Percent of service delivery points with adequate supplies of mineral/vitamin supplements
The percent of service delivery points (SDPs) with adequate supplies of quality mineral and vitamin supplements at the time of data collection.
This indicator is calculated as:
(Number of SDPs with an adequate supply of quality mineral/vitamin supplements / Total number of SDPs) x 100
Adequate supply is defined as availability of sufficient quantity and quality of mineral/vitamin supplements based on the needs of the client population served. The basic mix of supplements will include iron and folic acid, vitamin A, iodine and zinc in forms ranging from tablets and drops to injectables. Additional types may include vitamins B12 and D, calcium, and multiple vitamin and mineral supplement preparations. Evaluators should calculate each type of supplement separately, because the frequency of doses and, therefore, the amount necessary depend on the type of supplement (i.e., daily or weekly iron/folate supplements vs. single postpartum dose of vitamin A) and because some products are more difficult to procure or store in a given country or setting (Gorstein et al., 2007).
To compute sufficient quantity, evaluators estimate the size of the catchment area and the subgroup within that area in potential need of each supplement. Next, evaluators calculate the average quantity of each supplement needed per recipient in the target population for a specific reference period. This approach allows a crude calculation of the ‘sufficient quantity’ for each supplement relative to the client population served. There is no universally accepted standard for measuring adequate supplies; however, evaluators should consider the type of supplement, the frequency of supply, and the amount of supply available at the SDP when they define adequate quantities of supplies.
The quality of the mineral/vitamin supplement supply is acceptable if the supplements are:
- Labeled properly (i.e., supplement name, volume, usage, dosage, medical contraindications, and expiration date)
- Not expired
- Stored under the recommended climatic and lighting conditions specified by the manufacturer
Examples of additional criteria for quality of specific supplements are:
- Iron: Iron tablets and drops are considered acceptable if at least 90 percent of the tablets in the bottle are intact, and if any other recommendations from the manufacturer on proper storage are being followed.
- Vitamin A: The quality of vitamin A supplements is considered acceptable if supplements are stored away from light between 0°C and 30°C, and liquid vitamin A is discarded if it has been open for more than two months.
A count of the number of SDPs in the catchment area; a count of the potential client population(s) in the catchment area served at each SDP; a count of units of each supplement listed by form of the supplement (e.g., iron: tablets and drops; iodine: tablets and injectables; vitamin A: high- and low-dose capsules) of acceptable quality at the SDP; the volume of supply of each mineral/vitamin in terms of individual doses; and number of doses of each supplement judged to be both sufficiently well stocked and of adequate quality.
Program records indicating the number of SDPs and the population in the catchment area; the inventory of each SDP (special study) and inspection of each unit of supplement to determine the number of supplements that are of acceptable quality.
A number of vitamins and minerals (also known as micronutrients) are particularly important because they are essential for good health, growth and successful birth outcomes, and because large numbers of girls and women of reproductive age are deficient in them (Micronutrient Initiative [MI], 2009). These micronutrients include vitamin A, iodine, zinc, iron and folate. More recently, vitamin D, calcium, and vitamin B12 are being included for distribution in a number of regions and sites (Black et al., 2008). Access to adequate and safe supplies of micronutrients pre-pregnancy, during pregnancy and postpartum provides cost-effective health and survival protection for vulnerable populations of adolescent girls, women, and their offspring. The 2008 Copenhagen Consensus panel ranked the provision of micronutrients as the world’s best investment for development (MI, 2009). This indicator relates to three of the Millennium Development Goals: #1. Reduce poverty and hunger; #4. Reduce child mortality; and #5. Improve maternal health.
This indicator is important at the program level to evaluate the extent SDPs have supplements that are both available and of acceptable quality to meet clients’ nutritional needs. This indicator requires that the supplements meet both criteria of adequate quantity and of sufficient quality and evaluators need to assess the results of these two factors simultaneously to determine if a given SDP has an adequate supply.
An additional process indicator of the adequacy of supply is the frequency of stockouts (i.e., the percentage of SDPs that experience a stockout of supplements at least once over a 12-month period). For additional discussion on indicators for measuring supplies and stockouts, see the database section on Commodities, Security, and Logistics.
This indicator measures the presence of products at service delivery facilities. It does not, however, measure the effective distribution of these products to the intended beneficiaries. Staff awareness, motivation, and training will strongly influence this process. Assessment of facilities’ adequate storage and handling of supplements at the time of surveys may not capture the quality of the supply chain or ensure that there have not be lapses, such as, exposure to sunlight or electrical outages affecting cold storage.
The indicator applies to health service delivery points and may not include other sources for supplements, such as, local pharmacies and community based distribution mechanisms, thereby potentially underestimating supplies. The MI/CDC (Gorstein et al., 2002) indicators for micronutrient interventions include ‘selling facilities’ in measuring supplement availability.
nutrition, quality, commodity, safe motherhood (SM)
Black, RE, Allen, LH, Bhutta, ZA, Caufield LE, de Onis, M, Ezzati, M, Mathers, C, Rivera, J, “Maternal and child undernutrition: global and regional exposures and health consequences,” Lancet 2008; 371: 243-260.
Gorstein J, Sullivan KM, Parvanta I, Begin F. Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations. The Micronutrient Initiative (Ottawa) and the Centers for Disease Control and Prevention (Atlanta), May 2007. http://www.who.int/vmnis/toolkit/mcn-micronutrient-surveys.pdf
The Micronutrient Initiative (MI), 2009, Investing in the future: A united call to action on vitamin and mineral deficiencies, Canadian International Development Agency. Ottawa.
Quality of Care in Sexual and Reproductive Health Services