swiss agency for development and cooperation swiss red cross kyrgyz-swiss health reform support...
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Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
Tobias Schüth
Kyrgyz-Swiss Health Reform Support Project
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
Objective: Exclusive selling of iodised salt through local dealers
Strategy: • Testing campaign of salt in all households with information on
IDD• Documentation of test results including the name of the dealer
from whom salt was bought• Contact with all local salt dealers demanding provision of
iodised salt (consumer pressure)• Provision of test kits to all dealers (winning dealers as allies)
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
The setting: 2 areas, 2 variations of one strategy
1) Jumgal rayon, 40,000 people, remote mountainous region of Naryn oblast
2) Remaining 4 rayons of Naryn oblast and Naryn city with 210,000 people
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
Two variations of one strategy1)Jumgal rayon
– Tests done by Village Health Committees and staff of Family Group Practices (FGP)
– Test kits given to all dealers (kits for iodate salt only)
2)Naryn oblast– Tests done by Staff of Family Group Practices
– No test kits to dealers
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
76%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
households villages0
2
4
6
8
10
12
14
16
6643 households
16 villages(of 16)
Initial campaign, Jul-Aug 2002:Coverage by households and villages, Jumgal rayon
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
19%
70%
11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
iodised non-iodised
non-iodisediodidiodate
89%
Initial distribution of salts in households Jul-Aug 2002
n = 6643 households of all 16 villages of Jumgal rayon
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
households villages
0
2
4
6
8
10
12
14
16
6159 households
15 villages (of 16)
Monitoring testing, Oct-Dec - 02:Coverage by households and villages, Jumgal rayon
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
71%
18%
10%
91%
4%
5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
non-iodisediodidiodate
89% 95%95%
Baseline Monitoring
Salt in households at initial campaign and 4 months later
Baseline Jul-Aug 2002, n=6382 households (15 villages of Jumgal rayon )Monitoring Oct-Dec 2002, n=6182 households (15 villages of Jumgal rayon)
non-iodised non-iodisediodised iodised
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
10%
5%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Lama
Dyikan
Bayzak
Tugol-Sai
Epkin
Kuiruchuk
Ornok
Chon-Dobo
Tash-Dobo
Doskulu
Kyzyl-Jyldyz
Kok-Oy
Aral
Center, Chaek
Minkush
average
Average
Average
Change of prevalence of households with non-iodised salt after 4 months, by village
Baseline Jul-Aug 2002, n=6382 households (15 villages of Jumgal rayon )Monitoring Oct-Dec 2002, n=6182 households (15 villages of Jumgal rayon)
baseline monitoring
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
1%
5%
10%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Lama
Dyikan
Bayzak
Tugol-Sai
Epkin
Kuiruchuk
Ornok
Chon-Dobo
Tash-Dobo
Doskulu
Kyzyl-Jyldyz
Kok-Oy
Aral
Center, Chaek
Minkush
average
Average
Average
Results after 8 months 9 villages, 3312 households, Jumgal rayon
baseline 4 months 8 months
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Jumgal rayon
23
21
25 23
0
5
10
15
20
25
dealertest kitssalt samplesiodised
Dealers with test kits
Dealers tested Salt
samples tested
Iodised salt samples
Dealers Salt samples
Checking the Dealers: presence of test kits and of iodised salt,
9 months after initial campaign (March 03)
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
10
20
30
40
50
60
70
80
90
100
110
29793 households
Initial test campaign, Sep-Oct 2002: Coverage by households and villages
Naryn oblast (4 rayons and Naryn city)
Households Villages
87 villages and
cities (of 118)
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Initial test campaign, Sep-Oct: 2002:Coverage of households by rayon
Ak-Tala At-Bashy Kochkor Naryn Naryn city
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
64.0%
22.6%
13.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
non-iodisediodidiodate
86.6%
Initial distribution of salts in households (Sept-Oct 2002)
n = 29793 households of 4 rayons and Naryn city
iodised non-iodised
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
61%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
10
20
30
40
50
60
70
80
90
100
110
Monitoring testing Feb-March 2003: Coverage of by households and villages
4 rayons and Naryn city
Household Villages
63 villages and cities (of 118)28939
households
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Monitoring testing Feb-March 2003:Coverage by rayon
4 rayons and Naryn city
Ak-Tala At-Bashy Kochkor Naryn Naryn city
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
63.9%
22.7%
13.4%
78.3%
16.4%
5.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
non-iodisediodidiodate
86.6%94.7%
Salt in households at initial campaign and 5 months later
baseline n = 28939 households, Sep-Oct 2002, monitoring n = 24771 households, Feb-March 2003 4 rayons and Naryn city
iodised iodisednon-iodised non-iodised
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
Testing campaign, Naryn oblast
5%
13%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Ak-tala
At-Bashy
Kochkor
Naryn
Naryn City
average
Change of prevalence of households with non-iodised salt, after 5 months, by rayon
4 rayons and Naryn city, baseline: n = 28939 households, monitoring: n = 24771 households)(in Naryn city and Kochkor tests were done with iodat test kit only,
therefore iodid salt was measured as negative)
Average
Average
Baseline Monitoring
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The dealers and their salt
92%
78%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Checking the dealers: iodat salt samples at salt dealers, March 2003
in 3 rayons of Naryn oblast (Naryn, Kochkor, At-Bashy, n = 92), and Jumgal rayon, n = 25)
3 rayonsJumgal
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The dealers and their salt
60%
75%71%
91%
4%
18%
4%
21%20%
5%12% 11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
iodatiodidnon-iodised
Baseline3 Naryn
Monitoring Monitoring
3 rayons
Baseline
Jumgal
Effect of providing dealers with test kits:Prevalence of iodate and iodid in households
of Jumgal rayon (dealers with iodat test kits) and of 3 other rayons (dealers without test kits, At-Bashy, Ak-Tala, Naryn), Feb-March 2003
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
Costs of initial testing campaign and one monitoring round
Test kitsUS $
TrainingUS $
TotalUS $
Jumgal rayon(40,000 people)
55 285 340
Naryn oblast(without Jumgal,210,000 people)
515 992 1507
Total 570 1277 1847
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
Conclusions• The combination of a salt testing campaign in households
and of involvement of dealers can dramatically increase consumption of iodised salt in a very short time.
• Provision of test kits to dealers can influence the kind of salt people consume
• The intervention is very low cost
Swiss Agency for Development and Cooperation
Swiss Red CrossKyrgyz-Swiss
Health Reform Support ProjectTobias Schüth
The power of test kits:Inducing change from below
Extension of the campaign• March 03: initial testing campaign in Jalalabad oblast
(800,000 population)
• Further oblasts until June 03