Monitoring%20for%20the%20Elimination%20of%20Iodine%20Deficiency%20-Introduction%20of%20the%20framework-%20%20Moldova%20

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Monitoring for the Elimination of Iodine
Deficiency-Introduction of the
framework-Moldova April 2004 -Arnold
TimmerUNICEF Regional Office
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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

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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

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Why Monitor?

1. Ensure that people receive the supplement/fortifie
   d 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)

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Why Monitor?

• 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
• Reduce recurring costs (increase efficiency and
  sustainability)

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Why Monitor?

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

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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!!

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An incomplete Monitoring System does not tell you
much!

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

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Key Questions in Monitoring

• 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?

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Key Questions in Monitoring

• Is the intervention available, affordable and
  acceptable?
• Does the user have access to iodized salt and is
  it affordable and acceptable?

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Key Questions in Monitoring

• Is the intervention being used by the target
  group?
• Measures the coverage
• What percent of the target population uses
  iodized salt?

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Key Questions in Monitoring

• How has the micronutrient status improved in the
  (target) population?
• What is the iodine status in the target
  population?

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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) interventions
• External relations media, donor reporting
• Research

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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 lets do it!
• Develop a system to monitor process and impact
  how effective is it, at what effort?

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Salt Iodization

• Production/importation
• Distribution and sales
• Consumption

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Developing the framework

• What are the key questions you want to answer
• Indicators
• Who monitors
• Frequency
• Method of collection
• Information to be reported

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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 salt
• What 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)?

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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

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Salt Iodization who monitors

• Production/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

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Salt Iodization frequency

• Production/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

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Salt Iodization method

• Production/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

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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

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Example Salt Iodization
Is the intervention functioning adequately?
Determine what you need to know and why
Determine the frequency of data collection
Determine how to collect the information
Who collects
Method
Indicator
Question
Frequency
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
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Group work

• 1. Describe minimum monitoring system needed
• 2. Describe the existing monitoring system
• 3. Identify gaps, weaknesses, and suggestions for
  improvement

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Group work

• 1. 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?

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Group work

• 2. 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?

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Group work

• 3. Identify gaps, weaknesses and suggestions for
  improvement

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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