More than 120 million people in India are exposed to the risk of endemic goitre which has long been established as being a consequence of environmental iodine deficiency. Iodine prophylaxis through the widespread use of iodised salt is the accepted and financially feasible method of preventing and controlling endemic goitre. The National Goitre Control Programme (NGCP) is now two decades old. Yet, less than 15 per cent of the known endemic areas are being covered under the programme. Why has the NGCP failed? This article critically reviews the programme.