We are concluding our recommendation of the Global Alliance for Improved Nutrition (GAIN). This recommendation was originally based on GiveWell’s research related to universal salt iodization and designation of GAIN as a standout charity. With GiveWell retiring this designation, GAIN’s multifaceted programming beyond salt iodization to improve nutrition holistically, and our commitment to articulate impact to supporters, we currently do not have enough information to make a strong public recommendation of GAIN.
We continue to value GAIN’s mission and work in advancing nutrition outcomes for all and are happy to support donors who wish to continue donating to GAIN.
How Global Alliance for Improved Nutrition works
GAIN has been a major force in global universal salt iodization (USI) programs since 2008, when it was established in partnership with UNICEF and funded by the Bill and Melinda Gates Foundation. They support governments and salt producers in establishing and sustaining secure supplies of potassium iodate, improving iodization quality, effectively implementing salt quality laws, and putting monitoring systems in place.
GAIN can help build, expand, or sustain salt iodization programs depending on the country and the level of support it needs. It takes an investment of just US$0.15–$0.40 for GAIN to help provide one person access to adequately iodized salt through their lifetime.
In 2018, GAIN systematic review and meta-analysis of 50 studies which GAIN commissioned helped fill a critical knowledge gap about the full impact of salt iodization programs in low- and middle-income countries. It found that there was a 74% reduction in the odds of goiter and a significant reduction in iodine deficiency.
Global partnerships: GAIN works with a number of notable partners, including the Iodine Global Network, UNICEF, the Micronutrient Initiative, national and provincial governments, and dozens of salt industries.
Proven Impact: Salt iodization programs in low- and middle-income countries reduce the odds of goiter by 74% as well as significantly reduce iodine deficiency. GAIN uses existing local infrastructure, working with governments, nonprofits, and businesses to implement low-cost and effective salt iodization programs. They make sure supplies of potassium iodate will be available long-term and provide their expertise to ensure the USI programs continue after their direct involvement in the region has ended.
Recognition: GAIN’s Executive Director Dr. Lawrence Haddad is a recipient of the 2018 World Food Prize, which recognizes that his work has “significantly improved nutrition for mothers and children in the critical first 1,000 days of life.”
Cost-effective: GAIN estimates it has played a vital role in the expansion of USI coverage for approximately 460 million individuals at an average of US$0.27 per person, making this a cost-effective intervention to improve health outcomes.
Achievements: In Ghana, GAIN helped set up potassium iodate procurement and distribution systems for medium- and small-scale salt producers. In Ethiopia, GAIN provided initial fortificant and developed a supply system to produce iodized salt for 55 million people — increasing the country’s iodized salt level to 95%. In India, GAIN helped develop and implement a web-based information management system to improve government monitoring of salt supply.
GAIN’s work to reduce iodine deficiency
The Problem: Iodine is a micronutrient crucial for bone and brain development. However around 1.75 billion people — nearly a quarter of the world’s population — get too little iodine in their food. This leads to increased rates of miscarriage, stillbirth, and infant mortality, as well as cognitive and developmental problems, goiter, and hypothyroidism. Iodine deficiency is the leading preventable cause of intellectual and developmental disabilities in the world.
Huge progress has been made to address iodine deficiency through universal salt iodization (USI). The number of iodine deficient countries was reduced from 55 in 2003 to just 19 in 2017. Yet despite many years of effort, about 25% of households in the developing world are still iodine deficient — many of them in areas that are the poorest and hardest to reach.
The solution: We are in an unprecedented position: on the verge of being able to control iodine deficiency at a population level in a sustainable way. The good news is that fortifying salt with iodine is safe, relatively easy, has high returns on investment, and is extremely inexpensive. It is one of the most common forms of fortification, now practiced in more than 160 countries.
Adding potassium iodate to household salt during the production process gives people access to adequate iodine in their diet. Salt fortification is credited with preventing 750 million cases of goiter over the past 25 years and, according to Prof. Michael Zimmerman, Chair of Iodine Global Network, “89 studies worldwide have shown that salt iodization leads to an 87% decrease in cretinism and a 73% decrease in low IQ.”
While most large salt producers do this routinely, many small- and medium-sized producers in the developing world lack the means or knowledge to do so. Adapting USI models to include these smaller producers is needed to ensure full and sustained coverage.
