Achieving USI in Pakistan by Improved Quality Control and Better Government Ownership and Capacity

Abstract

Objectives: An evaluation in 2010 of 850 processors involved for over a year in a Universal Salt Iodization (USI) support program indicated 36% of their salt as adequately iodized. The main reasons were identified as limited technical capacity of medium and large salt processors for quality control, and inadequate monitoring and enforcement by regulatory authorities due to the large number of processors and geographical spread of the industry. The objective of the program was to increase the proportion of salt containing ≥ 30 ppm iodine by strengthening the capacity of the government to provide external quality assurance support to processors while also enforcing regulations. Methods: To ensure an adequate regulatory framework, the program facilitated enactment of USI legislation in 56 districts. District and provincial Iodine Deficiency Disorders Control Committees were established and activated to oversee external monitoring. Health managers, food and sanitary inspectors and field monitoring staff were trained on quality control and 64 quality control laboratories were established. Salt samples were collected from 1350 salt processors and tested on regular basis. Data on iodization levels was analyzed, provided as feedback regularly to salt processors and used to inform further technical assistance needs. Results: The proportion of salt containing ≥ 30ppm iodine increased from 36% in 2010 to 57% in 2012. Conclusions: Strengthened monitoring and mechanisms for effective enforcement within a strengthened enabling environment plausibly contributed significantly to increased availability of adequately iodized salt in Pakistan and to improved population iodine status.