Thus attempts have been made to elaborate a national Vitamin and Mineral Deficiency elimination strategy, and introducing Universal salt iodization (USI) as a joint initiative of the government, the donor community and civil society. However, the National Program for Decreasing IDD Levels in the Kyrgyz Republic for the years 2003-2007 is not being satisfactorily implemented. An accurate and transparent system of IDD registration and monitoring is practically non-existent in the country.

Data assessment and communication, as well as monitoring and evaluation, are essential phases of any IDD elimination program. Yet widespread confusion and manipulation of data reporting persists, and is conducted by Kyrgyz regional public health departments, control organs and national Ministries alike. Assessment capabilities remain relatively weak, despite key technical and capacity building input on the part of the international community. The Sanitary Epidemiological Service (SES) is allowed to conduct salt iodine tests only once a year, which is definitely insufficient for a competent monitoring and requisitioning process. Moreover, the SES is obliged to warn the respective entity about the monitoring check ten days in advance, which creates ample possibilities for the former to conceal counterfeit and non-iodized products.

Due to financial constraints and a lack of human resources, only cluster studies instead of more illuminating nation-wide IDD medical surveys can be conducted by the Ministry of Health. The city Endocrinology Dispensary is in a deplorable state.

Furthermore, Kyrgyzstan is totally dependent on importing salt, and the absence of viable border control had led to large-scale illegal import of technical and non-iodized salt. There is no domestic Kyrgyz salt production, although the first National Program of Prophylaxis of Abnormalities Related to Iodine Deficiency, signed in September 1994, mandated the creation of a national salt mining and manufacturing industry. Natural salt mines in Kyrgyzstan demand numerous investments, as the salt is extremely high in contaminants and the technological process of purification would be complex and expensive. In the absence of a Kyrgyz national salt mining and processing industry, imports nevertheless account for only 15 percent of total annual iodized salt consumption. The creation of a Kyrgyz association of salt producers seemed to give hopes of a sustainable and proper salt iodization and packaging process in the country. However, extensive smuggling of non-iodized salt and of low-quality iodized salt is an alarming fact. In 2004 alone, the SES confiscated more than 73,000 kilograms of inadequately iodized salt.

Likewise, controls have shown great amounts of counterfeit products in shops and markets all over Kyrgyzstan, since fraudulent businesses forge packets of well-known brands. The general economic situation is also mirrored in the salt business, as insufficient self-monitoring by producers and the concealment of real output and sales volume for the purposes of tax evasion remain widespread.

The leakage of technical salt to human consumption markets is another point of concern. It is estimated that technical salt now comprises a vast proportion of overall country salt sales. Although a number of governmental and presidential decrees and laws regulate IDD control and mandate universal salt iodization in Kyrgyzstan, the adoption and development of this legislation has been a painful process. Early documents (the first National Program and its Action Plan) suffer from multiple shortcomings. In general, these included ultimately unattainable goals, poor overview, and a lack of control mechanisms. Although every IDD elimination program requires a representative and full-fledged national body for program coordination and implementation, the Ministry of Health cannot cope with the multiple responsibilities of IDD eradication accorded to it by law. Under conditions of a drastic decrease of social spending, from 3,6 percent of GDP in 1996 to 1,8% in 2001, the Ministry lacks the financial and human capacity to perform national IDD prophylaxis and monitoring salt quality.

Moreover, overall political and moral fatigue and the steady deterioration of state mechanisms over the past years led to weak IDD legislation enforcement, and severe loopholes in the legislation itself. Resistance from certain political and business lobbies has resulted in prolonged legislative formalities and perpetual sabotage of the USI strategy. A lack of transparency and civil control over decision-making, characteristic of the entire Kyrgyz political system, has equally had a negative influence on the National Program’s elaboration and realization.

All these factors have a negative impact on the country’s IDD status. According to the former UNICEF Resident Representative in Kyrgyzstan, Richard Young, 72 percent of the country’s population is trying to buy only iodized salt, but 40 percent of sampled salt sold as iodized is actually not. Also, quality monitoring on salt import, production, storage and sale level need to be strengthened considerably.

The prompt adoption of the Law “On Introduction of Modifications and Amendments to the Law of the KR “On IDD Prophylaxis”” and introduction of technical regulations on fortified products is indispensable. Additionally, the importance of IDD communication cannot be overestimated.

Hence, the success of the IDD elimination program in Kyrgyzstan depends on numerous factors combined. These include a viable national decision-making and project implementation body functioning on a long-term basis; the creation of a working system of encouragement and economic incentives for producers of fortified products; efficient multi-sectoral participation in iodization programs; and ensuring sustainability by constant control and monitoring.