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In Tajikistan, Market-Based Interventions Address Iodine Deficiency Disorders

Iodine is a trace mineral essential for human development and growth. Before the introduction of iodized salt, iodine deficiency was the largest global cause of brain damage and a spectrum of growth disabilities collectively known as Iodine Deficiency Disorders. These health problems have serious consequences for a country’s long term social and economic development, as even moderate iodine deficiency can lead to a reduction of 10 to 15 IQ points. 

Salt iodization, a standard practice in almost all countries around the world, is a simple and proven approach to prevent iodine deficiency. That’s why the Global Alliance for Improved Nutrition (GAIN) is working with the Government of Tajikistan to implement universal salt iodization. This work is made possible by support from the U.S. Agency for International Development (USAID) as part of the Feed the Future initiative. The project aims to promote iodized salt consumption through a combination of market-based interventions to increase consumer preference for iodized salt and active private sector engagement to drive the production and marketing of this simple enhanced staple product.
Despite a Universal Salt Iodization law that has been in effect in Tajikistan since 2002, only 39 percent of Tajik households use salt that is adequately iodized (15 parts per million or higher). A 2012 assessment conducted by GAIN and USAID identified that salt production in Tajikistan is concentrated in very few areas and the dominant supply comes from the rural Khatlon Province in southern Tajikistan, where as few as 12 salt producers accounted for 90 percent of the processed and packaged salt supply. The assessments also identified that rampant false packaging claims of iodization created an uneven business environment and a disadvantage for producers that were compliant with salt iodization legislation.
In response to these challenges, the universal salt iodization project reached out to salt producing companies in Khatlon Province and collaborated to increase the quality of salt iodization, donating laboratoryequipment to the 12 major salt producing enterprises and providing hands-on training on good manufacturing practices and quality assurance. Technical audits of each of the salt factories and producers resulted in customized recommendations to improve productivity and efficiency. Currently, the project is working to establish a more cost-effective and affordable supply chain for potassium iodate, the primary ingredient for iodizing salt.
Another strategy, which replicates a similar successful effort in neighboring Kyrgyzstan, is a community and market-driven awareness campaign to educate consumers about iodine deficiency and to drive non-iodized salt products out of the market if they employ false advertising. In coordination with UNICEF, rapid test kits were distributed to salt distributors and retail outlets throughout the community, enabling them to differentiate between iodized and non-iodized salt with a drop of liquid test solution. The project also distributed 40,000 test kits to government agencies, the private sector, village and community leaders, shop owners, primary health care workers and private households. This initiative was widely supported by salt producers since it helped improve the position of properly iodized salt in the market and displaced illegal salt that was undercutting producer margins. 
Finally, USAID provided chemical analysis equipment to inspection agencies and offered training on quantitative iodine content measurement. This three-pronged strategy is expected to result in a combination of better market share for adequately iodized salt, a salt industry capable of meeting market demand and enforcement capacity that ensures a level and fair trade environment. 
The universal salt iodization project plans to conduct a household survey to evaluate and quantify improved access to iodized salt in April 2015.

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