most recognizable
for Improved Nutrition and the United
deficiency is the most prevalent cause sign of iodine deficiency is goiter
Nations Childrens Fund (UNICEF) have
of brain damage in the world. The mean swelling of the thyroid gland at the front
partnered to support the reduction of
IQ of a population is decreased by of the neck it is during pregnancy
iodine deficiency in 13 countries, as part
approximately 13.5 points when there and early childhood that iodine has the
of the global effort toward Universal
is a lack of iodine in diets1; significantly greatest public health impact. Without
Salt Iodization (USI). Since 2009, this
hindering the social and economic enough iodine during pregnancy and
collaboration has been committed to
development of a country. Goiter a through age 2 children are at risk of
reaching more than 750 million people
severe swelling of the thyroid gland suffering irreversible mental and physical
through sustainable, business-led and
is the most noticeable sign of iodine impairment.
market-orientated efforts. By working
deficiency.
together to eliminate iodine deficiency,
the partnership takes advantage of
An effective approach to tackling this
the available expertise from both the
deficiency is through iodizing one of the
public and private sectors to strengthen
worlds most well known condiments
accessibility, the policy regulatory
salt. Adding iodine to salt is recognized
environment, and the demand
as one of the safest and most cost-
and use of iodized salt.
effective strategies towards achieving
sufficient intake of the mineral. It is also
looked upon favourably in terms of public
health interventions for its high return
on investment; the World
Bank estimates the
annual cost of
It is the poor and those in geographically
isolated communities who are most
likely to suffer severe iodine deficiency,
said Greg S. Garrett, Director of Large-
Scale Food Fortification at GAIN. The
partnership is focused on improving
access and availability of adequately
iodized salt nationwide but with a focus on
these communities.

With increased availability and


improvements in iodization practices
and packaging, effective monitoring and
heightened consumer awareness, at least

USI in India THE EARLY DAYS 71 percent of households in India are now
consuming iodized salt.
One of the 13 focus countries of the India: early to adapt to salt iodization.
GAIN-UNICEF Salt Iodization (USI) The public health benefits of salt
Partnership Project, India has made iodization have been long understood THE MODEL
significant investments in salt iodization and accepted, in both developed and
and has momentum from the government developing countries. In the 1960s, India Building partnerships at the national
and the private sector to deliver iodized was among the first countries in Asia and regional level for salt iodization.
salt to the countrys population of to implement mandatory salt iodization
Prior to the formation of the partnership,
1.2 billion. As one of the largest salt practices with early fortification policies,
India had already launched and
industries and delivery networks in the forcing traders to sell only iodized salt.
implemented a coalition to monitor the
world, the partnership works closely While it has made significant strides
progress of salt iodization and to advise
with representatives of salt producers, in increasing iodized salt production in
the government on best practice for
regional organizations, government recent years, this progress has not always
delivering the most sustainable approach
officials and industry experts to been steady or straightforward.
to achieve USI. The GAIN-UNICEF USI
accelerate progress to reach and sustain
Partnership Project strengthened this
Universal Salt Iodization. In 2000, and before the formation of
National Coalition for Sustained Iodine
the GAIN-UNICEF USI Partnership
Intake through creating regional hubs in
India is the only country in the Project, the ban on selling only iodized
partnership with the added benefit of salt was lifted dramatically increasing
a dedicated Salt Department headed consumption of non iodized salt. Iodized
by the Salt Commissioner positioned salt consumption decreased within five
within the government. This department years with approximately half of Indian
head acts as a champion for adequately households consuming non-iodized salt.
iodized salt production, and is essential
to the delivery, production monitoring, As a result, the ban was reinstated
distribution and quality control. More in 2005. This, along with industry
recently, and with backing from the improvements in iodization practices and
Salt Commissioner himself, the packaging, placed iodized salt firmly back
partnership supported the introduction on the market. To date, the partnership
of an innovative online platform, which has helped improve the availability of
continuously monitors the quality of iodized salt across the country, with a
iodized salt across India. Using real-time focus on equitable distribution to hard-
data, the iodized salt industry can be to-reach populations. Particularly in rural
effectively regulated to ultimately monitor areas, these communities are less likely
Indias coverage of adequately iodized salt. to consume iodized salt.
environments. Leakage of non-iodized
The GAIN-UNICEF Universal
or inadequately iodized salt into the
Salt Iodization Programme
market does occur and can be attributed
The GAIN-UNICEF USI Partnership to a number of factors: from producers
Project responds to the needs for new being unable to properly iodize their salt
models of salt iodization. GAIN and or refusing to iodize, to poor packaging
UNICEF received funding from The Bill diminishing iodine levels. From salt
and Melinda Gates Foundation in 2008 producers to retailers, all parties along the
to contribute to global efforts to eliminate supply chain must remain committed to
iodine deficiency through salt iodization. preserving the quality and effectiveness
The 13 targeted countries have some of of the end product, so that adequately
the lowest coverage of iodized salt and iodized salt ultimately reaches the
greatest burden of iodine deficiency. consumer. To address this, the GAIN-
15 states to specifically engage with local UNICEF USI Partnership Project ensures
governments and key stakeholders, build Through the seven year project, GAIN the salt industry in India understands
awareness and improve local monitoring. focuses on the supply side of the salt and uses effective iodization techniques,
market and supports small- and large- and that governments and industry are
To make the product more appealing scale salt producers to iodize. GAIN is equipped with the necessary resources
and to create consumer demand in also responsible for strengthening public to monitor and maintain information about
these regions, effective social marketing health Monitoring and Evaluation to track production quality.
campaigns were introduced to specifically progress towards salt iodization and verify
target hard-to-reach populations. With the elimination of iodine deficiency. In India, external quality control is
assistance from local partners, highly conducted by the Salt Department.
strategic communications efforts helped To complement these efforts, UNICEF Officials collect salt samples for testing
raise consumer awareness of iodized creates and strengthens long-term in 32 laboratories throughout the country.
salt at the grassroots level. Schools and demand for iodized salt among In 2010, GAIN conducted an analysis
local health clinics, known as Anganwadi consumers and the salt industry. It also of laboratory capacity, and, through the
Centres, provided education sessions reinforces government and public sector Indian office of the International Council
for the most vulnerable rural populations commitment through advocacy. for the Control of Iodine Deficiency
about the benefits of consuming iodine Disorders (ICCIDD), provided technical
through iodized salt. assistance to establish a standardized
LESSONS LEARNED monitoring protocol. This was the first time
The GAIN-UNICEF USI Partnership Improving quality control. an outside agency gained access to data
Project has also helped to increase from government laboratories, and after
Although mandatory legislation exists
delivery of quality iodized salt to the training, 76 percent of the samples
and supports adequate iodization of
marginal populations through working analyzed met the appropriate standard a
salt in India, this often is not enough
with regional-level organizations and figure higher than previous measurements.
to achieve sustainable elimination of
industry in India. It has supported the
iodine deficiencies. To ensure all iodized
salt distribution network in Rajasthan,
salt being consumed by households Improving data collection through an
the countrys largest state. Through
and food producers contains the
online system.
targeting the delivery channels, the effort
appropriate amounts of iodine, robust India has one of the largest salt
significantly increased the availability
quality assurance is required across the industries in the world with over 13,000
of iodized salt through the Rajasthan
entire supply chain. Success requires salt producers and a complex delivery
Public Distribution System. Meanwhile,
active participation on many levels to network. Therefore, monitoring is a
the partnership also worked closely with
ensure high quality iodized salt reaches key challenge in such an intricate
industry in the southern state of Tamil
consumers. environment. With 55 percent of edible
Nadu. There, it supported the Tamil Nadu
Salt Company, a regional salt enterprise salt transported by rail, rail transport
Problems are inevitable during such a clearance offers a built-in check for
owned by the state government, in the
large-scale effort and enforcing legislation monitoring quality. Still, monitoring is a
production and delivery of sufficiently
is a key challenge in such complex key challenge.
iodized salt.
To effectively track production, quality, Formally launched in February 2012, THE FUTURE
and movement of iodized salt, especially this efficient Management Information
Developing this system for India is a
to rural regions, accurate and up-to-date System will complement improvements
key achievement, and is just part of
information and statistics are essential. in quality assurance and quality control
GAINs global work to improve the quality
Historically, the Salt Department would with the latest information on the iodized
of iodized salt in the GAIN-UNICEF
manually collect data through its network salt industry. For the Salt Department, it
USI Partnership Project countries. To
of divisional offices which was then will dramatically increase its efficiency in
address the specific needs of individual
communicated up a chain of reporting decision-making and reporting.
countries, GAIN and partners Intertek
channels to the Salt Commissioner. This
and the International Council for the
process resulted in data duplication, This investment will help future
Control of Iodine Deficiency Disorders
redundancy, and gaps; it was also labor- generations in India access adequately
are developing a universal set of quality
intensive and costly. iodized salt and avoid irreversible mental
management standards, manuals and
and physical setbacks, added Mr. Garrett,
training tools. These tools as well as
With technological expertise close at Director of Large Scale Food Fortification
the Management Information System
hand in India, there was no need to look at GAIN. Based on Indias experience,
designed for India are easily customised
far for a solution to monitor quality and our goal is to make available similar
for any country or USI project. In light of
distribution. Recognizing the limitations tools in other countries where we are
this, industry regulators in India now have
of the manual data collection process implementing our universal salt iodization
innovative tools available at their fingertips
and need for improved efficiency, the project in partnership with UNICEF.
to monitor and accelerate salt iodization
partnership joined other national partners
and reach the remaining 30 percent
to support development and installation of Countries involved in the
of consumers in India with adequately
a state-of-the-art Management Information GAIN-UNICEF Universal Salt
Iodization Partnership iodized salt.
System for the Salt Department to track
the iodine levels of salt being distributed
While over 120 countries have salt
across the country.
iodization programs in place, several of
these still face challenges in monitoring
With support from the GAIN-UNICEF USI
iodized salt quality, enforcing legislation,
Partnership Program, the Salt Department
distributing to remote areas, guaranteeing
is now implementing an online platform
access to fortificant for salt producers, and
which records the quality of iodized salt
improving consumer awareness.
across India. This allows officials to GAIN HQ Geneva
Rue de Vermont 37-39
centralise data collection, and effectively Bangladesh Niger CH-1202 Geneva
follow the salt to ensure equitable access. China Pakistan Switzerland
T +41 22 749 1850
Egypt Philippines F +41 22 749 1851
With the introduction of the system, the E info@gainhealth.org
Ethiopia Russia
efficiency of the department will increase Ghana Senegal www.gainhealth.org
exponentially, said Mr. M.A. Ansari, the India Ukraine
Salt Commissioner of India. It will go a Indonesia
long way in professionally managing Salt
Department processes.

1. Bleichrodt, N. and M. Born (1994). A meta-analysis of


research into iodine and its relationship to cognitive
development. New York,
Communication Corporation.