Percentage of health facilities dispensing ARV that experienced a stock-out of at least one required ARV in the last 12 months [disaggregated by sector (public, private)]

Export Indicator

Percentage of health facilities dispensing ARVs that experienced one or more stock-outs of at least one required ARV drug in the last 12 months. A stock-out is defined as the complete absence of a required ARV drug at a delivery point for at least one day
What it measures

This indicator measures a key aspect of antiretroviral (ARV) drug supply management: whether health facilities dispensing ARV drugs have run out of stock of at least one required ARV in the last 12 months.

Rationale
Numerator

Number of health facilities dispensing ARVs that experienced one or more stock-outs of at least one required ARV drug in the last 12 months.

Denominator

Total number of health facilities dispensing ARVs.

Calculation

Number of health facilities dispensing ARVs that experienced one or more stock-outs of at least one required ARV drug in the last 12 months
------------------------------------------------------------------------------------------------------------------------- x 100

Total number of health facilities dispensing ARVs

Method of measurement

This information is collected at central level, where health facilities submit their inventory control reports or requisition forms for ARVs. These forms have information on patients on ART, consumption data, and stock on hand with stock out information if any.
This indicator requires the following tools:
• Stock inventory control reports from health facilities indicating also the stock level of each item in the report.
• Requisition forms submitted from facilities during a defined period of time (e.g. last order period, last quarter, last year) for ARVs.
• List of ARVs that each facility is expected to dispense, if not already included in the inventory control reports or requisition forms

All the above work if the national Logistics management information systems (LMIS) is operational. If the national LMIS is not operational, or health facility surveys such as the Service Provision Assessment (SPA) or the Service
Availability Mapping (SAM) may be used provided they include questions on ARV stock-outs.

If there is one national logistics management information system (LMIS) with details on ARV availability at the health facility level, information should be extracted from this system to construct this indicator. Alternatively, the information may need to be collected through a special survey or site visits. If there are only a limited number of health facilities where ARVs are dispensed in the country, all health facilities dispensing ARVs should be included in the survey or site visits. If the number of health facilities dispensing ARVs is large, it may be necessary to select a representative sample from the total number of health facilities dispensing ARVs (the full list should be available at the national level). When sampling, it is important to ensure that the sample includes facilities at different levels (such as central, district, and peripheral levels). In countries where ARV drugs are dispensed at pharmacies or other non-health facility delivery points, stock-outs should also be monitored in these venues; feasibility will depend on the coverage of the Logistics Management Information System.

Data Quality Control and Notes for the Reporting Tool:
Comment on whether the data is based on national data or survey data from a sample of facilities. Please provide any other comments that would help the interpretation of data (e.g. if only public or private sector data is included, and whether it may be an over-or under- estimate).

Measurement frequency

Annual

Disaggregation

Sector: Private, Public

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator captures a crucial component of the ART programme: whether or not there is a continuous, uninterrupted supply of ARV drugs at the health facility level. This indicator does not, however, provide information on why stock-out problems occur; which ARV drug(s) are/were out of stock; or how long the stock-out lasted for a particular ARV drug. It also does not provide information on the quality of ARV drug storage, delivery, and distribution.
 
Simply monitoring stock-outs could be misleading because a facility may keep reserve stock, but may have a policy of not issuing the reserve stock. These facilities would not be counted as having experienced a stock-out using this indicator definition, though from a patient perspective, a required ARV drug would not be available for treatment. In settings where reserve stock is not issued during ARV stock-outs, it is preferable to collect information on a functional stock-out (i.e., the inability to access or make use of a required ARV drug).

Additional considerations:
In some situations, simply monitoring stock-outs could be misleading because a facility may keep reserve stock but maintains a policy of not issuing the reserve stock. These facilities would not be counted as having experienced a stock-out using this indicator definition, even though a patient would not be receiving a required ARV drug for treatment. In settings where reserve stock is not issued during ARV stock-outs, it is preferable to collect information on a functional stock-out (i.e., the inability to access or make use of a required ARV drug).

Data utilization: If stock-outs exist, assess whether the problem lies in the national distribution system or if it is a financial flow problem or a global ARV shortage problem. Find out whether the reason is due to projections of supply order or the distribution system or any other issue. Use this as an opportunity to see whether LMIS is functioning.

Further information

Other references: Harmonized monitoring and evaluation indicators for procurement and supply management systems.