Presentations

Title Presenter Abstract Download
Presentation
Symposium Process Introduction Sophie Bruas
The Unfinished Business of Vitamin A Supplementation in sub-Saharan Africa:
“Business as Usual is NOT AN OPTION”
Rolf Klemm–
HKI Headquarters

As polio disappears from Africa, so too does a key delivery platform and funding for VAS. Continued high prevalence of VA deficiency in SSA (increase by 3% in preschoolers between 1990 and 2013), as well as evidence suggesting that improving VA status can contribute to reducing all-cause child mortality by 12-24%, means that VAS is still a relevant and priority intervention for SSA. 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 VA deficiency & that assess reach and quality of VA interventions & status.

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French

Routine Vitamin A Supplementation in Senegal Overview, Challenges and Opportunities Ibrahima Ndao –
MI 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 criteria. This allows for a gradual increase of routine, decrease of campaigns and a maintenance of high coverage. Threats, opportunities and weaknesses of this approach are discussed.

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Distribution models for vitamin A supplementation (VAS) in DRC
Context Strengths-Challenges
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 VAD 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 deworming, CHDs and routine distribution. The coverage, strengths and challenges of the various models are discussed.

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Integrated Pilot Project – 6 month contact point: Mozambique Osvaldo Netto –
HKI Mozambique

A high proportion of children in Mozambique suffer from VAD (69%), IDA (75%) and malnutrition (43%). In 2008 a bi-annual Child Health Week as initiated to improve coverage of VAS, deworming and routine vaccination. In 2015 a pilot project was initiated to provide multiple micronutrient powders, VAS and IYCF 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.

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Mother and child health and nutrition week in Madagascar – History, approach, results and challenges 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 deworming for U5, immunization catch-up, SAM detection and referral, fistula detection and referral, as well as promotion of breastfeeding, hand washing and immunization uptake. The approach taken involves microplanning, services both fixed and outreach, decentralized coordination, and a supervision system. Successes and challenges are discussed.

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Integration of vitamin A supplementation program in to health system, Ethiopia Getu Molla –
MI Ethiopia

Ethiopia was implementing VAS through a campaign-based, vertical Enhanced Outreach Strategy (EOS) since 2004. Now there is a transition from EOS to CHDs 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 CHDs and CHDs to routine. Woredas that have transitioned to routine have maintained VAS coverage at 80%. Successes and challenges of the transition process are discussed.

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Results-based and equity-focused monitoring of Vitamin A supplementation programmes Nita Dalmiya –
UNICEF WCARO

Rational 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.

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Post Campaign coverage survey using LQAS: Experience from Benin  Ambroise Nanema &
Mawutundji Dekoun –
UNICEF Bénin

In the context of VAS, LQAS can be used to support the planning, implementation and quality of VAS and 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.

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Evaluation surveys for mass supplementation events  Mohamed Yattara –
HKI Regional

Post-Event Coverage Surveys (PECS) is a methodology being employed by HKI to evaluate the % of children who receive the 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 the identification of factors promoting or preventing high coverage, evaluating the best sources of information during campaigns, measuring the level of awareness among caregivers, evaluating the logistical and practical organization of the campaign, and improving of next 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.

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Data Driven Decision-making Tools – DHIS2 Sara Gari Sanchis –
UNICEF HQ

DHIS 2 is a tool for collection, validation, analysis, and presentation of aggregate health statistics. It has been used for routine monitoring, individual tracking overtime, and online dashboards for real-time monitoring. For vitamin A it can be used for microplanning, pre-positioning of stocks, improving programme reporting, and the tracking of bottlenecks. Using DHIS2 for vitamin A can improve data quality, decentralized data use, improve coverage, improve integration of CHD data into national systems, and enhance the interoperability across programmes.

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Public finance and Vitamin A 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.

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Institutionalizing VAS into the PHC system Banda Ndiaye –
MI 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 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.

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VAS financing mechanism in Burkina Faso Roméo Chrysologue
Wendpagnanguédé  Ouili – 
Ministry of Health

VAS implementation has moved from integration in health facilities, to 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.

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Institutionalization Of VAS In Nigeria Chinwe Ezeife –
MoH Nigeria

VAS was integrated into IPDS in 2000, and within a 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.

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Institutionalization Of VAS In Tanzania 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.

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French