Percent of health facilities without stock-outs of first-line antimalarial medicines, mosquito nets and diagnostics, by month
The percent of service delivery points that did not experience a stockout of first-line antimalarial medicines, insecticide treated nets (ITNs), or malaria diagnostics, within a one-month period. Evaluators should collect the indicator at all (or a sample of) facilities that are expected to distribute or provide these malaria commodities. The indicator should be calculated separately for each product and then aggregated by product to calculate the percent of facilities that experienced a stockout of each product.
‘First-line’” antimalarial medicines are those used to prevent or treat malaria. For intermittent preventive treatment during pregnancy (IPTp), currently this is sulfadoxine-pyrimethamine. The World Health Organization recommends treating both uncomplicated and severe malaria using artemisinin-based combination therapies (ACTs) (WHO, 2010).
There are two categories of ITNs: conventionally treated nets and long-lasting insecticidal nets (LLIN). Conventionally treated nets are mosquito nets that have been soaked with an insecticide within the past 12 months. An LLIN is factory treated net that does not require any treatment. It is designed to maintain efficacy against mosquito vectors for at least three years. Since 2007, WHO has recommended that malaria control programs and their partners procure only LLINs. For the purpose of these guidelines, LLINs and conventionally treated nets are included in the category of ITNs.
‘Diagnostics’ refer to microscopy and rapid diagnostic tests (RDTs). They assist in the diagnosis of malaria by providing evidence of the presence of malaria parasites in human blood. RDTs are an alternative to diagnosis based on microscopy, particularly where good quality microscopy services cannot be readily provided (PATH, 2008). In 2010, WHO recommended that all patients suspected of malaria receive parasitological confirmation either by microscopy or RDT before starting treatment. Treatment based on clinical diagnosis – that is, presumptively, based on presentation of the signs and symptoms of the disease – should be considered only when parasitological confirmation is not accessible (WHO, 2010)
This indicator is calculated as:
(Number of health facilities with no stockouts of first-line antimalarial medicines, ITNs and diagnostics, by month / Total number of health facilities providing these commodities surveyed) x 100
Information on stock levels of first-line antimalarial medicines, ITNs and diagnostics, by month
Analysis and reporting by province according to urban/rural setting is recommended.
Health facility surveys of physical inventories and stock records conducted at site visits; logistics management information system records; supervision records, if available
Health facility surveys, with questionnaires administered to the head of each section of sampled facilities. Surveys must be designed to include, for each district of interest, the district hospital and at least two other health centers/posts serving selected communities within the district.
The devastating effects of malaria during pregnancy was a relatively neglected problem until the past decade when more effective strategies for the prevention and control of malaria in pregnancy were developed and demonstrated to have a remarkable impact on improving the health of mothers and infants. Malaria prevention and control during pregnancy has a three-pronged approach:
- Vector control via ITNs;
- Prompt access to effective treatment; and
- Prevention and control of malaria in pregnant women (Roll Back Malaria).
This indicator measures from the commodity security and logistics side the month-by-month product availability of the commodities required to address malaria in pregnancy and serves as a proxy indicator of the overall ability of a facility or program to meet clients’ needs.
Stock records must be available and maintained regularly for this indicator to be accurate. It is also important to check stock records with what was “planned to be stocked”, to ensure that facilities are not rationing supplies in order to avoid stockouts.
If national policy dictates that different brands of the same product cannot be used interchangeably, then evaluators should monitor brands separately. If the policy allows substitution on equivalent brands, and if providers make such substitutions in practice, then evaluators can monitor different brands as a single product.
Because this data is collected monthly, evaluators must look at the stockout records retrospectively to consider seasonal variations in product use.
access, malaria, community, safe motherhood (SM)
PATH, HealthTech IV Program. Rapid Diagnostic Tests. 2008.
Roll Back Malaria. Malaria in Pregnancy. http://www.rollbackmalaria.org/microsites/wmd2014/rbminfosheet_4.html
Roll Back Malaria Partnership. A Guide to Gender and Malaria Resources. 2006.
WHO. Guidelines for the Treatment of Malaria, Second Edition. 2010. Geneva.