A Framework for Developing Effective Advocacy and Communication to Support Universal Salt Iodization

Abstract

Objectives: Tremendous progress has been made toward achieving universal salt iodization (USI).  Nonetheless, in some countries USI's momentum has stalled. UNICEF and GAIN have created a Partnership, under Gates Foundation funding, to revitalize and innovate for reaching the "last mile" of coverage in such countries and to ensure sustainability of past achievements. Under this initiative, USI advocacy and communications (A&C) activities were assessed in 13 countries to create a framework for guiding national programs in the creation of effective A&C strategies. Methods: Countries were selected based on low USI coverage or questionable sustainability of current coverage. Assessments examined legislation and enforcement, current coverage, salt manufacturing, and the consumer market, analyzed the salt distribution chain in detail, and identified priority needs and recommended approaches for expanding coverage. Results: As expected, constraints to stalled progress were unique to each country, requiring recommendations tailored to the local situation. Nonetheless, the exercise generated a framework, modifiable for use in any country, detailing a process for assessing legislation and enforcement; pinpointing links of the salt distribution chain; identifying key actors, actions, and communications needs at each link; and obtaining information about these actors and actions. The framework's summary matrix allows prioritization of A&C initiatives for greatest impact using available resources. Conclusions: This "salt chain" approach creates new opportunities for expanding A&C beyond the usual focus of simply targeting producers and consumers, and the new framework provides a useful tool for country programs to use when assessing A&C needs, formulating strategy and prioritizing A&C activities.