Power from below: test kits in the hands of retailers pressure producers to iodize salt
Tobias
Schueth
Swiss Red Cross, Kyrgyz-Swiss-Swedish Health Project, financed by SDC and Sida
Swiss Red Cross
0041 31 387 7111
Swiss address: Rainmattstr. 10, 3001 Bern. Kyrgyz address: Sydykova 187/1, Bishkek 720001, Kyrgyzstan
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.
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
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
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
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
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)
More than 10,000
$50 - 100
Yes
Operating for more than 5 years
Yes
Swiss Red Cross
More than 5 years
Yes
Yes
No
Yes
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
Further growth is not possible as it is already being implemented countrywide.
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.
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.
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