1. Monitoring for the Elimination of Iodine Deficiency -Introduction of the framework- Moldova – April 2004 - Arnold Timmer UNICEF Regional Office

2. 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

3. 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

4. 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)

5. 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)

6. Why Monitor?  Ensure that the intervention is achieving its goal: sustained change in iodine status in the target population

7. 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!!

8. An incomplete Monitoring System does not tell you much!  Information on impact needs to be complemented with information on the process

9. 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?

10. 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?

11. 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?

12. Key Questions in Monitoring 4.How has the micronutrient status improved in the (target) population? –What is the iodine status in the target population?

13. 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

14. 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?

15. Salt Iodization  Production/importation  Distribution and sales  Consumption

16. Developing the framework  What are the key questions you want to answer  Indicators  Who monitors  Frequency  Method of collection  Information to be reported

17. 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)?

18. 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

19. 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

20. Salt Iodization: frequency  Production/importation internal (by company itself): –iodine content saltevery hour –proceduresmonthly –packaging/storage conditionsdaily/monthly –quality/effectiveness of training/communicationannual external (by government): –iodine content saltmonthly –proceduresannual –packaging/storage conditionsannual –inspection of compliance with law and regulationsmonthly –quality/effectiveness of training/communicationannual

21. Salt Iodization: method  Production/importation internal (by company itself): –iodine content salttest kit/titration –proceduresobservation –packaging/storage conditionsobservation –quality/effectiveness of training/communicationquestionnaire external (by government): –iodine content salttest kit/titration –proceduresdocument review –packaging/storage conditionsobservation –inspection of compliance with law and regulationsdocument review –quality/effectiveness of training/communicationsurvey

22. 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

23. 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 collectsMethodIndicatorQuestionFrequency

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

25. 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?

26. 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?

27. Group work 3. Identify gaps, weaknesses and suggestions for improvement

28. 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