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Iodine Global Network (IGN)

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Iodine Global Network (IGN), formerly ICCIDD, does not meet all of our criteria to be a GiveWell top charity but is a standout charity. Although we don't recommend these organizations as strongly as we do our top charities, they stand out from the vast majority of organizations we have considered.

More information: What is our evaluation process?

Published: December 2014

Since publishing this review, we have published a 2015 update on IGN and notes from a conversation in 2016.

Summary

What do they do? The Iodine Global Network (IGN, ign.org) aims to reduce iodine deficiency globally by advocating for national salt iodization programs, tracking progress on iodization, and providing global and country-specific guidance on related programmatic and scientific issues.

Does it work? We believe there is strong evidence that salt iodization increases cognitive development in children with mild to moderate iodine deficiency (see our full report on salt iodization). Organizations that work with and partially fund IGN (such as the United Nations Children’s Fund, UNICEF, and the Global Alliance for Improved Nutrition, GAIN) have told us that IGN’s work is often important to salt iodization programs in which they are involved. However, we have not yet been able to find direct evidence of IGN making a critical difference in the iodine health of specific populations.

What do you get for your dollar? Salt iodization programs appear to be within the range of cost-effectiveness of our other priority programs. Estimating the cost-effectiveness of IGN’s funds specifically is much more difficult, but if IGN is succeeding in having an impact on the scope and quality of salt iodization programs it is likely highly cost-effective.

Is there room for more funding? IGN has told us it has a funding gap of about $2.2 million in 2015, most of which would be used to expand the capacity of existing part-time staff. IGN’s current budget for 2015 is significantly lower than in recent years because it recently lost a significant funding source.

IGN is a standout because:

  • It supports salt iodization programs. There is strong evidence that salt iodization programs have a significant, positive effect on children’s cognitive development and do so cost-effectively. (More in our full report on salt iodization.)
  • It has been very transparent, sharing significant, detailed information about its programs with us.

Major unresolved issues include:

  • We have thus far been unable to document a demonstrable track record of impact; we believe IGN may have had significant impacts, but based on our current information we are not confident in this conclusion.

Our review process

To date, our review process has consisted of:

  • Conversations with IGN headquarters staff: Michael Zimmerman (Executive Director), Maria Andersson (Secretary), and Jonathan Gorstein (Senior Advisor).1
  • Conversations with IGN regional and national coordinators: Gregory Gerasimov (Regional Coordinator for Eastern Europe and Central Asia), Izzeldin Hussein (Regional Coordinator for North Africa and the Middle East), Pieter Jooste (Regional Coordinator for southern Africa), Sangsom Sinawat (National Coordinator for Thailand), Chandra Pandav (Regional Coordinator for South Asia).2
  • Conversations with IGN board members: Venkatesh Mannar (former President, Micronutrient Initiative), Greg Garrett (Large-Scale Food Fortification, Global Alliance for Improved Nutrition - GAIN), and Arnold Timmer (Senior Adviser, Micronutrients Unit, UNICEF Nutrition Section).3
  • In spring 2014, we visited the IGN Secretariat in Zurich, Switzerland, where we spent four days in the above conversations.
  • Reviewing documents IGN sent us after these conversations.

Note that in IGN changed its name from the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) in December 2014, after this review was published, so source documents and quotes may refer to the organization as ICCIDD.

Our 2014 interim review of IGN is available here. Our 2009 review of IGN is available here.

What do they do?

IGN aims to reduce iodine deficiency globally by advocating for national-level support for salt iodization programs, tracking progress on salt iodization and iodine status, and providing global and country-specific guidance on related programmatic and scientific issues.4

IGN’s activities include:

  • Advocating for universal salt iodization in specific countries, including meeting with government officials, educating policy-makers about programmatically-relevant iodine science, and creating and facilitating national stakeholder coalitions, which may include government agencies, aid agencies, other non-profit implementers, and salt producers.5
  • Monitoring progress in salt iodization and iodine status.
  • Seeking targeted support from implementing agencies for specific countries when needed.6
  • Serving as a liaison between the scientific community and the global health community for iodine issues.7 For example, IGN helps the World Health Organization (WHO) maintain a database of iodine status for all countries,8 publishes a quarterly newsletter on universal salt iodization programs and related research findings, and summarizes scientific research on questions that are relevant to salt iodization programs.9

Organizational structure

The IGN Secretariat is located in Switzerland at the Swiss Federal Institute of Technology Zurich (ETH). Secretariat staff are part-time and include four scientists (the Executive Director, Secretary, and two Senior Advisors), and an Administrative Assistant.10

More than half of IGN's budget is spent on supporting a network of part-time Regional Coordinators (RCs); one in each of 10 regions around the world.11 The RCs are responsible for monitoring the countries in their regions and finding the best opportunities to improve and maintain the iodine status of the populations in their regions, including recruiting and managing volunteer National Coordinators (NCs) within countries to assist in that effort where possible.12 IGN asks each RC to spend at least 10% of the time a full-time staff member would on their IGN role, although some choose to work much more than that.13 In compensation, each RC receives an annual $10,000 stipend. RCs also receive an operational budget for their work in the tens of thousands of dollars. All NCs, RCs, and Secretariat staff, along with the Treasurers and Board members, are voting members at the annual IGN meeting.14

Role within broader iodine community

While IGN is the only global organization that focuses exclusively on iodine issues, there are several "implementing agencies" that help countries or salt producers build, operate, and monitor salt iodization equipment as part of a broader portfolio of activities.15 IGN rarely does this implementation work itself.

Three implementing agencies in particular are most frequently involved in salt iodization in the countries in which IGN works: the Global Alliance for Improved Nutrition (GAIN), the Micronutrient Initiative (MI), and the United Nations Children's Fund (UNICEF).16 GAIN and MI both work on implementing a variety of nutrition programs.17 UNICEF also does some iodine program implementation, as well as national level advocacy, in addition to its other nutrition and health work in many countries.18 For each implementing agency and for IGN, the precise role and level of involvement varies from country to country.

GAIN began working on salt iodization in 2005 and requested funding for this work from the Bill and Melinda Gates Foundation (BMGF). BMGF awarded $40 million to the GAIN-UNICEF Universal Salt Iodization Partnership Project to improve iodine status in 16 countries between 2008 and 2015.19 UNICEF, GAIN, and MI all have representatives that sit on IGN's board, and each organization contributed between $50k and $100k to IGN's 2014 budget.20

Expenses

IGN's estimated cash expenses in 2012 and 2013:21

Expense Category 2012 Expenses % of total 2013 Expenses % of total
Regional Coordinators22 $680,541 81% $458,000 67%
Secretariat $2,191 0% $53,000 8%
Treasurer's office23 $51,469 6% $53,000 8%
Newsletter $50,087 6% $50,000 7%
Organizational Meetings $44,776 5% $50,000 7%
Audit/Other $13,130 2% $19,800 3%
Total $842,194 100% $683,800 100%

The estimated value of IGN's cash expenses and major in-kind contributions in 2012 and 2013:24

Expense Category 2012 Expenses % of total 2013 Expenses % of total
Regional Coordinators25 $730,541 62% $508,000 50%
Secretariat $227,191 19% $278,000 27%
Treasurer's office26 $86,469 7% $88,000 9%
Newsletter $70,087 6% $70,000 7%
Organizational Meetings $44,776 4% $50,000 5%
Audit/Other $13,130 1% $19,800 2%
Total $1,172,194 100% $1,013,800 100%

Examples of IGN’s activities

The below examples provide more concrete illustrations of IGN’s work. We relied on IGN for the information in these cases. We did not seek to vet them with independent sources.

Sudan

According to IGN, Sudan has a history of poor iodine status and unsuccessful attempts to iodize the country’s salt supply.27 The most recent household survey, completed in 2005, found that about 10% of households were using iodized salt.28 In 2007, the GAIN-UNICEF Universal Salt Iodization Partnership Project selected initial target countries for salt iodization campaigns.29 Political instability was a key factor in the decision not to include Sudan on this list (Sudan's Second Civil War officially ended in 2005).30

In 2010, IGN's Regional Coordinator for the Eastern Mediterranean and Gulf, Dr. Izzeldin Hussein, made his first visit to Sudan.31 He met with government officials to advocate for iodization legislation. Iodization legislation was enacted shortly after, but because salt producers did not have the equipment, the training, or the incentive to follow the new law, there was no immediate major increase in the quantity of iodized salt.32

In 2011, UNICEF re-allocated $400,000 from within its GAIN-UNICEF Universal Salt Iodization Partnership Project grant to work on salt iodization in Sudan.33 IGN believes UNICEF’s decision to focus on Sudan was informed in part by the knowledge that Dr. Hussein would be available to engage the government of Sudan in any changes to law that would be necessary as part of the renewed campaign for universal salt iodization in the country.34

In early 2012, CIDA provided IGN with a $377,000 grant of which IGN used about a fifth to support and scale up Dr. Hussein’s work in Sudan.35

The IGN funds supported (a) workshops and meetings with government officials and salt producers to advocate for the project and advise on implementation,36 (b) a consultant to train salt producers on iodization techniques through two workshops for laboratory personnel from the salt industry, government, and non-governmental organizations (NGOs),37 and (c) laboratory equipment that IGN supplied to producers to test their salt.38

IGN believes that the renewed effort from UNICEF and IGN was successful at building the momentum necessary in the government and salt industry to improve salt iodization rates and that they improved from the campaign.39 However, Dr. Hussein believes that in 2014, the salt producers are no longer getting the same attention and funding from UNICEF, and as a result he expects they are iodizing salt at similar rates to 2011.40

Dr. Hussein has continued his work in Sudan; he is currently translating iodization quality control guidelines for Sudan from English to Arabic.41 Although IGN scaled down its efforts there in 2013-14, it plans to re-prioritize Sudan in its work plan for 2015.42

Ethiopia

According to IGN, in the 1990s, Ethiopia imported iodized salt from Eritrea and didn't produce significant quantities of domestically.43 At the time, household coverage with adequately iodized salt was close to 80%. In 1998, war broke out between Eritrea and Ethiopia, halting the iodized salt imports, and Ethiopia began importing salt from other countries such as Djibouti and India, much of which was not iodized.44 A survey 3-4 years later revealed that coverage of adequately iodized salt had fallen to 5% of households.45

In the mid-2000s, Micronutrient Initiative (MI) led a push to improve salt iodization in Ethiopia, with support from UNICEF and Vincent Assey, IGN’s East Africa RC.46 This work focused on stopping importation of non-iodized salt. In the late 2000s, the Ethiopian government enlisted UNICEF and others to help establish its own salt industry.47

By 2010, Ethiopia was producing much of its own salt.48 UNICEF and MI had donated salt iodization equipment, but this equipment was largely unused and began to quickly degrade in the harsh climate.49 Around that time, the Ethiopian Ambassador to Senegal became impressed with the importance of iodization.50 He brought the salt producers and health minister together to discuss iodization.51 UNICEF hired Vincent Assey and paid for him and several representatives of the Ethiopian government to go to Senegal to learn about its iodization program.52 In 2011, Ethiopia passed legislation requiring salt producers to iodize their salt.53 In January 2012, it began to enforce the new rules.54 Since that time the coverage of adequately iodized salt has gradually increased to over 80% of households, according to IGN.55

India

According to IGN, regulation of the salt industry in India is a highly sensitive issue because of the role salt played in India's independence movement.56 A federal ban on non-iodized salt was implemented in 1997, revoked in 2001, reinstated in 2006, and challenged in the Supreme Court in 2011.57

IGN credits its regional coordinator in South Asia, Dr. Chandrakant Pandav, with leading the successful efforts to reinstate the ban and defeat the legal challenge to it.58 He set up a meeting between the Director of UNICEF and the Prime Minister of India to discuss the ban before the 2006 reinstatement.59

Dr. Pandav was a founding member of IGN and is a doctor and academic at the All India Institute of Medical Services.60 Each year he submits a draft budget for $70,000-$80,000 and only receives $20,000-$30,000 due to IGN’s funding constraints.61

With more funding for his South Asia region, Dr. Pandav says he would invest in:

  • National coordinators. As the Regional Coordinator for South Asia, Dr. Pandav would invest some additional funds in National Coordinators in his region. He believes national coordinators would be more impactful with a stipend, funding for running their offices, and travel budgets. That funding would allow current national coordinators to spend more time on monitoring activities, and would also be useful in recruiting new national coordinators.62
  • Iodization monitoring. Monitoring salt iodization quality and quantity at production facilities has not occurred as often since a reduction in spending by GAIN in early 2014, but is essential for ensuring that progress in iodine nutrition continues. IGN can provide a standard operation procedure for salt producers in addition to checking for inadequately iodized salt.63
  • Travel budget for the Regional Coordinator. More travel would allow Dr. Pandav to conduct more monitoring visits outside of India and to attend more conferences. When Dr. Pandav travels to other South Asian countries, he organizes a national workshop which brings stakeholders together to discuss iodine issues. Dr. Pandav believes that the presence of an external consultant catalyzes progress in iodine nutrition programs.64
  • Enhanced communication with salt producers, government, and advocates of salt iodization. Dr. Pandav believes that regular conferences and dialogues among key players could help shift momentum on salt iodization issues in South Asia. For example, iodine levels in salt may need to be adjusted in reaction to salt consumption reduction. State-level conferences would provide a venue for sharing measures of progress in iodine nutrition on a regular basis. An increased budget could also be used for printed materials at these conferences, as well as translating the regional newsletter into other languages.65
  • Laboratories are necessary for quality assurance for iodine programs, both for testing urinary iodine concentrations and for testing iodization levels in salt. More funding is necessary for training technicians. Recently developed techniques, like screening for iodine deficiency disorders in specific areas, should also be funded and continued. Funding for Dr. Pandav’s two labs comes from IGN and the All India Institute of Medical Sciences (AIIMS).66

For more information about IGN’s campaigns, see the notes from our conversations with national and regional coordinators:

Does it work?

We believe that there is strong evidence that salt iodization improves the cognitive development of iodine deficient children, but we have not yet been able to identify a demonstrable impact that IGN has had in increasing or improving salt iodization programs.

Is there independent evidence that salt iodization is effective?

There is a strong case that fortifying salt with iodine improves the mental function of iodine deficient children with greater improvements the more severe the deficiency. We discuss the evidence for salt iodization extensively here.

Does IGN’s work lead to more countries establishing successful iodine programs, or improving established ones?

At this point, we have a relatively limited understanding of the role IGN has played in each country it has worked in and the likelihood that its activities were a crucial factor in the establishment of new universal salt iodization (USI) programs or improvement of existing ones.

We have spoken directly with five IGN part-time staff that have been involved with one or more salt iodization campaigns as an IGN representative over the last few years.67 We chose to focus on these regions because we believed they would have the best chance of demonstrating a clear impact of IGN’s involvement.

We were not able to discern a clear impact of IGN’s involvement from these conversations. We plan to continue our investigation to understand the impact of IGN’s involvement more clearly.

Impact of global coordination work

We spoke with two members of IGN's board who work for implementing agencies (GAIN and UNICEF) and one who is the former President of another (Micronutrient Initiative). Each noted that IGN's global coordinating role (described here) is a key piece of the IGN’s value added.68

We have chosen not to focus more on IGN’s role at the global level because we don't believe it will make a critical difference in our decision about recommending IGN.

Negative/offsetting impacts

We plan to discuss the potential negative or offsetting effects of salt iodization in our forthcoming report on salt iodization.

What do you get for your dollar?

Cost-effectiveness of salt iodization implementation

The cost-effectiveness of a salt iodization program depends on salt intake, the iodine content in salt once it reaches consumers (poor storage, for instance, can result in iodine loss), and the prevalence of iodine deficiency before implementation of the program. We have limited data on the costs of iodization, but estimates range from $0.05-$0.10 per person per year. Salt iodization appears to be within the range of cost-effectiveness of our priority programs.

For more, see our full report on salt iodization.

Cost-effectiveness of IGN’s work

Understanding the cost-effectiveness of IGN’s work is complex because of the role IGN plays in the countries in which it works. Key questions include:

  • How critical is IGN’s work to the existence and quality of salt iodization programs?
  • How much has IGN spent in the past to achieve these results?
  • To what extent do IGN funds leverage other sources of funding, from implementing partners, governments, and others?
  • Are future projects likely to be more, less, or similarly cost-effective as past projects?

Is there room for more funding?

IGN told us that its ideal annual budget for 2015 would be about $2.7 million, up from a historical level of about $0.6 million.69 Historically, the majority of the cash funding for IGN came from AusAID (now the Australian Government Department of Foreign Affairs and Trade). AusAID’s funding for IGN ended in 2012.70 As a result, IGN has been scaling down its activities and drawing down its funding reserves in 2013 and 2014.71 If it does not secure any new sources of funding, IGN expects to raise and spend about $433,500 in 2015.72

IGN told us that Regional Coordinators consistently submit work plans to IGN requesting more funding than it is able to provide. (One example of this dynamic, discussed above, was Dr. Hussein’s request for additional funds to increase activity in Sudan from 2010-2012.) IGN has offered to share IGN Regional Coordinator workplans with us. We expect to include an analysis of these workplans in our full review.

A significant input into our view of the value of additional funding would depend on the opportunities IGN sees for iodization in specific countries and the way in which additional funding would enable it to take advantage of these opportunities. We have not yet asked IGN about this and plan to do so as part of our ongoing analysis.

IGN expects to use additional funding that it receives by the beginning of 2015 roughly as follows:73

  1. First $1.76 million to increase operational budgets and salaries of RCs and NCs ($1.41 million)...
    • Increase regional operational budgets (~$692k)
    • Create two more regions from largest regions (~$160k)
    • Pay RCs for 20-60% of full time, rather than 10% (~$360k)
    • Give NCs in 10 countries a $10k budget and $10k stipend (~$200k)
  2. ...and to increase salaries, positions, and operations budget at global headquarters ($349k)
    • Pay half-time Executive Director (~$75k)74
    • Hire full-time Program Manager (~$80k)75
    • Hire full-time Administrative Assistant (~$80k)76
    • Hire half-time Communications Manager (~$50k)
    • Pay second Senior Advisor for 20% of full-time (~$20k)77
    • Global staff meetings (~$30k)78
    • Consolidate Treasurer’s office with Secretariat (~$14k)79
  3. Next $325k to sustain and expand regional workshops
    • Sub-regional workshops for the iodine community every six to eight years in each sub-region (~$300k)80
    • Satellite meetings attached to global health meetings (~$25k)81
  4. Next $144k to start supplemental projects
    • Conduct programmatically relevant scientific studies (~$120k)82
    • Translate the newsletter into other languages and add other media projects to increase the reach of IGN's message (~$24k)83
  5. Additional funds to replenish reserves
    • Since IGN has been drawing down its reserves since 2012, we believe that funding beyond about $2.2 million per year would go toward rebuilding these reserves.

The budget above would represent a significant expansion of IGN’s budget. IGN might encounter challenges to scaling up this broadly and quickly. This concern is somewhat mitigated by the fact that the majority of the additional funding would go towards larger operational budgets for existing staff, more paid time for existing part time staff, and replacing in-kind staff time donations with salaries, rather than primarily hiring additional staff or changing the organizational structure or breadth (though some hiring and adjustment of the structure would be necessary).

Major questions for further investigation

  • What is IGN’s value added?
    • How often has IGN contributed to significant program improvements in the past? What were the nature of these improvements?
    • What is IGN’s track record of advocating for new USI programs?
  • How effective are IGN-supported iodization programs?
    • Is salt iodized to appropriate levels?
    • How much better off are people in target countries once USI programs are established?
    • How common is over-consumption of iodine?
  • Given salt iodization’s cost-effectiveness and track record, why haven’t others closed the funding gap?
  • Will IGN’s future activities be as cost-effective as past attempts to increase iodization rates?

IGN as an organization

We believe that IGN is a strong organization:

  • Track record: IGN has been involved in iodization campaigns in numerous countries over many years, and has been recognized as a helpful ally by several implementing agencies (the representatives we spoke with are also board members of IGN). We are not sure of the extent to which IGN has made an impact on those campaigns.
  • Self-evaluation: We have not seen strong methods by which IGN evaluates the impact it is having.
  • Communication: IGN has communicated clearly and directly with us and given thoughtful answers to our critical questions. We believe the difficulty we have had in understanding IGN’s impact comes more from a lack of available information than from poor communication.
  • Transparency: IGN has consistently been strong in its commitment to transparency. We have not seen it hesitate to share information publicly (unless it had what we felt was a good reason).

More on how we think about evaluating organizations at our 2012 blog post.

Sources

Document Source
BBC News South Sudan independence 2011 Source (archive)
Caulfield et al 2006 Source (archive)
Gaffar 2012 Source (archive)
GiveWell non-verbatim summary of a conversation with Chandra Pandav on September 2nd, 2014 Source
GiveWell non-verbatim summary of a conversation with Gregory Gerasimov on September 3rd, 2014 Source
GiveWell non-verbatim summary of a conversation with Izzeldin Hussein on September 5th, 2014 Source
GiveWell non-verbatim summary of a conversation with Pieter Jooste on August 25th, 2014 Unpublished
GiveWell non-verbatim summary of a conversation with Sangsom Sinawat on August 22nd, 2014 Unpublished
GiveWell's non-verbatim summary of a conversation with Arnold Timmer on May 1st, 2014 Source
GiveWell's non-verbatim summary of a conversation with Greg Garrett on April 30th, 2014 Source
GiveWell's non-verbatim summary of a conversation with Greg Garrett on March 11th, 2014 Source
GiveWell's non-verbatim summary of a conversation with Greg Garrett on May 19th, 2014 Source
GiveWell's non-verbatim summary of a conversation with Michael Zimmerman on February 11th, 2014 Source
GiveWell's non-verbatim summary of a conversation with Michael Zimmerman on January 21st, 2014 Source
GiveWell's non-verbatim summary of a conversation with Michael Zimmerman on January 9th, 2014 Source
GiveWell's non-verbatim summary of a conversation with Venkatesh Mannar on April 30th, 2014 Source
GiveWell's summary of ICCIDD's 2015 funding gap 2014 Source
ICCIDD CIDA grant final report 2013 Source
ICCIDD CIDA grant financial report 2013 Source
ICCIDD conversations with GiveWell in Zurich, April/May 2014 Unpublished
ICCIDD core-plus funding scenario 2014 Source
ICCIDD estimated cashflow 2012 - 2013 Source
ICCIDD estimated cashflow 2013 - 2015 Source
ICCIDD iodine excess slides 2014 Source
ICCIDD Newsletter Belarus February 2014 Source
ICCIDD Newsletter DR Congo November 2007 Source
ICCIDD Newsletter DR Congo November 2008 Source
ICCIDD Newsletter Ethiopia November 2013 Source (archive)
ICCIDD Newsletter India August 2013 Source
ICCIDD Newsletter Nigeria November 2013 Source
ICCIDD Newsletter Senegal May 2012 Source
ICCIDD Newsletter Sudan IDD August 2006 Source
ICCIDD Newsletter Sudan May 2007 Source
ICCIDD Newsletter Sudan progress November 2007 Source
ICCIDD Newsletter Sudan USI launch August 2012 Source
ICCIDD Newsletter Thailand November 2008 Source
ICCIDD organizational structure 2014 Source
ICCIDD slides Belarus Russia 2014 Source
ICCIDD slides Ethiopia 2014 Source
ICCIDD slides India 2014 Source
ICCIDD slides Nigeria Senegal 2014 Source
ICCIDD slides on partnership with WHO 2014 Source
ICCIDD slides Sudan 2014 Source
ICCIDD slides Thailand 2014 Source
ICCIDD slides Vietnam 2014 Source
ICCIDD Sudan USI launch video July 13th, 2012 Source (archive)
UNICEF webpage on 2006 Sudan Household Health Survey, accessed June 23rd, 2014 Source (archive)
Zimmerman et al 2013 Source (archive)