Despite mandatory salt iodisation since 1994, iodine deficiency is still a public health challenge in Indonesia with limited coverage and status data. The last survey conducted in Indonesia in 2003 showed a total goitre rate (TGR) among school age children due to Iodine deficiency was 11% (MoH, 2003). According to the 2013 RISKESDAS study (Basic Health Research), the median urinary iodine concentration (MUIC) of School Age Children (SAC), Women at Reproductive Age (WRA) was optimal at the national level. However, pregnant women in marginalised groups revealed to have insufficient MUIC or in continued risk of deficiency, such as goitre, hypothyroidism, cretinism, abortion, still-birth, mental retardation, and psychomotor defects. Micronutrient deficiencies, including iodine deficiency has been recognised as the leading cause of hidden hunger. The prevalence of Iodine Deficiency Disorder (IDD) has gradually reduced in Indonesia, however there are still risks of poor cognitive development arising from poor dietary diversity and limited consumption of iodine-rich food.
The availability of sufficiently iodised salt is still low, which is 43% in 2013. Low levels of awareness, processing, procedures and capacity of salt farmer, small and medium processors who sell salt for consumption is one of the causes. There is also low priority and capacity for monitoring and law enforcement from Food and Drug Agency (Badan Pengawas Obat dan Makanan/BPOM) and districts government. Persistent problems are found along the salt supply chain, right from salt farmers, producers, KIO3 (potassium iodate) supplier, distributor/market, and at the household level. Challenges include the availability of raw salt that meets the SNI, the limited availability of domestic KIO3, and iodine inadequacy at the point of distribution. A study by the Ministry of Health in 2013 found that adequately iodized salt (30 ppm) was found only in 77% households. Most of the salt (84%) is used by the manufacturing industry. Purchasing iodine is not an issue for large salt industries/companies because they can buy it in large quantities by importing or procuring it through local suppliers. However, small, and medium-sized enterprises (SMEs) only need small amounts of iodine. Therefore, they cannot always afford it.
Moreover, currently in Indonesia, iodine is only produced by Kimia Farma (KF) and in limited amounts. East Java contributed to about one-third of the total salt production in 2019. The second-largest salt production centre is at Central Java. So those two provinces have become central to this project.
In East Java, GAIN has supported the Mahyra Utama Sejahtera (MUSE) Cooperatives to provide KIO3 (Potassium Iodate) and supported the SMEs of salt producers in enhancing their production of iodized salt. This has been done through public private partnerships in which the MUSE Cooperative has collaborated with government and private sectors to increase its sales and to assist SMEs in achieving their targets. The key to the success of this public private engagement was the inclusion of discounting of KIO3 price or shipping cost, providing free titration tools, joining salt entrepreneur groups over social media, and conducting training webinars. The KIO3 distribution business model carried out by MUSE Cooperative has been designed to facilitate SMEs in obtaining KIO3. The collaboration with the Association of Iodized Salt Producers (Asosiasi Produsen Garam Konsumsi Beryodium /APROGAKOB) in Central Java was the key to strong marketing. At the same time, the good relations with stakeholders led to high KIO3 sales in East Java. As part of the business model, MUSE Cooperative has supervised and monitored SMEs that had purchased KIO3 in East Java. This activity positively impacted sales and, more importantly, was the key to maintaining the sale network by building trust between the salt producers and MUSE Cooperative.
Building networks and maintain a good relationship with East Java’s Health Office and the District Agency of Industry and Trade Office have been imperative in achieving the sales target of the fortification effort with KIO3. Their support is important to gain commitment from the government to supply domestic KIO3 in adequate amounts and affordable price.
Additional Resources
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New WHA Resolution to Accelerate Efforts for Food Micronutrient Fortification
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Christina J. Siahaan is the Senior Communications and Fundraising Associate while Ardhiani Priamsari is the Programme Manager, Drivers of Food Systems Change. They are based at the GAIN Jakarta Office. Learn more about GAIN's work in Indonesia on their Website.