Activity report of the Secretariat, National Coalition for Sustained Optimal Iodine Intake (NSOI)

April 2013 to March 2014 ICCIDD, New Delhi

March 2014

1 Activity report of the Secretariat, National Coalition for Sustained Optimal Iodine Intake (NSOI) April, 2013 to March, 2014

Acknowledgement

Secretariat of the National Coalition for Sustained Optimal Iodine Intake (NSOI) acknowledges the financial grant received from Micronutrient Initiative (MI), Global Alliance for Improved Nutrition (GAIN) and United Nations Children’s Fund (UNICEF) in successful running of the Coalition. Secretariat also acknowledges the support of other partner agencies.

2 Contents

S. No. Content Page No. 1 Brief outline of the Secretariat of National Coalition for Sustained 4 Optimal Iodine Intake (NSOI) 2 Synopsis of the activities of the NSOI 5-7 3 Specific Activities undertaken as part of Terms of References (TORs) of 8-13 NSOI 4 List of Annexure 14

1. Brief outline of the Secretariat of National Coalition for Sustained Iodine Intake (NSCII)

3 1.1 National Coalition for Sustained Optimal Iodine Intake (NSOI) is a coordination platform representing stakeholders involved in control of Iodine Deficiency Disorders (IDD) in India. It was established in 2006 and the Secretariat of the Coalition is hosted at International Council for Control of Iodine Deficiency Disorders (ICCIDD) Regional Office since August 2009. The Secretariat is supported by a grant from United Nations Children’s Fund (UNICEF), Global Alliance for Improved Nutrition (GAIN) and Micronutrient Initiative (MI). This report provides details of activities of the NCSII during the period April 2013 to March 2014.

1.2 Terms of References (TORS) of the Secretariat of NSOI are-

1.2.1 To convene meetings on a regular basis of all the partner agencies; government, private and civil society stakeholders currently involved in activities of NIDDCP.

1.2.2 To prepare updates/ compile/analyze/interpret available information (surveys, studies, etc) on iodine status of the population, salt use, production figures of iodized salt, sales trends, price trends, market availability and transportation etc based on reports received from partner agencies, government ,private and civil society stakeholders involved in IDD program in India.

1.2.3 To facilitate preparation of specific activities plans identified during the deliberation of National Coalition meetings by various partner agencies with dedicated funding from concerned agencies for those specific activities.

1.3 Location of the Secretariat: ICCIDD Office, c/o Centre for Community Medicine, the All India Institute of Medical Sciences, New Delhi-110029.

2. Synopsis of the activities of the National Coalition

4 2.1 During the current period, the Coalition consolidated the achievements of the past and made forays in the new directions in the pursuit of achievement of Universal Salt Iodization and sustainable elimination of Iodine Deficiency Disorders in India. The major developments in the current period were; 1) National Stakeholders’ Consultation to strengthen NIDDCP in India 2) Advocacy at the highest level of government for strengthening of NIDDCP 3) Workshop of salt producers in Gujarat and Tamil Nadu 4) Meeting with salt traders in high priority states 5) Formation and strengthening of USI Coalitions in five priority states 6) Advocacy for strengthening of regulatory framework in five priority states 7) three meetings of the Coalition partners held over last one year; 8) inclusion of IDD as a disorder for screening in Rashtriya Bal Swasthya Karyakram; 9) sensitization of public health community to Iodine Deficiency Disorders and Universal Salt Iodization

2.2 Dr. Chandrakant S Pandav continues to be part of the steering committee and working groups of the Inter-Agency Group on Micronutrients set up by ICMR.

2.3 With the efforts of the Secretariat of the NSOI, Dr Ajay Khera and Dr Sila Deb, two senior officials in the Ministry of Health and Family Welfare, Government of India were nominated as focal points for IDD.

2.4 The Secretariat of the National Coalition also interacted with and provided assistance to the National and State IDD Cells for release of funds to states under NIDDCP.

2.5 The Secretariat of the National Coalition provided technical assistance to the National IDD Cell in a court case pertaining to legislation on USI in India.

2.6 The Secretariat interacted with officials from Food Safety and Standards Authority of India for effective implementation of Food safety and Standards Act 2006.

2.7 Technical Resource Group on Deficiencies of Rashtriya Bal Swasthya Karyakram- Dr. Chandrakant S Pandav was nominated a member of the Technical Resource Group on Deficiencies of the Rashtriya Bal Swasthya Karyakram (RBSK), which was launched on Feb 6, 2013 with an aim to screen and manage all children in the country from birth to 18

5 years of age for Defects at birth, Diseases, Deficiencies and Developmental delays including disabilities.

2.8 The Secretariat interacted with Directors of newly opened All India Institute of Medical Sciences at Bhopal, Raipur, Jodhpur, Patna, Rishikesh and Bhubaneswar for capacity building for monitoring of sustainable elimination of IDD and Universal Salt Iodization.

2.9 The Secretariat interacted with Ministry of Health and Family Welfare, Government of India for organization of a national level IDD Workshop and meeting of District Collectors of 12 major iodized salt producing districts.

2.10 The Secretariat provided technical assistance to states of Gujarat, Uttar Pradesh and Karnataka in planning and conducting IDD surveys. It is also providing technical assistance to Micronutrient Initiative in conducting Salt Iodine Stability Study.

2.11 The Secretariat is working closely with M S Swaminathan Research Foundation (MSSRF) and Jawahar Lal Nehru Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry to assess the health status of salt pan workers in Tamil Nadu and other states.

2.12 The National Coalition activities were supported and participated by widening array of stakeholders involved in iodine deficiency elimination activities in the country. These included Government of India agencies (Ministry of Health and Family Welfare and Salt Commissioners Office), State Government agencies (Ministry of Health and Family Welfare at State level), National Institutes/organizations (NIHFW, NCC), partner agencies (WHO, UNICEF, WFP, GAIN, MI, ICCIDD), health professionals groups (IPHA, IAPSM, ITS, ISPAE), Salt manufacturers associations (ISMA), civil society/ consumer advocacy groups (CLARA, Sharnum) and media advocacy groups like Communicators India, ITM Solutions, Via Media, etc.

2.13 NSOI activities provided a channel for high level advocacy. The Secretariat representative interacted and appraised Government policy makers including the Members of Parliament, Health Secretary, Ministry of Health and Family Welfare,

6 Secretary, Ministry of Women and Child Development, Secretary, Ministry of Industry and Planning, Mission Director, National Rural Health Mission, Joint Secretary, Ministry of Health Family Welfare, Joint Secretary, Ministry of Joint Secretary, Ministry of Industry, Secretary of state governments of Ministry of Health, Women & Child Development and Ministry of Industry.

2.14 The Coalition provided a platform bringing together all partner agencies and government agencies and departments. Various partner agencies shared their respective ongoing projects and future plans with the group thus enabling greater synergy of the individual efforts of all partner agencies.

2 Specific Activities undertaken as part of TORs of NCSII:

3.1 To convene meetings on a regular basis of all the partner agencies; government, private and civil society stakeholders currently involved in activities of NIDDCP.

7 3.1.1 National stakeholder Consultation on Strengthening the Supply Chain of Iodized Salt through National and State Level Activities- A national stakeholder consultation was held on 27 and 28 April 2013 at New Delhi to discuss and strategize for the strengthening of IDD elimination activities with a focus on strengthening the supply chain of iodized salt in India. The meeting resulted in formulation of an action plan. The report of the consultation is attached as Annexure 1.

3.1.2 Three meetings of the National Coalition were conducted. The meetings were hosted in rotation by various Coalition partners. The meetings were attended by all partner agencies working towards elimination of Iodine Deficiency Disorders in India namely WHO, UNICEF, WFP, GAIN, MI and ICCIDD. Meetings were also attended by the Salt Commissioner, Ministry of Industry, Government of India. The minutes of the meetings are attached as Annexure 2-4.

3.1.3 Meeting with senior Government Officials- the Secretariat communicated with Mr. Keshav Desiraju, Secretary, Ministry of Health and Family Welfare, Government of India regarding strengthening of NIDDCP. Communications to Mr. Desiraju is attached as Annexure 5 and 6. As a follow up, a team comprised of representatives from the Coalition held a meeting with Mr. Keshav Desiraju, Secretary, Ministry of Health and Family Welfare, Government of India and Dr. Rakesh Kumar, Joint Secretary (Reproductive and Child Health), Ministry of Health and Family Welfare, Government of India to impress upon them the importance of strengthening of National Iodine Deficiency Disorders Control Programme (NIDDCP) and suggested steps for the same. The minutes of the meeting is attached as Annexure 7. Some of the suggested steps were alignment of NIDDCP with Reproductive and Child Health (RCH) Programme, channeling of NIDDCP funds through State Health Societies instead of “treasury route”, appointment of nodal officer for Iodine Deficiency Disorders in the Directorate General of Health Services (DGHS), meeting of District Magistrates from salt producing districts, advisory to State Food Safety Authorities regarding implementation of Food Safety and Standards Act 2006 with regards to mandatory salt iodization, inclusion of IDD in RCH

8 review meetings, school based communication Programme on IDD and modification in survey guidelines under NIDDCP. A note on alignment of NIDDCP and RCH Programme was presented to the Secretary and Joint Secretary, which is attached as Annexure 8. As a follow up of the meetings with the Secretary and Joint Secretary, Dr. Kapil Yadav met Dr. Ajay Khera and Dr. Sila Deb, focal person for IDD and other officials from the National IDD Cell. Minutes of the meeting is attached as Annexure 9. The team from the Secretariat also met senior officials, Dr. Meenakshi Singh, Scientist (Standards) and Dr. Sandhya Kabra, Director (QA), in Food Safety and Standards Authority of India (FSSAI) for effective implementation of Food Safety and Standards Act 2006. As a follow up of these meetings, a communication was sent to FSSAI which is attached as Annexure 10.

3.1.4 Collaboration with six newly opened All India Institute of Medical Sciences (AIIMS)- The Secretariat developed collaboration with six newly opened All India Institute of Medical Sciences for capacity building for implementation and monitoring of NIDDCP at the regional level. Communication to the Directors of six newly opened AIIMS is attached as Annexure 11-16.

3.1.5 Meeting with Salt Producers in Gujarat and Tamil Nadu- The Secretariat facilitated a meeting with salt producers in Ahmedabad and Tuticorin. Meeting with salt producers in Tuticorin was held on 13 November 2013 and in Ahmedabad on 22 November 2013. Reports of the meetings are attached as Annexure 17-18.

3.1.6 Meeting with salt traders to strengthen state level iodised salt supply- The Secretariat facilitated meeting with salt traders in Bihar, and Tamil Nadu. 3.1.7 Strengthening of State USI Coalitions in Five Priority states- The Secretariat worked very closely with officials from state Health Departments, IDD Cells and partner agencies in the states of Bihar, Uttar Pradesh, Rajasthan, Tamil Nadu and Gujarat for formation and strengthening of state USI Coalitions. State USI Coalition was formed and first meeting of the Coalition was held in Bihar and Gujarat, technical sub-committee of the USI Coalition was formed in Uttar Pradesh, USI Coalition is in the advanced stage of notification in Tamil Nadu. Rajasthan already had a USI Coalition, meeting of which was

9 conducted in October 2013 and February 2014. Relevant documents are attached as Annexure 19-24.

3.1.8 Up-scaling/introduction of iodized salt in Public Distribution System (PDS) – The Secretariat carried out advocacy with state authorities for up-scaling/introduction of iodized salt in PDS. The Secretariat also provided business case study for inclusion of iodized salt in PDS in Uttar Pradesh which is attached as Annexure 25. The communication to the Principal Secretary (Food and Consumer Protection), Government of Bihar for up-scaling iodized salt in PDS is attached as Annexure 26.

3.1.9 Strengthening of regulatory framework for USI in five high priority states- The Secretariat undertook advocacy activities with Food Safety Authorities in the states of Bihar, Tamil Nadu, Gujarat, Rajasthan and Uttar Pradesh for strengthening of regulatory framework for USI. These activities resulted in notifications from state Food Safety Authorities for monitoring of mandatory salt iodization. A special drive was undertaken in Gujarat, Rajasthan and Uttar Pradesh. Gujarat undertook special drive for lifting salt samples from production areas in Kaharagoda and Halvad regions. Rajasthan undertook special drive in Nawa on 10-12 July, 2013 and Uttar Pradesh has been taken samples in each district on two days every month. In Bihar, the Food Safety Authority instructed District Magistrates of all major salt unloading districts to ensure lifting of salt samples at regular interval and in Tamil Nadu, Food Safety Officers were instructed to lift five salt samples every month.

3.1.10 The representative of the Secretariat participated in various other national and state level meetings and conference to strengthen the national program for Control of Iodine Deficiency Disorder in India. The brief list of meetings/conferences/workshop where the Secretariat, NCSII participated are as follows:

A. WHO Regional Committee for South-East Asia held at New Delhi, India from 10 to 13 September, 2013: Health Ministers from WHO’s South-East Asia Region met to review health development in the Region, identify challenges and provide policy

10 direction for future action on health issues. Delegations from the eleven SEAR Member States met for the Sixty-sixth session of the WHO Regional Committee, which is WHO’s governing body at the regional level. Director-General, Dr Margaret Chan and Regional Director, Dr Samlee Plianbangchang, were present at both the meetings. A statement was placed on behalf of Dr Chandrakant S Pandav representing the Secretariat, NSOI and ICCIDD. Health Ministers and Senior Health ministry officials of India were apprised of IDD status and priority concern areas. The statement of Dr. Chandrakant S Pandav is attached as Annexure 27.

B. Annual National Conference of National Institute of Nutrition- Dr Kapil Yadav from the Secretariat participated in the 45th Annual National Conference of National Institute of Nutrition on 21st November 2013 and made a presentation “A reliable and accurate portable devise for rapid quantitative estimation of iodine content in different types (refined, washed and common salt) of salt”.

3.2 To prepare updates/ compile/analyze/interpret available information (surveys, studies, etc) on iodine status of the population, salt use, production figures of iodized salt, sales trends, price trends, market availability and transportation etc based on reports received from partner agencies, government, private and civil society stakeholders involved in IDD program in India.

11 3.2.1 Regional IDD Newsletter- “IQ Plus Jagriti”- the Secretariat publishes a quarterly regional newsletter titled “IQ Plus Jagriti”. Four issues; March 2013, June 2013, September 2013 and December 2014 were published between April 2013 and March 2014. 3000 copies of every issue were printed which totals to 12,000 copies annually. The mailing list of the newsletter covers a wide spectrum of stakeholders and is as follows:

A. Central and State level policy makers, including Chief Secretaries and Secretaries of different ministries/departments like Health and Family Welfare, Industry, Women and Child Development, Food, Supplies and Consumer Affairs, Education. B. Members of Parliamentary Standing Committee on Health and Family Welfare. C. Key technical and administrative officials of Ministry of Health and Family Welfare at Central and State level. D. Salt Commissioners Office including all country wide administrative units/office under Salt Commissioners Office. E. Salt producers, iodised salt manufacturers and their respective trade associations. F. All Medical colleges, Institutes/departments of Nutrition and Home Science. G. Representative and office bearers of national medical professional bodies like Indian Association of Public Health (IPHA), Indian Association of Pediatrics (IAP), IMA, etc.

3.2.2 The secretariat also prepared a presentation on evolution of IDD Programme in India which was presented during a Coalition meeting on 9th April 2013. The presentation is attached as Annexure 28.

3.3 To facilitate preparation of specific activities plans identified during the deliberation of National Coalition meetings by various partner agencies with dedicated funding from concerned agencies for those specific activities.

3.3.1 The Secretariat is providing technical assistance to Micronutrient Initiative in conducting Salt Iodine Stability Study.

12 3.3.2 The Secretariat is providing technical assistance to states of Gujarat and Uttar Pradesh in planning and conducting IDD surveys. It is also providing technical assistance to Micronutrient Initiative in conducting Salt Iodine Stability Study. The Secretariat also presented a proposal for IDD survey in Uttar Pradesh which is attached as Annexure 29.

3.3.3 Proposal to develop IEC material on Iodine Deficiency Disorders- the Secretariat submitted a proposal to UNICEF for development of IEC material related to Iodine Deficiency Disorders.

3.3.4 The Secretariat submitted a proposal to MI for development of movies on Iodine Deficiency Disorders.

3.3.5 The Secretariat submitted a proposal to GAIN for strengthening regulatory framework for IDD in India.

3.3.6 A proposal for organization of National IDD Workshop was submitted to GAIN, MI and UNICEF.

3.3.7 The Secretariat also received a request for validation of new Double Fortified Salt (DFS) developed by Central Salt and Marine Chemicals Research Institute (CSMCRI), Bhavnagar, Gujarat which was shared with the Coalition partners for funding.

List of Annexure

No. Content Annexure 1 Report of National stakeholder Consultation on Strengthening the Supply Chain of Iodized Salt through National and State Level Activities Annexure 2 Minutes of the 14th meeting of National Coalition Annexure 3 Minutes of the 15th meeting of the National Coalition Annexure 4 Minutes of the 16th Meeting of National Coalition Annexure 5 Communication of Secretary, MoHFW, GoI regarding alignment of NIDDCP with RCH Annexure 6 Communication of Secretary, MoHFW, GoI regarding modification in IDD Survey

13 guidelines Annexure 7 Minutes of the meeting with Secretary and Joint Secretary, MoHFW, GOI Annexure 8 Note on alignment of NIDDCP with RCH Programme in India Annexure 9 Minutes of meeting with IDD focal persons and officials from National IDD Cell Annexure 10 Communication to FSSAI for effective implementation of FSSA 2006 Annexure 11 Communication to Director, AIIMS, Jodhpur for collaboration in IDD Annexure 12 Communication to Director, AIIMS, Patna for collaboration in IDD Annexure 13 Communication to Director, AIIMS, Bhubaneswar for collaboration in IDD Annexure 14 Communication to Director, AIIMS, Raipur for collaboration in IDD Annexure 15 Communication to Director, AIIMS, Rishikesh for collaboration in IDD Annexure 16 Communication to Director, AIIMS, Bhopal for collaboration in IDD Annexure 17 Report of the Salt Producers meeting at Tuticorin, Tamil Nadu Annexure 18 Report of the USI Workshop at Ahmedabad, Gujarat Annexure 19 Notification for formation of USI Coalition in Bihar Annexure 20 Notification for USI Coalition meeting in Bihar Annexure 21 Minutes of the USI Coalition meeting in Bihar Annexure 22 Minutes of the technical sub-committee meeting of USI Coalition in Uttar Pradesh Annexure 23 Communication to Principal Secretary, Health, Gujarat for formation of state USI Coalition Annexure 24 Notification for state USI Coalition meeting in Gujarat Annexure 25 Business case study for inclusion of iodized salt in PDS in Uttar Pradesh Annexure 26 Communication to Principal Secretary (Food and Consumer Protection), Government of Bihar for up-scaling iodized salt in PDS in Bihar Annexure 27 Statement of Dr. Chandrakant S Pandav in Sixty-Sixth Regional Committee meeting of WHO-SEARO Annexure 28 Presentation on evolution of IDD Control Programme in India Annexure 29 IDD survey proposal for Uttar Pradesh

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