Rolf Klemm, HKI
As polio disappears from Africa, so too does a key delivery platform and funding for VAS. Continued high prevalence of Vitamin A deficiency in Sub-Saharan Africa (increase by 3% in preschoolers between 1990 and 2013), as well as evidence suggesting that improving Vitamin A status can contribute to reducing all-cause child mortality by 12-24%, means that VAS is still a relevant and priority intervention for Sub-Saharan Africa. However, countries relying on the polio system need to start a transition process now in order to ensure VAS coverage. Strategies need to re-focus on community-based approaches which will reach every child. And there needs to be greater investment in strategies that address the root cause of Vitamin A deficiency & that assess reach and quality of Vitamin A interventions & status.
Ibrahima Ndao, NI Senegal
VAS in Senegal has gone through several implementation models including event-based and routine distribution. From 2013 there has been a progressive effort to slowly shift towards ensuring VAS is included as part of routine health services. The shift has been intentionally progressive with specific criteria to define when a district would move from campaign-style to routine, with a campaign model remaining in districts which did not meet the criteria. This allows for a gradual increase of routine delivery and decrease of campaigns, while maintaining high coverage. Threats, opportunities and weaknesses of this approach are discussed.
Kamanda Bishmini, PRONANUT DRC
DRC has high infant and child mortality, chronic malnutrition, and anemia prevalence in both women and children. In addition the prevalence of Vitamin A Deficiency is at 61% according to a 1998 survey. From 1998-2015 the main distribution models for VAS have been local and national immunization days, campaigns paired with de-worming, Child Health Days and routine distribution. The coverage, strengths and challenges of the various models are discussed.
Osvaldo Netto, HKI Mozambique
A high proportion of children in Mozambique suffer from Vitamin A Deficiency (69%), Iron Deficiency Anaemia (75%) and malnutrition (43%). In 2008 a bi-annual Child Health Week as initiated to improve coverage of VAS, de-worming and routine vaccination. In 2015 a pilot project was initiated to provide multiple micronutrient powders, VAS and Infant and Young Child Feeding (IYCF)Y counseling at 6 month contact points for children 6-23 months in 2 districts of Gaza province. Pilot was enhanced by community involvement, child registration, and the use of district level platforms to coordinate actions.
Siméon Nanama, UNICEF Madagascar
Since 2006, Madagascar’s VAS programme has been institutionalized within a Maternal and Child Health Week (MCHW). Currently the package contains VAS and de-worming for children-under-five, immunization catch-up, Severe Acute Malnutrition (SAM) detection and referral, fistula detection and referral, as well as promotion of breastfeeding, hand washing and immunization uptake. The approach taken involves micro-planning, fixed and outreach services, decentralized coordination, and a supervision system. Successes and challenges are discussed.
Getu Molla, NI Ethiopia
Ethiopia was implementing VAS through a campaign-based, vertical Enhanced Outreach Strategy (EOS) since 2004. Now there is a transition from EOS to Child Health Days (CHD) to routine distribution. Transition was mandated in key documents and a Technical Working Group was established. Criteria were established for woredas to transition between EOS to CHD and CHD to routine. Woredas that have transitioned to routine have maintained VAS coverage at 80%. Successes and challenges of the transition process are discussed.
Nita Dalmiya, UNICEF WCARO
Rationale and methodologies for monitoring VAS programme performance and coverage are discussed. A Theory of Change (ToC) is proposed for monitoring the VAS programme journey – in order to assess the logical link between situation analysis, programme design, and results. A brief monitoring framework details the indicators that could be tracked at an input, outputs (including a bottleneck analysis), outcome and impact level. Different methods and levels (national/sub-national) for monitoring are discussed. Countries should develop a performance monitoring framework which is linked to the ToC and is able to monitor performance of the various delivery platforms.
Ambroise Nanema & Mawutundji Dekoun, UNICEF Bénin
In the context of VAS, Lot Quality Assurance Sampling (LQAS) can be used to support the planning, implementation and quality of VAS and Expanded Program on Immunization (EPI) events. In Benin it was specifically implemented to assess coverage of VAS and EPI, and to identify barriers to access and utilization of VAS. Three questionnaires (6-11 months, 12-23 months & 1-59 months) were administered to 19 households in 94 supervision zones, providing a total of 1786 respondents. Advantages of the LQAS approach is that data can be collected by disaggregated age groups, it can identify communes of low coverage and low performance, it can be relatively affordable, and it can support the identification of underlying causes of low coverage or performance.
Mohamed Yattara, HKI Regional Office
Post-Event Coverage Surveys (PECS) is a methodology being employed by HKI to evaluate the percentage of children who receive vitamin A capsules during supplementation events. It can be conducted a maximum of 6 weeks after an event and employs a 30×30 cluster sampling approach to reach 900 children. PECS has many advantages as it supports the detailed understanding of coverage problems in specific populations by identifying factors that promote or prevent high coverage, evaluating the best sources of information during campaigns, measuring the level of awareness among caregivers, and evaluating the logistical and practical organization of the campaign; by understanding these factors, program managers can improve coverage in future campaigns. As disadvantages, it is financially and logistically heavy, requires rigorous translation of questions, and requires contentious initial planning to allow for disaggregation of results. An application in Mali is discussed.
Matthew Cummins, UNICEF HQ
The financial landscape for VAS programming is changing with decreasing external financing from donors, and therefore a Public Finance for Children (PF4C) perspective is proposed for institutionalizing VAS financing within government systems. Public Financial Management (PFM) is the way governments manage public resources (revenue and expenditure) and how such resources impact the economy or society. And within that, PF4C describes efforts to increase the transparency, adequacy, value for money and equity of public investments in children, including VAS programs. Several PFM related bottlenecks for VAS are detailed, based on adequacy, value for money, and equity. A tool is introduced which supports and guides countries on how to remove the PFM related bottlenecks.
Banda Ndiaye, NI Senegal
Currently VAS is using opportunistic delivery systems, is not embedded in government accountability and finance systems, uses a parallel supply system, and is poorly integrated into Health Management Information Systems (HMIS). Institutionalization of VAS is necessary to ensure universal coverage for young children is sustained at a low cost, so countries can afford and sustain this highly cost effective child survival intervention. A series of steps for integration are discussed.
Roméo Chrysologue Wendpagnanguédé Ouili, MoH Burkina Faso
VAS implementation has moved from integration in health facilities, to National Immunization Days (NIDs), and finally in 2011 to Vitamin A+ days (JVA+). JVA+ are heavily financed by the Programme to Support Health Development (PADS). Details of the PADS system are described, as are challenges and opportunities.
Chinwe Ezeife, MoH Nigeria
VAS was integrated into Immunization Plus Days (IPDs) in 2000, and within Maternal, Newborn and Child Health WeekS (MNCHW) in 2010. VAS is mandated as a key intervention in several critical documents, a communication system is envisioned, there is a decentralized planning and coordination mechanism, enhanced funding, and is a vehicle for delivery other critical interventions. In addition, VAS benefits from a real-time monitoring initiative. Challenges and successes are discussed.
Francis Modaha, MoH/TFNC Tanzania
In 2008 the ownership of VAS was gradually shifted to local government authorities for planning and resource allocation. Policies, guidelines and supplies availability are handled at national level. Funding for VAS is a mix of Government, UNICEF, HKI and FH360. Factors impacting sustainability include enabling environment, a skilled and motivated workforce, supply chain management, community demand and M&E. Successes, challenges, threats and opportunities are discussed.