I. PLAN OF PRESENTATION

1. SECOND ANNUAL INTERNATIONAL SYMPOSIUM OF THE AFRICAN SCIENCE ACADEMY DEVELOPMENT INITIATIVE: PRIORITIZING FOOD SECURITY POLICIES FOR HEALTH AND DEVELOPMENT IN AFRICA. YAOUNDE, NOVEMBER 15 – 16, 2006 WED. 15/11/2006 11.30 – 13.00 SESSION III: STRUCTURED, DOCUMENTED PROCESSES FOR PROVIDING EVIDENCED-BASED POLICY-ADVICE: CASE STUDIES. CASE STUDY FROM CAMEROON: INFORMING POLICIES TO IODIZED SALT BY Prof Daniel. N. LANTUM

2. I. PLAN OF PRESENTATION • SYMPOSIUM OBJECTIVE: TO FOSTER ACADEMY/POLICY-MAKER INTERACTION FOR EVIDENCE – BASED POLICY ENACTMENT. • WHAT WAS THE PUBLIC HEALTH PROBLEM REQUIRING POLICY? • A CASE OF ENDEMIC GOITER • GOITER PREVALENCE SURVEYS: EVIDENCE • POLICY STRATEGIC OPTIONS • POLICY INSTRUMENTS • PARTNERSHIPS – COALITIONS = ALLIANCES = BY POLICY • IMPLEMENTATION – MONITORING = POLICY AMENDMENT • OUTCOMES: IODIZED SALT; USI, MONITORING. PROCESS • PROGRAMME – USI IMPACT EVALUATION • SUSTAINABILITY • REVIEW OF SCIENTIST/POLICY MAKER INTERACTION CYCLE • LESSONS LEARNT

3. II. WHAT WAS THE PUBLIC HEALTH PROBLEM? IODINE DEFICIENCY MALNUTRITION SEE TABLE COMMON INDICATOR: GOITRE Goitre

4. III. A CASE OF ENDEMIC CRETINISM FROM OSHIE PHOTO A Cretin 50 yrs old North West Province with Dr Kamga Fotso August 1993

5. IV. EVIDENCE – COLLECTION – GOITER PREVALENCE SURVEYS • ISOLATED RESEARCHERS – 1950 –1990 • BASE-LINE SURVEY: 1990-1991 • COMMUNITY DIAGNOSIS • COMMUNICATION TO POLICY MAKERS • EVIDENCE – GOITER PREVALENCE • GERMAN REPORT OF 1904 – WUM – NW • R. MASSEYEFF (1955) – EAST CAMEROUN • PELE PELE 1969 – AKONOLINGA • F. STEPHANY ET AL 1970 – EAST CAMEROUN • LOWEINSTEIN 1972 - EAST CAMEROUN • PIERRE NGUESSI 1975 – EAST CAMEROUN • D. MFONFU ET AL 1987 – OCEAC – NATIONAL REVIEW • ANDI CHI TEMBON – 1988 – NORTH WEST PROVINCE • R. AQUARON ET AL 1971-1977 – IODINE IN SPRINGS • J. WONGHI NGUM – 1990 – N/W – BUI SCHOOLS

6. V. COMMUNITY DIAGNOSISTABLE II: ESTIMATES OF POPULATION AT RISK OF IDD IN CAMEROON IN 1991 For 1991, with population annual growth of 2.92%, add 10%. Pop at risk « Multiplier » is 2.5 (Source = 1987 census, Cameroon National IDD Survey 1990 – 1991, By Lantum et al 1991

7. VI. COMMUNICATION TO POLICY – MAKERS (MPH) • COMMUNICATION TO POLICY – MAKERS (MPH) • CONFERENCE • WORKSHOP – YAOUNDE 8-24 APRIL 1991 • PAMPHLET: “IDD IN CAMEROON 1990-91”

8. VII. POLICY STRATEGIC OPTIONS • IODIZED CAPSULES • IODIZED BREAD • IODIZED WATER • IODIZED SALT • * DECISION IODIZED SALT STRATEGY • (WHO/UNICEF/ICCIDD MARCH 1986 • WHA 43.2 MAY 1990

9. VIII. POLICY ENACTMENT PROCESS • MPH/MINCOM – INDUSTRY – TO IODIZE • IODIZED SALT – READY IN THE MARKET • MIN ORDER NO 0133/A/MSP/SG/DSFM/SDSF/SN OF 09 MAY 1991 • LAUNCHING – PRESS CONFERENCE 21ST JUNE 1991 = COMMUNICATION – USI • MONITORING PROCESS COVERAGE: 1992/93 • BY FACULTY OF MEDICINE/IMPM • BY MIN P. HEALTH

10. IX. CREATION OF ADVISORY/CONSULTATIVE PARTNERSHIP = COALITION = ALLIANCE • DECISION NO 255/D/MSP/SG/DSFM/SDSF/SN OF 14/2/1995 • INTER- SECTORAL – LIST • MPH, MINCOM, MINDIC, MINAS, MINAGRIC • WHO, UNICEF, WFP, ICCIDD • 3 Sub – Committees CREATED • IDD • VIT A • FER - ANAEMIA • INDUSTRY • FAC/MED - RESEARCH

11. X. IMPLIMENTATION OF IDD/USI, POLICY MADIFICATION • LABELING • FIELD FINDINGS: K1 USED • DECISION: K103: MANDATORY • NO 096/A/MSP/SG/DSFM/SDSF/SN/BCDA DU 16 MAI 1995 MODIFYING • No 0133/A/MSP/SG/DSFM/SDSF/SN of 9 May 1991 • MONITORING – USI COVERAGE • - CONSERVATION - MAGAZINAGE • - QUALITY ASSURANCE • - PRODUCTION • - NORMS – ICCIDD/UNICEF/WHO • - IMPORTATION • - NORMS – CODEX ALIMENTARIUS • - COMMUNICATION FOR “DEMAND CREATION”

12. XI. RESULTS OF PROGRAMME • IODIZED SALT PRODUCTION – INCREASE • PROGRESS: USI COVERAGE 0% - 90% • GOOD QUALITY IODIZED SALT IN MARKET • CHANGE: GOITRE PREVALENCE DECREASE • USE OF SENTINEL SITES • NATIONAL SURVEY 2002 • CHANGE: URINARY IODINE EXCRETION LEVELS – PROGRESSIVE RISE • PRESENCE: CASES OF ENDEMIC CRETINISM – NO NEW ONES • POPULATION AWARENESS INCREASE • RADIO, PRESS, TV, LITERATURE, SCHOOL CURRICULA • INCREASE DEMAND FOR IODISED SALT

13. XII. PROGRAMME MONITIRING: PRODUCTION AT FACTORY

14. XIII. TESTING FOR IODINE IN SALT IN SCHOOLS

15. XIVPROGRAMME IMPACT VERIFICATION (2003) • PRODUCERS – COMMITMENTS – ALL 4 • USI COVERAGE – SUSTAINED • IODIZED SALT PRODUCTION/IMPORTATION • PREVALENCE – TGR = 5-8% • URINARY IODINE EXCRETION MEDIAN 159ug/L • NO NEW CRETINS

16. XV. SUSTAINABILITY 1. POLICY – LEGISLATION IN PLACE 2. ENFORCEMENT OF POLICY 3. QUALITY ASSURANCE INSPECTIONS 4. QUALITY CONTROL PRACTICES 5. IODINE LABORATORY IN IMPM / MINRESI 6. PRODUCERS ASSOCIATION IN PROCESS OF FORMATION 7. MPH – NUTRITION SERVICE – IDD DATA BANK 8. RETRAINED PERSONNEL - NEEDED 9. IDD IN SCHOOL CURRICULA 10. VIGILANT CIVIL SECTOR – NUTRITIONISTS, COMMUNITIES 11. YEARLY REPORTING = EPIDEMIOLOGIC SURVEILLANCE SYSTEM

17. XVI. RESUME: REVOLVING SOCIAL PROCESS OF CHRONIC ENDEMIC DISEASE CONTROL Scientists 1 Research Academies Scientists Managers 2 Communication SC/PM Resolution Sustain 6 Evaluation Feedback 3 Policy 4 Resource Development Management 5 Implementation Monitoring Managers -Training • Equipment • Material • Infrastructure

18. STRENGTHS AND WEAKNESSES STRENGTHS • CONCERNED ACADEMIES • SCIENTIST IN POLICY POSITION • ACADEMY LINKS WITH SCIENTISTS/ PARTNERSHIP • CHAMPIONS OF A CAUSE • LINKS WITH INDUSTRY • DATA-BASE SERVICE IN FACULTY OF MEDICINE • COMMUNICATION SYSTEM • PARTNERSHIPS • WEAKNESSES • NON COORDINATION OF SCIENTISTS BY SOME MINISTRIES • LIMITED COMMUNICATION • VERTICAL/PARALLEL RELATIONSHIPS • WEAK ACADEMIES