Power from below: test kits in the hands of retailers pressure producers to iodize salt
This entry has been selected as a finalist in the
Improved Nutrition: Solutions through Innovation competition.
Providing salt retailers with test kits for iodised salt so that they can test the salt they purchase at wholesale markets. This creates pressure on salt producers to iodise their salt and drives non-iodised salt out of the market.
About You
Section 1: About You
First Name
Tobias
Last Name
Schueth
Website
Organization
Swiss Red Cross, Kyrgyz-Swiss-Swedish Health Project, financed by SDC and Sida
Country
Kyrgyzstan
Section 2: About Your Organization
Organization Name
Swiss Red Cross
Organization Website
Organization Phone
0041 31 387 7111
Organization Address
Swiss address: Rainmattstr. 10, 3001 Bern. Kyrgyz address: Sydykova 187/1, Bishkek 720001, Kyrgyzstan
Is your organization a
Non‐profit/NGO/citizen sector organization
Organization Country
Switzerland
Your idea
Name Your Project
Power from below: test kits in the hands of retailers pressure producers to iodize salt
Country your work focuses on
Kyrgyzstan
Describe Your Idea
Providing salt retailers with test kits for iodised salt so that they can test the salt they purchase at wholesale markets. This creates pressure on salt producers to iodise their salt and drives non-iodised salt out of the market.
Website URL
Innovation
What makes your idea unique?
The use of test kits in iodised salt promotion is not new. However, to my knowledge and after review of published literature, they have only been used either to monitor the coverage with iodised salt or for educational purposes. What is new in our idea is that they are used to create market pressure on producers to iodise their salt. This pressure is created by distributing the test kits to a sufficiently large majority of retailers and ask them to use them when purchasing salt at wholesale markets.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
1) Coverage with iodised salt in the whole country over 90% (see details below under Results)
2) adoption of the approach by the Ministry of Health, including its financing, and countrywide extension
Problem
Despite laws and regulations in Kyrgzystan demanding universal iodisation of salt to fight iodine deficiency diseases and despite a high awareness of the population of the need to consume iodised salt the coverage of households with iodised salt remained far below the desired minimum of 90% because of fraudulent business practices (labeling non-iodised salt as iodised or using the less stable potassium iodide instead of the preferred potassium iodate for iodisation)
Actions
Providing a large majority of salt retailers with test kits for iodised salt that react only to potassium iodate and asking them to use these kits when purchasing salt at wholesale markets. Volunteers provide them with new test kits and test a sample of salt periodically, reminding retailers of using the test kits
Results
1) over 80% of retailers have test kits (2008 data)
2) In all regions where we introduced the approach we saw an increase in coverage with iodised salt within one year. See the following list.
Naryn region October 2002: 76% – September 2003: 90%
Talas region: April 2005: 91% – April 2006: 97%
Issyk-kul region: April 2006: 62% – April 2007: 90%
Batken region: September 2007: 85% – September 2008: 94%
Chui West region: September 2007: 85% – September 2008: 93%
3) The approach very likely contributed to the considerable decrease in goitre in school students in Kyrgyzstan during the last decade (see attachment)
4) Adoption of the approach by the Ministry of Health of the Kyrgyz Republic
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
1) continued implementation of the approach by the Ministry of Health
2) continued distribution of test kits by volunteers
3) continued use of test kits by retailers at wholesale markets
regarding 1) The test kit approach has been adopted by the public health department of the Ministry of Health. Therefore funding is secure and implementation can continue countrywide.
regarding 2) The volunteers from the Village Health Committees like this task and will therefore likely continue distribution of test kits and periodic testing of samples at retailers.
regarding 3) The retailers know that people demand iodised salt and they know that volunteers will test samples periodically, and therefore will likely continue to use them at wholesalers
What would prevent your project from being a success?
1) discontinuation of support of the approach by the ministry of health (unlikely as it is successful and iodine deficiency disorders are a serious issue in Kyrgyzstan)
2) discontinuation of volunteers distributing the test kits (nothing so far indicates that this might happen)
How many people will your project serve annually?
More than 10,000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for more than 5 years
In what country?
Kyrgyzstan
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
Swiss Red Cross
How long has this organization been operating?
More than 5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have any non-monetary partnerships with NGOs?
Yes
Does your organization have any non-monetary partnerships with businesses?
No
Does your organization have any non-monetary partnerships with government?
Yes
Please tell us more about how these partnerships are critical to the success of your innovation.
The partnership with the Village Health Committees is critical as they distribute the test kits to the retailers and periodically test samples of salt at retailers
The partnership with the government (the Ministry of Health of the Kyrgyz Republic) is critical as it has adopted the appraoch and implements it countrywide
What are the three most important actions needed to grow your initiative or organization?
Further growth is not possible as it is already being implemented countrywide.
The Story
What was the defining moment that led you to this innovation?
We had just established the first Village Health Committees, voluntary organisations ready to work for health in their villages. They had identified goitre as one of their main health issues. I learned then about the availability of thousands of test kits in another organisation that didn't know what to do with them. I immediately thought that these kits could be very powerful tools in the hands of the village health committees, if they tested salt in the households and gave them to retailers to use them at wholesale markets. We asked to get the kits from the other organisation and got them for free, and could quickly document the effect they had on the presence of iodised salt at retailers and in households.
Tell us about the social innovator behind this idea.
Dr. Tobias Schueth from Germany is a public health physician who has worked for the last 15 years for community development and health in rural areas of South Asia and Central Asia. Since 2001 he is the country representative of the Swiss Red Cross in Kyrgyzstan and has developed there the countrywide Community Action for Health program, which has become a part of the national health reform.
How did you first hear about Changemakers?
Friend or family member
If through another, please provide the name of the organization or company
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Comments
It’s really interesting how the tool-kits were used to address a very important issue, and we would love to hear more about how you plan on scaling this to other issues related to nutrition. Have you thought about packaging this model to roll out in other countries? What are your plans for sustainability when tool-kits or materials are not free? Also, since this is a volunteer-based program, how do you plan on making this a sustainable initiative? This is a really great initiative, and the strategy is extremely innovative. Thanks for a great entry!
- Naveen Shakir, Ashoka’s Changemakers
thank you, Naveen, for you comments and questions.
regarding scaling this approach to other issues: the test kits are giving only a qualitative indication of the iodine content, not a quantitative. The next issue in Kyrgyzstan is too ensure that iodised salt contains the correct amount of iodine, as most producers still do not add enough iodine. We are about to use the same principle of market power that was used in the test kit approach. We will test regularly samples of all salt producers for iodine content and then publish the results, indicating clearly for the population which salts fulfill the criteria and which not. This should create the same market pressure on producers as with the test kits. Preparations for this strategy are on the way.
Regarding sustainability of the test kit strategy: 1) the Ministry of Health has taken it up to purchase the test kits (the amount needed is small) and 2) the Village Health Committees, whose members distribute the test kits to the retailers, are supported by the governmental health system and exist in 85% of all villages; with this official support they are likely to sustain. Because of these two reasons we think the approach is as sustainable as it can be.
I agree with Naveen and truly applaud you for your strategy and success. Are there examples in other countries that use a similar 'empowerment of retailers to quality test' model?
I would suspect ultimate success depends on consumers demanding the higher quality and being willing to pay for it.
Sub-quality pharmaceuticals are such a large problem throughout the developing world but price is usually the determining factor for both consumers and point of sale retailers. How do you educate consumers or provide incentives to retailers to sell the higher quality salts?
Thank you, David, for your comment. To my knowledge, test kits have only been used for educational and monitoring purposes, not as a tool to create market pressure. I believe that this is what is new in our approach. Of course you need a lot more test kits for this, but they are very cheap. The yearly costs for the whole country of Kyrgyzstan are about 10000 USD.
Regarding consumer demand, our intervention included also large scale testing of salt in households, by volunteers from the Village Health Committees; this had a very strong educational effect, which increased further the already high awareness about iodised salt among Kyrgyz consumers. But the issue remained that fraudulent producers labeled non-iodised salt as iodised. These were driven out of the market by the test kits in retailers' hands. In addition, of course, retailers are realise through this intervention the importance of iodised salt and therefore strive to offer only iodised salt. And consumers buy what is on offer... Retailers don't need incentives to offer the higher priced iodised salt - higher prices=higher profits. But we found that many retailers simply care about offering a healthy product to their communities of which they are a part. For those who don't care - the Village Health Committees keep up the pressure by checking a few packets at the retailers twice yearly.
It would be wonderful if there were such easy test kits for pharmaceuticals...
On January 18, 2010 the judges reviewed the entries for the Changemakers Improved Nutrition: Solutions through Innovation competition and would like to pass on the following feedback (listed below) for your entry. Thank you for applying and for your hard work in the field. We are excited to archive your entry to serve as a leading solution for the worldwide community of innovators. We wish you continued luck with your innovative, sustainable, and socially impactful initiatives.
All the best, The Changemakers Team
“I really liked this initiative and I thought it was quite compelling. It has a lot of potential and it seems like the best way to motivate business and industry from below. However, based off my experience in the field, I have found that testing urinary iodine may be more effective rather than having people testing themselves.”
“The social impact of this initiative is quite high, and it seems to have been quite successful already. The fact that it is government dependent works too, since it’s important to have a monitoring system that is on a national scale. I’m interested in learning more about what the motivation is for retailers.”
- Changemakers Improved Nutrition: Solutions through Innovation Judges
Dear Naveen, thanks for your new comment. Regarding the urinary iodine testing - this is something completely different. It is a laboratory based research tool that can only be applied to a small sample of the population, and it is purely for monitoring/research purposes, not for motivational purposes. Our goal was not research but change.
Using test kits in people's kitchens who then see immediately whether their salt turns blue or stays white, ie. contains iodine or not, is very convincing educationally and creates demand. The question on the motivation of retailers I answered in my previous answer to David's comment. As my entry explains test kits in the hands of retailers are the real change tool that translates people's demand into pressure on whole sellers and producers.
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