Percentage of ARV storage and delivery points experiencing stock-outs in the preceding six months
This indicator measures whether stock-outs occur at storage or delivery points of the drug supply system. A stock-out is defined as the complete absence of a required drug at a storage point or delivery point for at least one day.
Continuous monitoring of the inventory and system of distribution of ARVs, including accounting for any loss and registering supply for first-line and second-line drugs, is essential for the adequacy of ARV supply and the prevention of drug resistance. Data should be collected separately for storage points and service delivery points (pharmacies, health centres), although they can be aggregated for simple reporting. If stock-outs are found, however, disaggregated data allow the evaluation of the points at which the system has failed.
Number of ARV storage and delivery points that have recorded at least one stock-out in the preceding six months.
Total number of storage points and total number of delivery points surveyed.
If there is one national system of drug procurement, delivery and tracking, the information for this indicator can be extracted from it. However, if there are several parallel systems of drug supply and delivery (public, not-for-profit) a special survey of them should be conducted. Storage and distribution points can be identified through a review of the drug delivery system. Each central, regional or local point at which drugs are received for storage should be included in the denominator. If only a limited number of service delivery points provide ARVs in the country concerned, all should be included (among them the facilities identified for Core Indicator 2, Percentage of districts or local health administration units with at least one health facility providing ART services in line with national standards, plus any pharmacies if relevant). If the number of service delivery points is large a sample should be selected. In order to measure this indicator, stock cards should be observed at each of the storage points and selected delivery points.
Geographic location: N/A
Pregnancy status: N/A
Time period: N/A
Type of orphan: N/A
Vulnerability status: N/A
This indicator builds on the drug delivery and tracking systems that exist in most countries and captures a crucial component of the ART programme: a continuous supply of ARV drugs.
It does not, however, provide information on why stock-out problems occur or on the quality of the storage, delivery and distribution system. Some countries may wish to summarize the overall quality of these systems, as suggested in Additional Indicator 3.1, Percentage of ARV storage and delivery points meeting the minimum quality criteria in addition to having no stock-outs. Stock-outs may also be misleading as an indicator because a warehouse may always reserve a small stock but have a policy of never issuing the reserved stock. It may be preferable to collect information on a functional stock-out (inability to issue a required drug).
This indicator is focused on public and not-for-profit systems of drug supply. In some countries, however, the private sector plays a significant role in supplying ARV drugs. In such cases, wherever possible, private drug supply systems should also be included in this assessment.