Percentage of ARV storage and delivery points meeting the minimum quality criteria in addition to having no stock-outs
This indicator measures a number of key components of the ART supply chain. An ART programme can be effective only if an uninterrupted flow and appropriate quality of ARV drugs is maintained.
This indicator builds on Core Indicator 3, Percentage of ARV storage and delivery points experiencing stock-outs in the preceding six months. It describes some key aspects of the quality of the distribution system. It can track improvements in quality. Disaggregation of the data by quality aspect provides an insight into where problems are occurring and can guide programmatic action on addressing them.
Number of storage and delivery points that meet the quality criteria.
Total number of storage and delivery points sampled (preferably the same number as sampled for Core Indicator 3, Percentage of ARV storage and delivery points experiencing stock-outs in the preceding six months.).
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 the number of service delivery points providing ARVs in the country concerned is limited they should all 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. A storage or distribution point must meet all the following criteria if it is to be included in the numerator (in addition to experiencing no stock-outs in the preceding six months).
1. Distribution to the point of delivery to patients:
a. Sufficient number of functioning vehicles.
b. Sufficient number of licensed drivers.
c. Established delivery routes and shipment records.
2. Storage quality, including:
a. A method in place to control temperature.
b. Windows that can be opened or air vents.
c. Direct sunlight is prevented from entering the storage area (e.g. by means of painted window panes or curtains/blinds).
d. Area free from moisture (e.g. leaking ceiling, drains, taps).
e. Medicines are not stored directly on the floor.
f. There is a cold store with a temperature chart.
g. Medicines are stored in a systematic way (e.g. alphabetical, pharmacological
or first expiry / first out).
h. Tablets/capsules are not manipulated by naked hand.
i. There is adequate space to store the medicines.
j. An adequate security system protects against theft.
Geographic location: N/A
Pregnancy status: N/A
Time period: N/A
Type of orphan: N/A
Vulnerability status: N/A
The strength of this indicator is that the information needed can be obtained from the national quality tracking system existing in many countries. If such a system is not available the indicator can easily be collected by observing a sample of storage and delivery points. This indicator can provide information allowing comparison between different regions within a country, particularly if there are notable rural-urban differences in the quality of the health system. However, it captures only the basic elements of quality (stock-outs, delivery and storage). Other important components of a drug supply system of satisfactory quality are not captured. This indicator is meant to provide an illustration of quality for national-level tracking and comparisons. For thorough programmatic action a drug-tracking and quality assurance system must be in place. 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. Once the drug supply system is in place with the basic quality characteristics, the ART country programme is likely to shift to more comprehensive quality assurance management.