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International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD) - 2014 interim review

This page is an interim review. We have published a more recent version of this review here. As of December 2014, ICCIDD is now know as the Iodine Global Network.

International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD) is applying to be a 2014 top-rated charity. Here we discuss what we have learned so far and our major outstanding questions.

More information:

Published: July 2014

Summary

What do they do? The International Council for the Control of Iodine Deficiency Disorders Global Network (ICCIDD, iccidd.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? Our analyses of the effectiveness of salt iodization programs and ICCIDD's value added are ongoing. We plan to complete these analyses as part of our full review process.

What do you get for your dollar? Our research is ongoing, but our impression is that the cost-effectiveness of salt iodization programs may be in the same range as that of our priority programs. We have not yet attempted to estimate the cost-effectiveness of ICCIDD’s work.

Is there room for more funds? ICCIDD 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. ICCIDD’s current budget for 2015 is significantly lower than in recent years because it has recently lost a significant funding source.

What are GiveWell’s next steps? ICCIDD is a contender for a GiveWell recommendation. We plan to continue our review process with ICCIDD to try to answer our outstanding questions.

Why we are publishing this page

As we discussed in our plan for 2014, one of GiveWell’s key research priorities for this year is actively pursuing investigations of several particularly promising charities including ICCIDD. This page is intended to update our followers on ICCIDD's application and what we've learned so far.

Our investigation process

To date, our investigation process has consisted of:

  • Conversations with ICCIDD staff: Michael Zimmerman (Executive Director), Maria Andersson (Secretary), and Jonathan Gorstein (Senior Advisor).1
  • Conversations with ICCIDD 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).2
  • In spring 2014, we visited the ICCIDD Secretariat in Zurich, Switzerland, where we spent four days in the above conversations.
  • Reviewing documents ICCIDD sent us after these conversations.

Our 2009 review of ICCIDD is available here.

What do they do?

ICCIDD 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.3

ICCIDD’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.4
  • Monitoring progress in salt iodization and iodine status.
  • Seeking targeted support from implementing agencies for specific countries when needed.5
  • Serving as a liaison between the scientific community and the global health community for iodine issues.6 For example, ICCIDD helps the World Health Organization (WHO) maintain a database of iodine status for all countries,7 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.8

Organizational structure

The ICCIDD 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.9

More than half of ICCIDD's budget is spent on supporting a network of part-time Regional Coordinators (RCs); one in each of 10 regions around the world.10 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.11 ICCIDD asks each RC to spend at least 10% of the time a full-time staff member would on their ICCIDD role, although some choose to work much more than that.12 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 ICCIDD meeting.13

Role within broader iodine community

While ICCIDD 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.14 ICCIDD rarely does this implementation work itself.

Three implementing agencies in particular are most frequently involved in salt iodization in the countries in which ICCIDD works: the Global Alliance for Improved Nutrition (GAIN), the Micronutrient Initiative (MI), and the United Nations Children's Fund (UNICEF).15 GAIN and MI both work on implementing a variety of nutrition programs.16 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.17 For each implementing agency and for ICCIDD, 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 2015.18 UNICEF, GAIN, and MI all have representatives that sit on ICCIDD's board, and each organization contributed between $50k and $100k to ICCIDD's 2014 budget.19

Expenses

ICCIDD's estimated cash expenses in 2012 and 2013:20

Expense Category 2012 Expenses % of total 2013 Expenses % of total
Regional Coordinators21 $680,541 81% $458,000 67%
Secretariat $2,191 0% $53,000 8%
Treasurer's office22 $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 ICCIDD's cash expenses and major in-kind contributions in 2012 and 2013:23

Expense Category 2012 Expenses % of total 2013 Expenses % of total
Regional Coordinators24 $730,541 62% $508,000 50%
Secretariat $227,191 19% $278,000 27%
Treasurer's office25 $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 ICCIDD’s activities

The below examples provide more concrete illustrations of ICCIDD’s work. We have not yet vetted these examples and much of the information is from conversations with ICCIDD.

Sudan

According to ICCIDD, Sudan has a history of poor iodine status and unsuccessful attempts to iodize the country’s salt supply.26 The most recent household survey, completed in 2005, found that about 10% of households were using iodized salt.27 In 2007, the GAIN-UNICEF Universal Salt Iodization Partnership Project selected initial target countries.28 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.)29

In 2010, ICCIDD Regional Coordinator for the Eastern Mediterranean and Gulf, Izzeldin Hussein, made his first visit to Sudan.30 He met with government officials to advocate for iodization legislation. Iodization legislation was enacted shortly after.31 After that visit, he requested additional funding from ICCIDD to enable him to visit Sudan more often.32

In early 2012, CIDA provided ICCIDD with a $377,000 grant of which ICCIDD used about a fifth to support and scale up Dr. Hussein’s work in Sudan.33 Around this time, UNICEF re-allocated $400,000 from within its GAIN-UNICEF Universal Salt Iodization Partnership Project grant to work on salt iodization in Sudan.34

The ICCIDD funds supported (a) workshops and meetings with government officials and salt producers to advocate for the project and advise on implementation,35 (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),36 and (c) laboratory equipment that ICCIDD supplied to producers to test their salt.37

Dr. Hussein has continued his work in Sudan – he is currently translating iodization quality control guidelines for Sudan from English to Arabic – though ICCIDD has otherwise scaled down its efforts there.38 ICCIDD believes that its efforts led to UNICEF’s increased commitment, and that with Sudan’s salt iodization program now operating, the need for ICCIDD’s involvement is less urgent.39

Ethiopia

According to ICCIDD, in the 1990s, Ethiopia imported iodized salt from Eritrea and didn't produce significant quantities of domestically.40 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.41 A survey 3-4 years later revealed that coverage of adequately iodized salt had fallen to 5% of households.42

In the mid-2000s, Micronutrient Initiative (MI) led a push to improve salt iodization in Ethiopia, with support from UNICEF and Vincent Assey, ICCIDD’s East Africa RC.43 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.44

By 2010, Ethiopia was producing much of its own salt.45 UNICEF and MI had donated salt iodization equipment, but this equipment was largely unused and began to quickly degrade in the harsh climate.46 Around that time, the Ethiopian Ambassador to Senegal became impressed with the importance of iodization.47 He brought the salt producers and health minister together to discuss iodization.48 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.49 In 2011, Ethiopia passed legislation requiring salt producers to iodize their salt.50 In January 2012, it began enforce the new rules.51 Since that time the coverage of adequately iodized salt has gradually increased to over 85% of households, according to ICCIDD.52

India

According to ICCIDD, regulation of the salt industry in India is a highly sensitive issue because of the role salt played in India's independence movement.53 A federal ban on non-iodized salt was implemented in 1997, revoked in 2001, reinstated in 2006, and challenged in the Supreme Court in 2011.54

ICCIDD credits its RC in South Asia, Chandrakant Pandav, with leading the successful efforts to reinstate the ban and defeat the legal challenge to it.55 He set up a meeting between the Director of UNICEF and the Prime Minister of India to discuss the ban before the 2006 reinstatement.56

Dr. Pandav was a founding member of ICCIDD and is a doctor and academic at the All India Institute of Medical Services.57 Each year he submits a draft budget for $70-$80,000 and only receives $20-$30,000 due to ICCIDD’s funding constraints.58

Does it work?

We are still in the midst of assessing (a) the evidence of effectiveness of salt iodization programs, and (b) ICCIDD's value added. We plan to complete these assessments as part of our full review process.

Is there independent evidence that salt iodization is effective?

We are currently working on a report on the evidence of effectiveness for salt iodization. We will complete this before we publish a full review of ICCIDD.

Does ICCIDD’s work lead to more countries establishing successful iodine programs?

At this point, we have a relatively limited understanding of the role ICCIDD 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. We plan to focus on this in our ongoing analysis.

This investigation will likely focus on analyzing case studies of ICCIDD’s past work, including existing evidence for national-level improvements in salt iodization and iodine status. ICCIDD has suggested twelve countries as potential case studies: Belarus, China, Democratic Republic of the Congo, Ethiopia, India, Nigeria, Russia, Senegal, South Africa, Sudan, Thailand, and Vietnam.59 ICCIDD has provided preliminary information or contacts for these case studies, of which the information on Sudan is the most detailed.60 It is not clear to us whether these cases are representative of ICCIDD’s work.

Does ICCIDD’s work improve mature iodine programs?

ICCIDD and others have noted that one of ICCIDD's most important functions in the global iodine community is sustaining and improving the quality of salt iodization programs in countries that have already scaled up salt iodization.61

In our ongoing analysis, we plan to investigate cases where ICCIDD has worked in countries with established iodization programs. ICCIDD has mentioned Thailand, India, Vietnam, and China as possible examples.62

Impact of global coordination work

We spoke with two members of ICCIDD's board who work for implementing agencies (GAIN and UNICEF) and one who is the former President of another (Micronutrient Initiative). Each noted that ICCIDD's global coordinating role (described here) is a key piece of the ICCIDD’s value added.63

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

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

We are in the process of assessing the cost-effectiveness of salt iodization programs. We plan to complete this assessment as part of our full review process.

Cost-effectiveness of ICCIDD’s work

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

  • How critical is ICCIDD’s work to the existence and quality of salt iodization programs?
  • How much has ICCIDD spent in the past to achieve these results?
  • To what extent do ICCIDD 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?

Room for more funding?

ICCIDD 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.64 Historically, the majority of the cash funding for ICCIDD came from AusAID (now the Australian Government Department of Foreign Affairs and Trade). AusAID’s funding for ICCIDD ended in 2012.65 As a result, ICCIDD has been scaling down its activities and drawing down its funding reserves in 2013 and 2014.66 If it does not secure any new sources of funding, ICCIDD expects to raise and spend about $433,500 in 2015.67

ICCIDD told us that Regional Coordinators consistently submit work plans to ICCIDD 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.) ICCIDD has offered to share ICCIDD 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 ICCIDD 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 ICCIDD about this and plan to do so as part of our ongoing analysis.

ICCIDD expects to use additional funding that it receives by the beginning of 2015 roughly as follows:68

  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)69
    • Hire full-time Program Manager (~$80k)70
    • Hire full-time Administrative Assistant (~$80k)71
    • Hire half-time Communications Manager (~$50k)
    • Pay second Senior Advisor for 20% of full-time (~$20k)72
    • Global staff meetings (~$30k)73
    • Consolidate Treasurer’s office with Secretariat (~$14k)74
  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)75
    • Satellite meetings attached to global health meetings (~$25k)76
  4. Next $144k to start supplemental projects
    • Conduct programmatically relevant scientific studies (~$120k)77
    • Translate the newsletter into other languages and add other media projects to increase the reach of ICCIDD's message (~$24k)78
  5. Additional funds to replenish reserves
    • Since ICCIDD 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 ICCIDD’s budget. ICCIDD 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 ICCIDD’s value added?
    • How often has ICCIDD contributed to significant program improvements in the past? What were the nature of these improvements?
    • What is ICCIDD’s track record of advocating for new USI programs?
  • How effective are ICCIDD-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 ICCIDD’s future activities be as cost-effective as past attempts to increase iodization rates?

Sources

Document Source
Caulfield et al 2006 Source (archive)
Gaffar 2012 Source (archive)
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)