Background

Collaborative Campaign Planning of Vitamin A Supplementation and LF Elimination

A pilot study of collaborative planning for integration of vitamin A supplementation and mass drug administration for eliminating lymphatic filariasis (LF) in Nepal.

Background

Scene of school children walking in Nepal (Shutterstock)

Nepal is a country of 29 million people, composed of multiple ethnic groups and ecologically diverse settings. LF is a significant public health problem in the country. LF MDA and vitamin supplementation campaigns overlap in 10 districts where LF is endemic. 

Nepal recently shifted to a decentralized model of health system governance in which municipalities implement health programs, guided by the National Health Policy. The goal of campaign integration was to increase coverage of LF MDA and vitamin A supplementation, and more effectively utilize resources in the context of decentralization. This study, conducted by HEAL Group, documented the collaborative planning process for partial integration of these campaigns to inform national scale-up.

The CMS Approach and FCHV's

Female community health volunteers (FCHV)  are the backbone of Nepal’s health system, working as a bridge to increase community access to health services. FCHVs advocate for healthy behaviors among mothers and community members to promote safe motherhood, child health, family planning, and other community-based health promotion and service delivery (1). FCHVs used the complementary monitoring and supervision (CMS) approach to identify gaps in LF MDA coverage while conducting vitamin A distribution.

What is the Complementary Monitoring and Supervision (CMS) Approach?

  • Sharing information on both health interventions with households.
  • Verifying if family members received MDA during the LF campaign that was conducted a week prior to the vitamin A campaign.
  • Reinforcing the importance of taking LF medications if they were missed.
  • Referring individuals to a nearby health facility for LF medication (FCHVs could only offer vitamin A capsules during household visits).
  • Recording and reporting those who did not accept LF MDA to the local health facility and/or to the Ward Community members.

CMS supports implementation of integrated campaigns at the municipal level in the context of the country’s transition to a decentralized health system. Various municipal sectors can be incorporated into CMS, including in Nepal, education, women and children’s health, agriculture, veterinary, and Ayurveda. A supplementary program is needed to reach people missed in scheduled campaigns, particularly during high-travel festival seasons. Following this study, it was recommended that a representative study accounting for Nepal’s diverse ethnic groups and geographic settings would provide more evidence to promote policy change.

(1) Nirmal Kandel, Jaya Lamichhane, “Female health volunteers of Nepal: the backbone of health care,” The Lancet 393, no. 10171 (February 2019): E19-E20, https://doi.org/10.1016/S0140-6736(19)30207-7

Context

Problems and Opportunities

Nepal has not achieved LF elimination goals after 17 years of MDA. In contrast, vitamin A campaigns conducted since 1993 have achieved high levels of coverage. A longstanding nationwide network of FCHVs administer vitamin A supplementation during house-to-house visits.

Integration of LF MDA with the national vitamin A supplementation campaign is an opportunity to advance LF elimination and increase efficiency.

  • Both campaigns utilize a large network of FCHVs for service delivery, monitoring, and reporting; efficiency and impact of FCHVs could be increased through integration.
  • Integration could serve as a more efficient way to administer albendazole due to overlap in age groups targeted during LF and vitamin A campaigns*.
  • Campaign integration will improve effective use of limited resources at the local level.

*Children aged 24-59 months receive albendazole for LF MDA, and 12-59 months receive albendazole for deworming during vitamin A campaigns. A dose could be ‘saved’ through integration.

Objectives

The objective of this case study was to identify, support, and document the collaborative planning approach to health campaign integration.

The objectives of the collaborative planning process were to:

  1. Explore potential benefits or challenges of integrating campaigns
  2. Initiate collaboration across program and logistics divisions involved in LF and vitamin A campaigns (break down silos)
  3. Develop an effective collaborative plan, implement and assess outcomes

This study involved partial integration of vitamin A and LF campaigns—household visits for vitamin A supplementation provided an opportunity to identify individuals missed during the preceding LF campaign.