Transcript The Turning Point of The Programme:1983 Mrs. Indira Gandhi

The Turning Point of The Programme:1983
Meeting With The Prime Minister of India:
Mrs. Indira Gandhi
Outcome : Political support from the PM
 Redefining IDD : National developmental problem
 Strategy
: From District specific to
Universal Salt Iodisation (USI)
 Solution
: Liberalization of production
- Encouragement to private sector
 Prime Minister’s 20-point Programme:
“Goitre Elimination”
Progress since 1983 - 1
1984
: Policy of Universal Salt Iodisation
: Private sector encouraged to
produce iodised salt
1992
: National Goitre Control Programme
(NGCP) renamed as National IDD
Control Programme (NIDDCP)
1995
: Independent survey evaluation of
USI in Madhya Pradesh ; New Delhi;
Sikkim
Progress since 1983 - 2
1997
: Sale & storage of common salt
banned
1998-99 : NFHS - 2 Survey on Household
consumption of iodised salt
13th Sept. : Ban on sale of common salt
2000
lifted by the Central Government
Capacity & Production
(in lakh tonnes)
Graph of progress of USI at a glance
1983-2000
140
140
116
120
100
80
80
60
37
40
20
0
2
2
1983
7
40
44
16
1986
1995
Year
1998
2000
Production
Capacity
India: Use of Iodised Salt
National Family Health Survey – 2
(NFHS –2) : 1998-1999
- 71% consuming salt with some iodine
- 49% use adequately iodised salt
(recommended level of 15 ppm or more)
- 22% use inadequately iodized salt
- 29% use non-iodized salt
The World In Which Policies
Should Be Made
1) Health Problem/Issue
2) Information
+ Values
3)
Institutional
structure for
decision making
4) POLICIES
World In Which Policies Should Be Made
Values
CORE VALUES (IDEOLOGIES)
Gandhians – Salt as a icon of the freedom struggle
SJM – Globalization & Liberalization
BELIEFS
Casual Assumptions –
Iodine & Impurity
INTERESTS –
Iodine & Import
Loose Vs Packaged
Small Vs Big producers
National Vs Multinational
Dr. Denish Moorthy,
Ph.D. Student,
Centre for Community Medicine
AIIMS,
who has been associated with
Prof. Ramalingaswami since 1999
to take us through the events related to role of
values in health policy formulation
Year 2000 & Beyond
May 2000:
Central Government decides to lift the ban on the
sale of common salt
May - Sept 2000:
Communication to elected representatives of
Central & State Govt. through meetings & letters
Proactive IEC in print & electronic media on
importance of IDD elimination & Benefits of
iodised salt
Sept 2000:
- Government lifts the ban at the Central Level
- States continue to have the ban
Withdrawal of The Ban
• National Ban on sale of common salt for human
consumption withdrawn
- Government of India, 13th Sept. 2000
• Reason Given:
On point of principle, compulsions in the matter
of individual choice in undesirable
Current Scenario Of The Ban
Andhra Pradesh & Maharashtra - Partial ban continues
Kerala - No ban (Status Quo);
But recent (May 2001) statewide survey
shows IDD as public Health problem
Gujarat and Orissa – Lifted the ban
Orissa – Restored the ban after 6 months
Year 2000 & Beyond
Probable factors responsible for lifting of the ban:
1. PFA Legislation – harassment
2. Politics of liberalization
3. Price difference and perceptions
4. Principle of choice
Core Values, Beliefs, Interests:
The Three Key Players
Common & Iodised Salt
Manufacturers
+
Swadeshi Jagran Manch (SJM)
+
Gandhians
Profile of Common Salt Manufacturers
 Statewise production
 Gujarat
 Tamil Nadu
 Rajasthan
: 73%
: 13%
: 9%
 Sector wise production




Private Sector
Un-recognised Sector
Co-operatives
Public Sector
: 60%
: 28% (Half in Gujarat)
: 9%
: 3%
 Category wise production
 Small - < 10 acres
: 62%
Large - > 100 acres
: 28%
 Medium - 10 - 100 acres: 10%
Profile of Iodised Salt Manufacturers
 Number of salt iodisation plants
: 964 (Year 2000)
 State wise production
 Gujarat
 Rajasthan
 Tamil Nadu
: 61%
: 13%
: 9%
 Refineries (Production of refined / vacuum iodised salt)
 Installed Capacity
 Iodised Salt Production
 Proportion of total production
: 25 lakh tons
: 8 lakh tons (1998)
: 8 /44 = 18 %
 Sector wise production
 Private
 Public
: 98%
: 2%
Salt Manufacturers & Traders
Salt manufacturers
Medium +
Large Scale
Refined
Free flowing Salt
Good Quality salt
With Adequate
iodine content
No problems with
the PFA Act
Small Scale
Question of
quality and
Adequate iodine
content
of salt
PFA Act: Harassment
Repackers (Traders)
Brand Imitation
Poor
Quality salt
With
Inadequate
iodine
content
Problems with
the PFA Act
Petitioning elected representatives:
Lifting of the ban
Past
Salt Manufacturers
 Availability of Technology – Large and medium
scale producers cutting into small scale producer’s
market
 Cooperatives formed to assist the small producers
 Issues in PFA Act
 Issues in implementation of PFA Act
Proposed plan of action
 Availability of Technology – Innovative ways of Cooperation
 Issues in PFA Act
 Efforts to modify Act
 Monitoring of quality of iodised salt by the producers
themselves
 Certification of product: WTO & ISO 9002
Swadeshi Jagran Manch (SJM)
Points related to ideology
 Globalization – “Multinational” and
large corporation angle to salt in India
 Perceptions about common & iodised
salt
 Price of iodised salt
 Liberalization – Import of iodine –
a burden on economy!
IDD Control Programme:
A National Effort - 1
 Contribution Made For Assessment
& Tracking Progress:
- By national institutions
- With national support
- By national scientists
- Using national laboratory &
equipments
IDD Control Programme:
A National Effort - 2
Contribution Made For Control:
- Self Sufficiency in common salt production
- Indigenous manufacture of salt iodisation
plants & accessories
- Supported by national technical efforts
- Conversion of iodine to potassium iodate
done in India
- Indigenous packaging
- Import of Iodine:
(Iodine’s share of Total Indian Imports: 0.005%)
Perception about common salt & iodised salt
Universal Salt Iodisation (USI) = Legislation =
PFA = Iodised Salt = Packaged Salt =
= Refined Salt = High Priced salt
Crystal
Common salt
- in Jute Bags
- 75 Kgs. / 100 kgs.
Powdered
iodised salt
- in Polypacks
- of ½ Kg / 1 kgs.
Cost Of Iodine For Salt Iodisation
 Total Production of
Iodised salt in India
: 44 Lakh tons
 Iodine Required for Salt
Iodisation (30 mg I2 /Kg Salt )
 Price of iodine per ton
: 144 Tons
: Rs. 7.3 Lakhs
(@ US$15.5 / Kg)
 Total cost of Iodine required
for salt Iodisation
: Rs. 10.5 Crore
Cost Of Iodine Per Person Per year
 Total cost of Iodine required for
salt Iodisation : Rs. 10.5 Crores
 Rs. 10.5 Crores for 100 Crores population
 Cost of iodine per person per year : 10.5 paise
Acts and Rules for Salt
• “Salt” is declared as an item of food
under Essential Commodities Act, 1955
• State governments have been
authorized to administer the Act for
– Fixing the prices of salt
– Its movement within their States, if
necessary
States/UTs Supplying Iodised Salt
Fully/Partly Through PDS - I
S.No.
State / UT
PDS selling price/ kg.
1.
Maharashtra
Rs. 2.90 DPAP areas
Rs. 1.65 ITDP areas
2.
Tripura
Rs. 1.90
3.
Lakshadweep
Rs. 2.50
4.
Assam
Rs. 2.00 powdered
Rs. 3.00 packed salt
5.
Kerala
Rs. 2.45 Crystal salt
Rs. 4.65 Free Flow
States/UTs Supplying Iodised Salt
Fully/Partly Through PDS - II
S.No.
State / UT
PDS selling price /kg.
6.
7.
Orissa
Rajasthan
Rs. 2.00
Rs. 3.25
8.
9.
Tamil Nadu
Delhi
Rs. 2.50
Rs. 2.50
Rs. 3.50 Refined free flow
10.
11.
Arunachal Pradesh
Gujarat
Rs. 2.60
Rs. 0.60
Gandhian Movement
Their Arguments
 Do we need universal salt iodisation?
 Why a compulsion for iodised salt?
 Salt An Icon of the Freedom Struggle
 Why not have a Choice?
Do we need universal salt iodisation?
 IDD is a public health problem ; Therefore it requires
public health solution
 The serious irreversible effects of IDD (stillbirths ,
abortion, neonatal mortality and mental handicap)
are not obvious
 Prevention (Health Promotion & specific protection –
public health approach)
is better than
Cure (early diagnosis and treatment, disability
limitation, rehabilitation – Clinical approach)
Yes- A Worthwhile Investment in Health
Cost per person per year of protection
: 50 paise
(less than a price of cup of tea!)
Cost benefit ratio (only health effects) : 1:3
If benefits related to education
(13 I.Q points) & livestock
(increased productivity & yield of
eggs, milk, wool, etc) included, then:
Cost benefit ratio
: 1:10
(This work was conducted as part of the INCLEN
Training of Dr. Pandav at McMaster University,
Canada, 1990-1991)
India: Use of Iodised Salt
National Family Health Survey – 2
(NFHS –2) : 1998-1999
Socioeconomic Status & Use of Iodised Salt
Socioeconomic
status
Noniodised
Salt
Inadequately
Iodised Salt
Adequately
Iodised
Salt
Total
(%)
(%)
(%)
(%)
Low
36
28
36
100
Medium
28
22
50
100
High
13
9
78
100
Scientists Point of View
- “Improving beneficial components of diet” does not
increase iodine intake
- Dietary diversification does not increase iodine intake
because:
“Iodine deficiency is a disease of the soil”
- Therefore the need for universal salt iodisation
- Most cost-effective, economical &
physiologically safe means of eliminating
iodine deficiency is regular continuous
consumption of adequately iodised salt
“Consumption of Iodised Salt: A Healthy Habit”
Dr. Chandrakant S Pandav,
Member,
Clinical Epidemiology Unit,
&
Addl. Prof., Centre for Community Medicine
AIIMS,
who spent his school life at Aga Khan
Palace, Pune where Mahatma Gandhi was
imprisoned during the Quit India Movement
To summarize The Case Study
“I would be hard-hearted enough to let
the sick die if you can tell me how to
prevent others from falling sick”
- Mahatma Gandhi
Lessons Learnt From NIDDCP
1) Health Issues are Social,Political &
Economic Issues
2) In the Formulation of Policy in a
Democratic Environment, we require:
a) Identification of the health problem/issue
b) Information to knowledge –
- Evidence based data
- Effective & efficient intervention to
eliminate the problem
Lessons Learnt From NIDDCP
•
In the Formulation of Policy in a Democratic
Environment, we also require:
a) Formal networks
b) Informal networks
c) Values – Core values, beliefs, interests
4) Implementation of policy based only one or
two factors will:
a) Achieve less than optimum results
b) Lead to a retrograde step as seen in the Case
Study of NIDDCP
World In Which Policies Should Be Made
1) Health Problem/Issue
2) Information
3) Values
4)
Institutional
structure for
decision making
5) POLICIES
In Summary…
1) Iterative Loop: Research – Policy Programme
2) World In Which Policies Were Being Made
3) World In Which Policies Should Be Made –
A Case Study of NIDDCP
1)
Lessons Learnt From the NIDDCP
2)
In Summary…
Thank You for Your
Kind Attention!