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This paper presents a regional position on Universal Salt Iodation (USI) intervention in 14 countries ill the East, Central and Southern Africa( ECSA) region,namely;Botswana,Kenya,Malawi,Mauritius,Mozambique,Namibia,bells,South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe The is a follow-up to a resolution on the need to develop a regional position on USI intervention which was made at the Commonwealth Regional Health Community 25th Health Ministers Conference in Port Louis, Mauritius from November;29,1996. The overall objective was to get views on the implementation of USI intervention in order to identify areas requiring facilitation, harmonization , coordination and collaboration at nation and regional levels in the ECSA. The preparation of paper involved reviewing of USI legislation regulations plans of action, survey reports and workshop papers. To substantiate the literature review, individual interviews were held with USI stakeholders in Malawi, Namibia, Tanzania, Zambia, and Zimbabwe from July 10-21, 1997 In respect of the findings, all the CRHC mainland member states are implementing USI intervention as a long term strategy for virtual elimination of the year 2000. The evaluation results of some of the national programmes have shown improvement of indicators of adequacy of iodine in the body. For example there is crease in levels of urinary iodine and reduction of goiter in countries where the intervention has been implemented actively over the past few years. In order to enforce the marketing of iodated salt, more than half of the CRHC member states have legislated USI where those who have not passed legislation yet are promoting USI through extensive advocacy and marketing strategy. These national USI programmes are being augmented by technical, financial and material support from United Nations and multilateral agencies, and the cooperation and compliance of the salt industry in iodating and packaging salt in line with USI legislation of country in the ECSA region. There are obstacles and constraints that impinge on the progress of USI in the entire ECSA region: The national USI legislation and regulations are not harmonized. The role of other sub-sector such as agriculture, trade and industry, and issues related to quality assurance are not spelt out in the regulations. There is still disparity in level of awareness of USI and its importance at all levels. Except Malawi, the rest of CRHC member states have no USI legislation for all salt intended for animal consumption. This is threatening sustenance of USI as there some leakages of uniodated salt from livestock sub-sector to people. Further threat emerges from communities who produce uniodated salt on a small scale for their own consumption and sale in their localities. The export and import duty for iodated and uniodate salt are the same. This does not deter traders and consumers to market and use uniodated salt because its price is either low or similar to the price of iodated salt. The challenge is, therefore, how to place the USI high on the agenda of relevant national and ECSA regional sub-sectors which formulate, implement and coordinate policy in order to strengthen and harmonize the intervention as well as deploying regionally acceptable measures to overcome the constraints. The CRHC should facilitate the harmonization of the USI regulations in the ECSA region including the reduction of the present high iodine levels to the levels (20-40ppm iodine[30-66ppm Potassium iodate]) that are recommended by the WHO. The CRHC should ensure that quality assurance issues are made mandatory in order to promote quality of salt iodations during production and packaging. The CRHC should facilitate development of guidelines regarding the roles of all sub-sectors such as ministries of Agriculture, Health and Trade and Industry, Departments of customs (Revenue Collection Authorities) and Bureaus of Standards in the USI which should issued under the directive of the Southern Africa Development Community and Common Market for Eastern and Southern Africa trade agreement. The CRHC should facilitate and support promotion of USI through regional networking,development and production of information, education and communication(IEC) material, designation of a regional IDD/USI day establishment of IIDD newsletter. The CRHC should ensure that member states consider making uniodated salt for whatever use a controlled commodity and impose deterrent export and import duty in order to protect, support and promote use of iodated salt for human and animal consumption in the region. The CRHC should facilitate establishment of at least one regional micronutrients reference laboratory and improvement of the national laboratories. The CHRC should strengthen the Department of Food Security and Nutrition of personnel in order to enhance capacity to accomplish the suggested activities listed below along with other planned work in the Department. The CHRC should endeavor to mobilize technical, financial and resources for support of salt iodations in the region especially in countries which are lagging behind and small salt procedure. Facilitating and supporting the evaluation of selected national USI programmes in order to confirm the case for reduction of iodine levels in the ECSA region. Facilitating review and harmonization of USI legislation and relevant Standards Act in the ECSA region. Initiating and supporting the collaboration on the proposed imposition of deterrent export and import duty on uniodated salt in order to protect and promote use of iodated salt. Facilitating and supporting the guide for role vital sub-sector such as Bureaus of Standard, Chamber of Commerce, and Ministries of Trade and Industry, Agriculture, departments of Customs and Excise, in the promotion, supporting, protecting and monitoring USI in the ECSA region. Facilitating network and all aspects of IEC and designation of an IDD day in ECSA. Conducting ECSA regional conferences on USI policy direction and review with consideration of SADC and COMESA trade agreements. Establishing a regional data bank on USI and micronutrient in order to enhance and facilitate regional networking. Establishing a regional micronutrients reference laboratory for improvement of micronutrients laboratory services whilst on one hand, supporting devolution of some the services to the provinces in order to easy congestion in national laboratories. Collecting, documenting and disseminating USI current information and technology in the ECSA member states through newsletter, bulletins and regional workshops. Conducting and supporting training on: Micronutrients, food security and nutrition in order to develop and capacity for execution of intervention and Programme-driven (operational) research on micronutrient, food security and nutrition. \u
