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.
Table of Contents
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
- 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)
- ...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
- Next $325k to sustain and expand regional workshops
- Next $144k to start supplemental projects
- 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
- 1
- GiveWell's non-verbatim summary of a conversation with Michael Zimmerman on January 9th, 2014
- GiveWell's non-verbatim summary of a conversation with Michael Zimmerman on January 21st, 2014
- GiveWell's non-verbatim summary of a conversation with Michael Zimmerman on February 11th, 2014
- ICCIDD conversations with GiveWell in Zurich, April/May 2014
- 2
- GiveWell's non-verbatim summary of a conversation with Venkatesh Mannar on April 30th, 2014
- GiveWell's non-verbatim summary of a conversation with Greg Garrett on March 11th, 2014
- GiveWell's non-verbatim summary of a conversation with Greg Garrett on April 30th, 2014
- GiveWell's non-verbatim summary of a conversation with Arnold Timmer on May 1st, 2014
- 3
ICCIDD conversations with GiveWell in Zurich, April/May 2014
- 4
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 5
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 6
ICCIDD performs several functions at the global level that may contribute to the existence or quality of salt iodization programs broadly.
- Helping set ideal iodine per salt standards (“Since 1993, ICCIDD partners with WHO to write and disseminate global and regional program guidelines and indicators." ICCIDD slides on partnership with WHO 2014, Pg 2.)
- Helping WHO maintain a database of salt and Urinary Iodine Concentration (UIC) status globally ("Part of WHO's mandate is to assess the iodine status of populations, monitor and evaluate the impact of strategies and to track related trends over time. To do this, WHO works in close collaboration with the ICCIDD GN Secretariat." ICCIDD slides on partnership with WHO 2014, Pg 5.)
- Research to improve understanding/quality of salt iodization for health (For example, Zimmerman et al 2013 or anticipated research on the ideal iodine levels for pregnant women. ICCIDD conversations with GiveWell in Zurich, April/May 2014.)
- Facilitating communication about iodine in the global health community, particularly ICCIDD's newsletter and formal facilitation roles. Two examples of the latter:
- ICCIDD helped develop a consensus among implementing agencies that countries should pay for their own potassium iodate (KIO3) within 5 years of starting their programs. (ICCIDD conversations with GiveWell in Zurich, April/May 2014.)
- ICCIDD’s role in connecting UNICEF and GAIN in Mozambique (“In 2012, UNICEF was the only organization working on iodine issues in Mozambique. It struggled to motivate medium-sized salt producers to iodize their salt. UNICEF discussed the issue with ICCIDD, and ICCIDD made the link with GAIN to offer assistance on the issue. GAIN now collaborates with UNICEF on salt iodization programs in Mozambique especially to align salt iodization with other food fortification efforts that GAIN is supporting." GiveWell's non-verbatim summary of a conversation with Arnold Timmer on May 1st, 2014, Pg 4.)
- Raising awareness of salt iodization as a problem and priority. For example:
- ICCIDD reports successfully advocating for several World Health Assembly resolutions mandating countries to report on their iodine status periodically (“IDDs are an important cause of preventable cognitive impairment. In 1990, the World Health Assembly aimed at eliminating them as a public health problem and has reaffirmed that goal in resolutions since then, most recently at the 66th WHA in 2013. Advocacy by ICCIDD national coalitions within Member States has played a key role in these resolutions. WHA60.21 Sustaining the elimination of IDD Geneva, 14-23 May 2007; WHA58.24 Sustaining the elimination of IDD Geneva, 16-25 May 2005; WHA49.13 Prevention and control of IDD Geneva, 20-25 MAY 1996; WHA52.24 Prevention and control of IDD Geneva, 17-25 May 1999; WHA43.2 Prevention and control of IDD Geneva, 7-17 May 1990; WHA39.31 Prevention and control of IDD Geneva, 5-16 May 1986." ICCIDD slides on partnership with WHO 2014, Slide 4.)
- ICCIDD reports having worked with the Scaling Up Nutrition (SUN) program to advocate for more consistent inclusion of salt iodization as a high priority in the countries in which SUN operates. (ICCIDD conversations with GiveWell in Zurich, April/May 2014.)
- 7
"Part of WHO's mandate is to assess the iodine status of populations, monitor and evaluate the impact of strategies and to track related trends over time. To do this, WHO works in close collaboration with the ICCIDD GN Secretariat." ICCIDD slides on partnership with WHO 2014, Pg 5.
- 8
For example, ICCIDD conducted a study on the upper limits of safe iodine consumption, which was funded by the United Nations Children's Fund (UNICEF). ICCIDD conversations with GiveWell in Zurich, April/May 2014
The study can be found here: Zimmerman et al 2013. - 9
- 10
RCs and their projects make up 72%, 54%, and 53% of total planned cash expenses ($458k of $638.8k, $250k of $458.8k, and $227.7 of $433.5) in 2013, 2014, and 2015, respectively. ICCIDD estimated cashflow 2013 - 2015.
As of May 2014, ICCIDD also has a deputy RC in each of 2 regions for a total of 12 RCs. With sufficient funding ICCIDD would like to break up the largest regions to make a total of 12 regions. ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 11
ICCIDD conversations with GiveWell in Zurich, April/May 2014
- 12
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 13
"All are VOTING MEMBERS of ICCIDD Global Network, at the Annual General Meeting in June" ICCIDD organizational structure 2014, Pg 13.
- 14
- ICCIDD conversations with GiveWell in Zurich, April/May 2014
- "Important implementation opportunities include:
- Working with salt producers, particularly small-scale producers, to mechanize iodization and maintain quality control through testing.
- Establishing revolving funds for potassium iodate (KIO3) in countries such as Afghanistan and Pakistan. A revolving fund has been successfully established in Ethiopia and is a good model for transitioning away from free or subsidized KIO3 and sustaining the supply of iodization ‘premix,’ or KIO3. A number of countries without systems for procuring premix currently receive premix donations from grants from USAID and other donors, but this meets only a small portion of the total demand."
GiveWell's non-verbatim summary of a conversation with Greg Garrett on March 11th, 2014, Pg 2.
- 15
ICCIDD conversations with GiveWell in Zurich, April/May 2014
"GAIN is the largest organization focusing solely on nutrition, followed by MI and HKI. Other organizations in this space include: Project Healthy Children… WHO… UNICEF" GiveWell's non-verbatim summary of a conversation with Greg Garrett on March 11th, 2014, pg 3.
- 16
"Key players in implementation and programming include the Global Alliance for Improved Nutrition (GAIN) and the Micronutrient Initiative (MI)." GiveWell's non-verbatim summary of a conversation with Greg Garrett on March 11th, 2014, pg 2.
- 17
"UNICEF, which focuses on policy and could potentially do more work in implementation and programming." GiveWell's non-verbatim summary of a conversation with Greg Garrett on March 11th, 2014
- 18
- ICCIDD conversations with GiveWell in Zurich, April/May 2014
- “In 2005, GAIN became interested in promoting salt iodization for the majority of the remaining fraction of households worldwide that lacked iodine coverage. Work in 14 countries is funded through the GAIN-UNICEF USI Partnership Project, which was GAIN’s first foray into salt iodization. GAIN was the initiator of the USI Partnership Project, and the Bill and Melinda Gates Foundation ultimately funded UNICEF to work alongside GAIN, bringing with it its USI experience, particularly in policy and advocacy in salt iodization." GiveWell's non-verbatim summary of a conversation with Greg Garrett on May 19th, 2014, Pg 1.
- 19
UNICEF $100k, GAIN $50k, MI $50k ICCIDD estimated cashflow 2013 - 2015.
For board makeup see ICCIDD organizational structure 2014.
- 20
Revenue and expenses for 2013 are listed in both documents and don’t agree. We assumed the numbers from the more recent document were more accurate and ignored the 2013 numbers from the other document.
- 21This category includes the $10,000 stipend each Regional Coordinator (RC) receives each year. The remaining amount represents the regional operational budgets, of which the largest category is travel expenses. ICCIDD conversations with GiveWell in Zurich, April/May 2014
- 22 Responsible for audits and finances.
- 23
ICCIDD has been receiving relatively large budgetary value from in-kind contributions of staff time and office expenses. While it is more difficult to place a precise value on these in-kind contributions, we have made an attempt to assign a value to them here in order to be able to understand how ICCIDD allocates its total resources including these contributions. We have grouped the major in-kind contributions into three categories:
- Donated Secretariat staff time: All ICCIDD staff only work part time for the organization, and most Secretariat staff work full time for organizations that allow them to spend part of their time on ICCIDD. Thus ICCIDD doesn't currently pay most of its Secretariat staff members any salary, including the Executive Director, Secretary (Executive Committee member), one of two Senior Advisors, and Administrative Assistant. Those staff officially work 20% time for ICCIDD but receive a full salary from the Swiss Federal Institute of Technology in Zurich (ETH) or the Bill & Melinda Gates Foundation (in the Senior Advisor's case). ICCIDD conversations with GiveWell in Zurich, April/May 2014
- Donated RC stipends: Several of the RCs, which receive a $10,000 stipend (to represent about 10% of a full time salary with the idea that they work 10% as many hours as a full time position) include that stipend in their operational budget, effectively donating their own time as well.
- While actual donated time in each of the above categories may be much larger, the total value of ICCIDD's officially donated staff time (based on budgeted percentage of full time work multiplied by ICCIDD's suggested full-time salary equivalent for that position) is about $190,000 annually. (ICCIDD core-plus funding scenario 2014)
We believe this is a conservative estimate of the value of donated staff time to ICCIDD, since it appears that staff are likely to spend more than the officially allocated portion of their time on ICCIDD work, especially RCs who in some cases are retired or otherwise not employed full-time elsewhere.
- Donated office space and resources: The Secretariat office space and associated amenities in Zurich are donated in kind by ETH, as are the packaging and mailing costs of the newsletter. Similarly, the Treasurer office space and associated costs in Ottawa are donated by the University of Ottawa. ICCIDD reports that the combined value of these donations are about $90,000. ICCIDD conversations with GiveWell in Zurich, April/May 2014
Thus we estimate that officially donated staff time and office resources sum to about $280,000.
- 24This category includes the $10,000 stipend each Regional Coordinator (RC) receives each year. The remaining amount represents the regional operational budgets, of which the largest category is travel expenses. ICCIDD conversations with GiveWell in Zurich, April/May 2014
- 25 Responsible for audits and finances.
- 26
Because two quotes from ICCIDD materials appear to contradict each other, we are unsure of whether a decree was made. We think it is reasonable to interpret that no decree was enforced.
- "Sudan adopted USI as a National IDD prevention strategy in 1994 and Ministerial Decrees issued at the time require all edible salt to be iodized to a level of 50 ppm using potassium iodate. Several amendments to these decrees have been issued since but these have not been enforced." ICCIDD Newsletter Sudan progress November 2007, pg 1.
- "Sudan adopted salt iodization as the long-term strategy to control IDD, but there was no order or decree prohibiting the sale of non-iodized salt." ICCIDD Newsletter Sudan USI launch August 2012, pg 1.
- 27
Two sources report slightly different figures:
- "...while in 2005, 10.0% of households in Sudan were using adequately iodized salt ( >15 parts per million-ppm) with wide variation between states (Gaffar & Mahfouz, 2011; 'Sudan Household Health Survey (SHHS),' 2006)." Gaffar 2012.
- A UNICEF website reports consumption of iodized salt measured at 11% in the same survey: "Consumption of iodised salt – a vital protection against goiter, child stunting and mental retardation – is just 11%." UNICEF webpage on 2006 Sudan Household Health Survey, accessed June 23rd, 2014 (the survey was conducted in 2005 and published in 2006).
- 28
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 29
ICCIDD conversations with GiveWell in Zurich, April/May 2014
More on the GAIN-UNICEF Universal Salt Iodization Partnership Project below.
- 30
ICCIDD conversations with GiveWell in Zurich, April/May 2014
Izzeldin Hussein is based at the University of Oman and has a faculty position at the London Metropolitan University, and had served as a consultant to WHO’s Eastern Mediterranean Regional Office (EMRO) and UNICEF before joining ICCIDD as a Deputy Regional Coordinator for the Gulf in 2009.
He was born in Oman and speaks Arabic fluently, which has helped him connect with government officials and other players with whom he meets in Sudan, instead of being seen as an “outsider." ICCIDD conversations with GiveWell in Zurich, April/May 2014
- 31
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 32
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 33
ICCIDD CIDA grant financial report 2013.
According to ICCIDD, CIDA chose to include Sudan as one of the target countries based in part on ICCIDD's belief that an external push in Sudan might enable universal salt iodization to finally take hold. ICCIDD conversations with GiveWell in Zurich, April/May 2014.
- 34
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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- "Working with national and international partners, such as WHO, UNICEF, the World Food Programme, and the Micronutrient Initiative (MI), ICCIDD led the launching of the long awaited USI programme in Sudan, trained laboratory personnel, and participated in drafting and enacting legislation to ban the production and sale of non iodized salt. We met with more than 15 state ministers from all governorates in Sudan, senior officials from central government agencies, UN agencies, NGOs, academic institutions, development partners, and salt manufacturers, to sensitize them about the burden and impact of IDD in the country and to create synergies between different agencies involved in USI and IDD control. We also carried out training high-level workshops to ensure government interest in enforcing and sustaining salt iodization." ICCIDD CIDA grant final report 2013, Pg 32.
- "Through a series of advocacy meetings with government authorities, we initiated the process, wrote the terms of reference, and helped set up this national multi-sectoral body that now oversees the implementation of USI programme. At the time of this report, ICCIDD and the national coalition were developing a nation-wide USI/IDD advocacy and education effort. In addition, the Sudan government appointed an officer responsible for the IDD/USI programme. This new coordination, overseeing, and policy steering framework is a positive indicator of IDD control sustainability. However, lack of adequate national budget may undermine these efforts in the medium to long term. The role and participation of the private sector should be strengthened to increase and sustain household access to iodized salt." ICCIDD CIDA grant final report 2013, Pg 33.
- Dr. Hussein created a salt situation analysis "to determine current IDD/USI status, identify needs and challenges, and launch the USI programme. It also provided the foundation to review existing legislation and draft a new national law banning the production of non-iodized salt." ICCIDD CIDA grant final report 2013, Pg 33.
- Dr. Hussein used part of the funds for travel costs to visit Sudan more often, in part to complete the above activities. ICCIDD conversations with GiveWell in Zurich, April/May 2014
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- ICCIDD conversations with GiveWell in Zurich, April/May 2014
- $26,000 for “Senior consultant - training" and $3,000 for “Second IDD consultant - training" ICCIDD CIDA grant financial report 2013.
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“We supplied reagents, glassware and pipettes to salt industry, and we trained industry personnel for titration at factory level." ICCIDD CIDA grant final report 2013, pg 33.
Titration is the name of the laboratory process that quantifies the amount of iodine in a sample of salt. ICCIDD conversations with GiveWell in Zurich, April/May 2014 - 38
ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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“Progress was very slow due to factors including: lack of commitment by salt producers to iodize, the harsh weather in Afdera, low productivity of the iodization machines, lack of infrastructure (water, electricity), lack of skilled human resources and lack of a clear strategy to enforce the salt legislation. But the Council of Ministers passed new salt legislation in February 2011. In January 2012, the government started enforcing the legislation and the rate of salt iodization progressively increased, from a low of 10% to over 90%, but the quality of salt iodization still remained a challenge." ICCIDD Newsletter Ethiopia November 2013, pg 1.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD conversations with GiveWell in Zurich, April/May 2014
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The documented information we have about these countries:
- ICCIDD CIDA grant final report 2013
- ICCIDD slides Vietnam 2014
- ICCIDD slides Thailand 2014
- ICCIDD slides Sudan 2014
- ICCIDD slides Nigeria Senegal 2014
- ICCIDD slides India 2014
- ICCIDD slides Ethiopia 2014
- ICCIDD slides Belarus Russia 2014
- ICCIDD Newsletter Sudan May 2007
- ICCIDD Newsletter Thailand November 2008
- ICCIDD Newsletter Senegal May 2012
- ICCIDD Newsletter DR Congo November 2008
- ICCIDD Newsletter Nigeria November 2013
- ICCIDD Newsletter India August 2013
- ICCIDD Newsletter DR Congo November 2007
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- “ICCIDD takes on several roles in reducing iodine deficiency, including coordinating the
iodine health community, establishing key indicators for USI, designing iodine health
surveys, being a “watchdog” for iodine health problems in countries with iodization
programs, and advocating for improved policy in some countries.” GiveWell's non-verbatim summary of a conversation with Greg Garrett on April 30th, 2014, Pg 2. - “Many countries have large-scale salt iodization programs, which are very cost-effective. Salt iodization has the potential to be a sustainable intervention, but this will require efforts to maintain iodization programs in regions that currently have sufficient iodine coverage. At the national level, organizations need to ensure that governments maintain iodization policies. At the global level, organizations need to make the prevention of iodine deficiency a priority and ensure that it is included in international programs such as Scaling Up Nutrition (SUN). ICCIDD helps organizations support effective iodine programs and helps foster a clear consensus among the private sector, the public sector, and academia on iodine deficiency.” GiveWell's non-verbatim summary of a conversation with Arnold Timmer on May 1st, 2014, Pg 1.
- “Without ICCIDD, there would be a risk that the progress on iodine deficiency would be reversed. ICCIDD monitors salt iodization worldwide and alerts governments about potential problems related to iodine.” GiveWell's non-verbatim summary of a conversation with Venkatesh Mannar on April 30th, 2014, Pg 2.
- “ICCIDD takes on several roles in reducing iodine deficiency, including coordinating the
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ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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- “ICCIDD takes on several roles in reducing iodine deficiency, including coordinating the
iodine health community, establishing key indicators for USI, designing iodine health
surveys, being a “watchdog” for iodine health problems in countries with iodization
programs, and advocating for improved policy in some countries.” GiveWell's non-verbatim summary of a conversation with Greg Garrett on April 30th, 2014, Pg 2. - “ICCIDD’s task forces identify challenges in reducing iodine deficiency. Organizations often
have different strategies for iodine programs, so ICCIDD uses scientific evidence to help
organizations find the most effective methods. For example, organizations disagreed over
the most effective strategy to promote iodization among small salt producers. One strategy
is to provide subsidies and extensive support to the producers to help them iodize their
salt. The other strategy is to let the free market find a solution to iodization regulations, so
that salt producers who did not find a way to iodize would shut down. ICCIDD initiated a
discussion of this issue and examined the evidence. ICCIDD is more suited to facilitating
this type of discussion than other organizations or individual agencies.
ICCIDD also facilitates the sharing of information among organizations that administer salt
iodization programs. If organizations have problems implementing iodine programs, they
first discuss the issues with one another and then ask ICCIDD for assistance.
ICCIDD has recently been organizing workshops on iodine deficiency with a focus on
sustainability, but it has sometimes been challenging to have national participation, like in
Latin America where the ICCIDD does not have the clout in all the countries.” GiveWell's non-verbatim summary of a conversation with Arnold Timmer on May 1st, 2014, Pg 2. - “INFLUENCING WHO: ICCIDD works to influence the World Health Assembly, an annual meeting organized by the World Health Organization (WHO) that includes health ministers from around the world. It tries to put iodine on the agenda at the assembly and encourages WHO to recommend universal salt iodization and monitoring and reporting of iodine status.
PARTNERSHIPS WITH UNICEF: ICCIDD assists UNICEF with iodine programs. It would be difficult for UNICEF to do significant work on iodine independently because it works on many other issues. A UNICEF national office may only have one or two people working on all nutrition issues, of which micronutrients are a small subset. UNICEF sometimes requests the assistance of ICCIDD in administering surveys on urinary iodine concentrations. UNICEF also uses the global database on iodine issues that is managed by ICCIDD and WHO.” GiveWell's non-verbatim summary of a conversation with Venkatesh Mannar on April 30th, 2014, Pg 3.
- “ICCIDD takes on several roles in reducing iodine deficiency, including coordinating the
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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, ICCIDD 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. - 65
- ICCIDD estimated cashflow 2012 - 2013.
- ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD started 2013 with $967,516 in assets. It drew down its reserves by $512,618 in 2013, leaving $454,898 in reserve at the end of the year. It projected drawing down its reserves by an additional $142,773 in 2014, and scaling down expenses to match projected funding by 2015 at $433,500. ICCIDD estimated cashflow 2013 - 2015
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ICCIDD would continue its in-kind staff time donations (estimated above at $280,000) with reserve funding holding steady at $312,125. ICCIDD estimated cashflow 2013 - 2015
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The rough prioritization of these categories are based on ICCIDD conversations with GiveWell in Zurich, April/May 2014.
The estimates are based on ICCIDD’s description of its ideal budget (ICCIDD core-plus funding scenario 2014) minus its projections of spending in 2015 barring additional funding (ICCIDD estimated cashflow 2013 - 2015). Some of the numbers suggested by those documents have been adjusted according to our understanding based on conversations with ICCIDD (ICCIDD conversations with GiveWell in Zurich, April/May 2014) as described in this spreadsheet: GiveWell's summary of ICCIDD's 2015 funding gap 2014. - 69
Current Executive Director Michael Zimmerman is paid full time by ETH and is allowed to spend 20% of his time on other projects, which he spends on ICCIDD. ICCIDD conversations with GiveWell in Zurich, April/May 2014
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This position would oversee the RCs.
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The current Administrative Assistant is paid full time by ETH and is allowed to spend 20% of her time on other projects, which she spends on ICCIDD. ICCIDD conversations with GiveWell in Zurich, April/May 2014
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One of the two current Senior Advisors is paid for 20% time by ICCIDD, while the other is paid for 20% time to work with ICCIDD by the Gates Foundation. ICCIDD conversations with GiveWell in Zurich, April/May 2014
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Management Council Meeting and Board Meeting. ICCIDD core-plus funding scenario 2014 $50k is already allocated from current budget. ICCIDD estimated cashflow 2013 - 2015
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The $14k estimate represents the ideal budget of $70k minus office costs already allocated in current budget from current funding sources for: the Secretariat ($15k: $35k for “ED Secretariat" minus $20k of that for Senior Advisor salary), the Treasurer ($20k: $50k for “Ottowa Office" minus $30k of that for Treasurer salary), “Audit" ($10k), “Legal/insurance" ($5k), “Restructuring" ($5k), and “Bank Charges" ($800).
- ICCIDD core-plus funding scenario 2014
- ICCIDD conversations with GiveWell in Zurich, April/May 2014
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Each region would have one workshop about every other year, but it would rotate among the 3-4 sub-regions in that region. Each would cost about $50k. ICCIDD conversations with GiveWell in Zurich, April/May 2014.
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ICCIDD would hold auxiliary meetings adjacent to relevant global health conferences such as those hosted by the American Thyroid Association (ATA), the Latin American Thyroid Society (LATS), the Asia Oceania Thyroid Association (AOTA), the European Thyroid Association (ETA), and regional WHO meetings. Each would cost about $5k. ICCIDD core-plus funding scenario 2014
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"Support an active science council to supervise an applied research fund" ICCIDD core-plus funding scenario 2014.
ICCIDD mentioned this study is an example of the type of research it would like to fund: Zimmerman et al 2013. ICCIDD would like to have an ongoing fund to be ready to do a study quickly when a need arises. ICCIDD conversations with GiveWell in Zurich, April/May 2014 - 78
ICCIDD told us that the ideal budget for the newsletter would require $80k, and that “The Kiwanis grant for the IDD Newsletter is at 56K USD per year in 2013 and 2014. Actual expenses (Swiss francs) per quarterly issue are 7.8 K for editing and setting, 4.2K for printing and 0.5K for mailing (the Swiss government pays in-kind for the remaining postage). So each issue costs 13.5K, 4 issues cost 54K Swiss francs and with the current exchange, this comes to 58-60K USD.” ICCIDD conversations with GiveWell in Zurich, April/May 2014