Monitoring for the Elimination of Iodine

Deficiency-Introduction of the framework-

Moldova – April 2004 -

Arnold TimmerUNICEF Regional Office

Monitoring and evaluation: The reasons for monitoring The type and quality of information to

collect Data collection methods Who collects, processes and uses the

information Sustainability aspects

Considerations in selecting the indicator, method and frequency

Monitoring

Regular monitoring of the intervention provides feed back about the functioning and impact of the intervention

Allows us to know in the course of implementation where we are in reaching our goal

Allows us to modify the intervention where needed

Why Monitor?

1. Ensure that people receive the supplement/fortified food at the correct level (safe and compliant with government standards) over an appropriate period of time

2. Ensure coverage of those at highest risk (achieving and sustaining it)

Why Monitor?

3. Ensure, improve and sustain the functioning of the intervention. For example:• Adequate attention to logistics of

intervention (e.g. delivering iodized salt)• Make stakeholders (health workers,

community organizations, target groups, food producers, government) aware about the importance of iodine deficiency and what needs to be done

4. Reduce recurring costs (increase efficiency and sustainability)

Why Monitor?

Ensure that the intervention is achieving its goal: sustained change in iodine status in the target population

For example,Monitoring helps you to:

Identify geographic areas or population groups not covered by the iodization program

Identify problem points in the iodization program e.g. production, distribution, price, acceptance

Ensure safety, that the iodine content of salt is within the desired range

Conclude that the iodine status is improving!!

An incomplete Monitoring System does not tell you much!

Information on impact needs to be complemented with information on the process

Key Questions in Monitoring

1. Is the intervention functioning adequately?• Is iodized salt available in sufficient

amounts?• Is quality assurance in place and

functioning?• Is the communication program in

place and functioning?

Key Questions in Monitoring

2. Is the intervention available, affordable and acceptable?• Does the user have access to

iodized salt and is it affordable and acceptable?

Key Questions in Monitoring

3. Is the intervention being used by the target group?• Measures the coverage:

– What percent of the target population uses iodized salt?

Key Questions in Monitoring

4. How has the micronutrient status improved in the (target) population?

– What is the iodine status in the target population?

Purposes for monitoring

Programme management:• magnitude of the problem• effectiveness of each activity• Impact: progress toward the goal

Advocacy:• political commitment (cost of iodine deficiency,

magnitude of the problem)Evaluation of (aspects of) interventionsExternal relations: media, donor reportingResearch

Steps of an Intervention

Problem identification ...what is the problem?Strategy development ...what can we do?Advocacy and commitment building

…we have to do something about it!Put the intervention in place … let’s do it!Develop a system to monitor process and

impact …how effective is it, at what effort?

Salt Iodization

Production/importationDistribution and salesConsumption

Developing the framework

What are the key questions you want to answer

IndicatorsWho monitorsFrequencyMethod of collectionInformation to be reported

Key Questions -example What proportion of households uses iodized salt:

• Are all areas and population groups equally covered? Is the salt adequately iodized:

• At production/import level• At household level

Is the population aware of iodized saltWhat % of salt at production level meets the

standard? What is the iodine status in the population?What is the price difference between iodized and

non-iodized salt?Do concerns exist about the use of iodized salt

(public and food companies)?

Salt Iodization: possible indicators

Production/importation– iodine content in salt– packaging/storage conditions

Distribution and sales– iodine content salt at wholesale, retail level– storage conditions– price– quality/effectiveness of training/communication

Consumption– Presence of iodized salt in household– Awareness about iodized salt– iodine in urine

Salt Iodization: who monitorsProduction/importation

• internal (by company itself):– iodine content salt– procedures– packaging/storage conditions– quality/effectiveness of

training/communication• external (by government):

– iodine content salt– procedures– packaging/storage conditions– inspection of compliance with

law and regulations– quality/effectiveness of

training/communication

Salt Iodization: frequencyProduction/importation

• internal (by company itself):– iodine content salt every hour– procedures monthly– packaging/storage conditions daily/monthly– quality/effectiveness of

training/communication annual• external (by government):

– iodine content salt monthly– procedures annual– packaging/storage conditions annual– inspection of compliance with

law and regulations monthly– quality/effectiveness of

training/communication annual

Salt Iodization: methodProduction/importation

• internal (by company itself):– iodine content salt test kit/titration– procedures observation– packaging/storage conditions observation– quality/effectiveness of

training/communication questionnaire• external (by government):

– iodine content salt test kit/titration– procedures document review– packaging/storage conditions observation– inspection of compliance with

law and regulations document review– quality/effectiveness of

training/communication survey

Salt Iodization: information reported

Production/importation• internal (by company itself):

– Amount of non-iodised and iodised food grade salt produced/imported/ exported and distributed in the country (total and proportion of total)

– % of iodised salt samples/batches complying to national standards (within set range or above minimum level mg/Kg)

– QA and QC procedures for salt iodisation– Labeling, packaging and storage procedures and conditions

• external (by government):– % of iodised salt samples/batches complying to national

standards (within set range or above minimum level mg/Kg)– QA and QC procedures for salt iodisation– Labeling, packaging and storage procedures and conditions

Determine what you need to know and why

Example: Salt Iodization

Determine the frequency of data collection

Determine how to collect the information

Is the intervention functioning adequately?

Is iodized salt available in sufficient quantity?

Amount iodized salt imported and distributed

Reports from industry, sales data

Salt companies importers and distributors; MoCommerce

On-going

Who collectsMethodIndicatorQuestion Frequency

Group work

1. Describe minimum monitoring system needed

2. Describe the existing monitoring system3. Identify gaps, weaknesses, and

suggestions for improvement

Group work1. Describe minimum monitoring system needed:

• List all the information you require and for each:At what level will the information be collected?Who should collect it?How often does the information need to be

collected?What is the method of collection?What should be reported and to whom?How will the information be used and who is the

user?

Group work2. Describe the existing monitoring system:

• List all the information that is collected and for each:Where is the information collected?Who collects it?How often is the information collected?What is reported and to whom?How is the information used and who is the

user?

Group work3. Identify gaps, weaknesses and suggestions

for improvement

Example:What: Iodine in salt:

- where: at factory level- who: by the factory itself and external control by SES- to whom and what: information reported to SES;

total amount of edible salt produced for domestic market, total amount of edible iodized salt produced, % of samples (in)adequately iodized

- frequency: continuous, every hour- how used: information will be used to guarantee that

iodized salt is produced of good and required quality, providing adequate iodine to the consumer