Published: September 2016, based on information received in 2015
We last published a review of the Iodine Global Network (IGN) in 2014. Our full review is here. Our view of the organization has not changed substantially since that time.
In 2015, we had a series of conversations with IGN to determine whether we could establish an evidence-backed case for the impact of IGN's past work. We focused on IGN's work in small countries because we and IGN agreed that its success stories in these countries might be able help us to better understand its impact on salt iodization. After several conversations, we paused this work because we did not believe that we would be able to reach the level of confidence in IGN's impact that we were seeking from the information that was available.
Notes from our conversations:
- GiveWell's non-verbatim summary of a conversation with Dr. Michael Zimmermann on February 11, 2015
- GiveWell's non-verbatim summary of a conversation with Dr. Michael Zimmermann on April 28, 2015
- GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on May 11, 2015
- GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on June 22, 2015
- GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on October 2, 2015
Below, we discuss two updates that came out of these conversations and that we thought were worth summarizing:
- IGN's work in "special initiative" countries, with a focus on Lebanon and Burundi
- Changes to IGN's fundraising targets
In addition, when discussing the 2015 update with IGN in August 2016, IGN shared some additional updates with us:
- IGN 2015 Annual report
- IGN brief summaries of recent work in five countries
- IGN budget (updated June 2016)
IGN's work in special initiative countries
In 2015, IGN conducted "special initiatives" in nine regions. Our understanding is that many (though not all) of these were small countries where IGN was the main aid agency working on salt iodization,1 and that these projects were one of the main uses of funds IGN received as a result of GiveWell's recommendation.2 Our impression is that most of the work on the special initiatives was undertaken by IGN's Regional Coordinators (RCs), National Coordinators (NCs), and headquarters staff.
The main difference we know of between the special initiatives and IGN's work in other countries is that the special initiatives cost around $20,000 each, while RCs tended to spend around $5,000 in each of the other countries where they worked.3 We assume that, given the differences in expenditures, IGN was more active in the special initiative countries than in most of the other countries where RCs spent funds.
We attempted to understand IGN’s work in 2015 special initiatives countries where IGN was the main aid agency working on salt iodization (including its work in these countries in earlier years). We did this both because IGN suggested that this might be a promising route to understanding IGN's impact and because we thought that IGN's impact might be clearer in these countries due to the absence of other aid agencies.
We felt that we gained the clearest picture of IGN's possible impact in Lebanon and Burundi, though not enough information is currently available about IGN's work in either country for us to be confident in IGN's impact.
In 2013, Dr. Omar Obeid, IGN's NC in Lebanon and a Professor of Nutrition at the American University of Beirut (AUB), led a partnership between IGN and AUB to survey the urinary iodine concentration (UIC, a key indicator of iodine health) of schoolchildren in the country. This was the first survey of iodine nutrition in Lebanon in approximately ten years.4 IGN provided most of the funding for the study and supported its design and execution. The survey found a median UIC of 66 micrograms/liter, one of the lowest national-level UICs in the world.5
IGN believes that improving iodine nutrition in the country will require improving iodization legislation and enforcement as well as working with industry. Dr. Obeid held a workshop with government and industry in April 2015 and has been working to form a national iodization coalition.6 IGN allocated $20,000 to Lebanon in 2015 to fund creation of a policy brief and to support monitoring.7 IGN expects that Mr. Obeid's activities could lead to measurable improvements in salt iodization and UIC in the near future,8 though we are not aware of any specific plans to conduct a follow up survey of UIC levels. According to IGN, there are no other aid agencies working on USI in Lebanon.9
In 2015, IGN allocated $40,000 to Dr. Vincent Assey, IGN's East Africa RC, for work in Burundi.10 Dr. Assey met with salt producers in Tanzania that export their salt to Burundi to encourage them to iodize their salt. He also met with Burundi's Ministry of Health to encourage the government to use rapid test kits to check that salt entering the country contains iodine. IGN believes that stricter border enforcement over the past year has led to a higher proportion of salt on the market being iodized.11
IGN also conducted workshops in Burundi to advocate for USI. IGN began discussions with the government about conducting a survey of iodine nutrition, but the discussions have stalled due to civil unrest.12
IGN's impact on iodine nutrition may be hard to measure in Burundi, since our understanding is that there is no recent data on iodine nutrition available to serve as a baseline.13
Changes to fundraising targets
In 2014, IGN told us that its ideal annual budget for 2015 would be about $2.55 million, up from a historical level of about $0.6 million.14 In 2015, IGN told us that its ideal budget of unrestricted funding going forward would be about $829,000 per year.15
IGN told us that it reduced its ideal yearly budget after reflecting on its mandate and determining that it should focus on high-level advocacy and technical assistance. In addition, IGN decided that it would be sufficient to ask RCs and NCs to devote a smaller proportion of their time to their work for IGN than IGN had previously budgeted for.16
IGN told us that it would plan to use the $829,000 per year as follows (we have also included the 2015 budget for reference:17
|Expense category||Ideal budget for unrestricted funds||2015 budget (includes restricted funds)18|
|Regional coordinators (and "GiveWell special initiatives")||$430,000||$374,000|
|Secretariats and secretariat staff||$214,000||$170,95019|
|Newsletters and web maintenance||$65,000||$89,000|
|Special initiatives / research studies||$25,000||$568,66822|
|Travel, audit and legal, insurance, and bank charges||$30,000||$19,800|
We do not have a current estimate of how much IGN expects to raise in 2016.
IGN's 2015 special initiative regions were Burundi, Ethiopia and Sudan, the Gulf States, Haiti, Lebanon, Madagascar, Niger, Sudan, and Yemen. IGN 2015 estimated budget, Pg 3, Table: GiveWell Revenue Flow.
IGN 2015 estimated budget, Pg 2.
IGN 2015 estimated budget. Spending on special initiatives: Pg 3, Table: GiveWell Revenue Flow. RC spending in countries: Pg 5, Table: Regional Coordinator Budgets.
Lebanon is a relatively small country with a population of approximately four million. It has a law mandating salt iodization. In the early 2000s, several measures were put into place to improve its iodine nutrition program. Surveys conducted approximately ten years ago indicated acceptable household coverage levels across the country. Since the influx of significant numbers of refugees from the Syrian war, the work of the Ministry of Health and development agencies has largely been focused on their needs. Enforcement, monitoring, and quality assurance of salt production has ceased. Recent data on iodine status and iodized salt in Lebanon is unavailable.
To address the lack of data, IGN’s national coordinator, Dr. Omar Obeid, led a partnership between IGN and the American University of Beirut (AUB), where he is a professor in the Department of Nutrition and Food Science. IGN designed a protocol for a urinary iodine concentration (UIC) survey of school children, funded laboratory analytics, and supported Dr. Obeid in his advocacy with national stakeholders. The AUB funded the fieldwork." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on May 11, 2015.
"In 2013, Dr. Obeid and Dr. Zimmermann designed the first national urinary iodine concentration (UIC) survey for Lebanon, with help from the statistics office at AUB in designing the sampling scheme. The survey included about 1,000 children from across Lebanon. Survey samples were analyzed at Dr. Zimmermann’s lab in Zurich. The median UIC was found to be only 66 micrograms/liter, one of the lowest national-level median UICs in the world and well within the range that randomized controlled trials have suggested can cause a drop of 2 to 4 IQ points in children.
The survey was designed, executed and funded by IGN with support from AUB. Dr. Obeid received funding for fieldwork from AUB, while IGN provided funding for laboratory measurements and analysis of the survey, as well as some of the funding for transport of samples and travel. Dr. Zimmermann estimates that IGN funded about three-quarters of the overall cost of the survey." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on June 22, 2015.
Note that in an earlier conversation, IGN indicated that the survey was conducted in 2014 and that it found moderate UIC levels. “Lebanon’s Ministry of Health (MOH) called for a national iodine survey in 2014 (in part due to advocacy by IGN’s national coordinator in Lebanon, Dr. Omar Obeid). […] The survey showed moderate iodine deficiency.” GiveWell's non-verbatim summary of a conversation with Dr. Michael Zimmermann on April 28, 2015.
- "Dr. Obeid is currently using the survey results to advocate for the Lebanese government to enforce iodization legislation. IGN held a workshop in April, attended by two nutrition officials from the MoH and a major salt producer. Dr. Obeid is currently forming a national iodine coalition that includes the government, salt producers, and civil society." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on June 22, 2015.
- "Restarting the iodization program will depend on commitment among the major salt producers, better enforcement and revision of the legislation around iodization. The legislation must be changed in order to remove ambiguities and align more closely with the practical capabilities of salt producers, including reducing the amount of iodine added and introducing some regulatory monitoring requirements. Along with the Ministry of Health, UNICEF and salt producers, Dr. Obeid has been conducting a landscape analysis of the industry to determine what program revisions will be necessary, and will develop a detailed plan of action to implement. IGN is in a unique position to facilitate this work in Lebanon as there are no other agencies working directly on USI." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on October 2, 2015.
"[$]20,000 Lebanon[:] Lead initiative to develop policy brief, stimulate Reg monitoring support, UIC survey with MoH and Salt Industry - no implementation partners active." IGN 2015 estimated budget, Pg 3.
"If all proceeds according to plan, adequately iodized salt could begin appearing on the Lebanese market by early 2016. It is expected that this increase in the availability of iodine in the diet will cause UICs to increase to adequate levels. These improvements could also increase the availability of iodized salt in Syria, as one of Lebanon’s four main producers is the primary supplier of iodized salt to Syria." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on May 11, 2015.
"IGN is in a unique position to facilitate this work in Lebanon as there are no other agencies working directly on USI." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on October 2, 2015.
"[$]40,000 Burundi[:] Coordinate with MoH to implement testing of iodine in imported salt to comply with national legislation; workshop with large Tanzanian salt exporters to Burundi to ensure QA of iodine content in exported salt; perform national urinary and salt iodine survey in coordination with MoH, UNICEF to update evidence on iodine status in Burundi and judge impact of the above measures." IGN 2015 estimated budget, Pg 3.
Dr. Zimmermann believes that rapid gains are possible in Burundi.
Burundi imports most of its salt from Tanzania and Kenya. IGN’s regional coordinator visited several salt producers, including a major producer in southern Tanzania that provides much of Burundi’s salt, and encouraged them to iodize the salt that they export. He also met with Burundi’s MOH about ensuring that border checkpoints use rapid test kits to ensure that salt entering the country is iodized.
IGN believes that over the past year, due to stricter border enforcement, a higher proportion of salt entering Burundi has been iodized. IGN plans to run a study of household coverage and urinary iodine levels in October, and to have an evaluation of impact by November. Previously, data on household coverage was about 10 years old." GiveWell's non-verbatim summary of a conversation with Dr. Michael Zimmermann on April 28, 2015.
"IGN has organized a series of advocacy workshops in Morocco, Burundi and Haiti to encourage these countries to jump-start universal salt iodization (USI) programs. In Burundi, IGN has been involved in discussions towards the design and implementation of a national IDD survey, but these have been stalled due to political and civil unrest. In each of these countries, IGN plays a role in bringing together key partners, reviewing critical bottlenecks in programs, and developing plans for program acceleration. To facilitate this, IGN has made use of GiveWell funds for field visits and consultations." GiveWell's non-verbatim summary of a conversation with Drs. Michael Zimmermann and Jonathan Gorstein on October 2, 2015.
"IGN believes that over the past year, due to stricter border enforcement, a higher proportion of salt entering Burundi has been iodized. IGN plans to run a study of household coverage and urinary iodine levels in October, and to have an evaluation of impact by November. Previously, data on household coverage was about 10 years old." GiveWell's non-verbatim summary of a conversation with Dr. Michael Zimmermann on April 28, 2015.
The historical level is based on ICCIDD conversations with GiveWell in Zurich, April/May 2014.
Ideal budget is from ICCIDD core-plus funding scenario 2014.
Neither of these figures include in-kind contributions. In a fully funded scenario, IGN expects that most salary in-kind contributions would cease, but that some office space, overhead, and newsletter postage would continue to be donated. ICCIDD conversations with GiveWell in Zurich, April/May 2014.
"The total estimated budget for the IGN is can comfortably operate on a total unrestricted annual budget of approximately $815,000." IGN budget narrative for GiveWell, October 2015, Pg 1. The budget document lists this total as $814,000, while the total of the line items in IGN draft projected budget for GiveWell, October 2015, Pg 1 is $829,000.
"Reduction in unrestricted budget
The $750,000–$1 million range is lower than the figure IGN had projected in 2014 (~$2.7 million). This reduction is in large part due to IGN’s efforts to clarify the differences between its own mandate and that of implementing partners like UNICEF, the Micronutrient Initiative (MI), and the Global Alliance for Improved Nutrition (GAIN) and to ensure that its budget reflects the work that it is best suited to take on. IGN has a mandate which focuses on advocacy and convening major stakeholders to develop harmonized goals and strategies. Thus, IGN often leads on the development of work plans and providing technical guidance, but does not engage in direct implementation-related work. In contrast, UNICEF, GAIN, and MI require large periodic investments for providing equipment, on-the-ground implementation assistance, and ongoing training.
Last year, as the IGN explored a number of potential options to expand its reach, it considered providing discretionary funding to national coordinators (NCs) in several countries. However, it has since concluded that the NCs can perform their advocacy work and serve a convening function effectively with less funding than projected. IGN also had projected a large increase in budgets for all of its regional coordinators (RCs) so that they could devote 50% or more of their time to working for IGN, but has determined that the RCs can perform well with a lower time commitment (25%-45%). As such, while the RCs need an incremental increase in funding above pre-2014 levels (when the RCs were allocated funds to support about 10% of their time to the IGN), it is less than projected in initial discussions with GiveWell."
IGN draft projected budget for GiveWell, October 2015, Pg 1. Organizational meetings includes Board meeting and Mgt Council meeting. Other includes travel, audit and legal, insurance, and bank charges.
- 18. IGN 2015 estimated budget, Pg 2.
- 19. There are no costs listed in the 2015 budget for the line items for Executive Director and Communications staff salaries.
- 20. Budget notes that these meetings are not taking place in 2015.
- 21. There is no line item for fundraising in the 2015 budget.
- 22. Includes all 'Specific Project outflows' from the budget, including $205,000 for 'GiveWell special initiatives,' except 'Newsletter and website.'