Research Project

Evaluation of the Transition of Vitamin A Supplementation to the Routine Health System in Côte d’Ivoire Using a Health Systems Framework

Summary

A mixed-methods study examining the effectiveness of transitioning vitamin A supplementation to the routine health care system across 28 districts in Côte d’Ivoire.

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Côte d’Ivoire

Vitamin A Supplementation & Nutrition

  • Create a system for articulating and monitoring monthly vitamin A supplementation coverage goals
  • Improve collaboration with partners and across sectors
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Key Messages

To identify lessons learned regarding the routine delivery of vitamin A supplementation (VAS) in Côte d’Ivoire, Helen Keller International studied the effectiveness of VAS delivery in 28 districts where this intervention is provided through the routine health care system.

The coverage survey included a representative sample of 1828 households with children aged 6 to 59 months, as well as 112 community health workers and 96 health center workers.
  • Under the routine VAS delivery model, health posts and community health workers must be involved in setting monthly coverage goals.
  • Low stocks of medication pose a substantial challenge to VAS delivery in Côte d’Ivoire. Factors that contribute to these shortages include limited knowledge about the populations served, as well as insufficient monitoring capacity.
  • For routine VAS delivery to succeed, it is important to raise community awareness about the availability and benefits of this intervention.
  • Multi-sectoral collaboration is fundamental to planning, implementing, and supporting the transition of VAS to the routine health care system.
  • Tailored support promotes uptake in hard-to-reach areas. Existing health systems should serve as the foundation for reaching these populations with VAS.

Background

Context

Regular vitamin A intake among children 6 to 59 months of age helps to control health issues that stem from micronutrient deficiencies. Due to diminished campaign funding, the Côte d’Ivoire government has begun to transition the delivery of vitamin A supplementation (VAS) to district-level routine health care systems.

Problems or Gap

Previously, door-to-door campaign delivery attained high VAS coverage. Within the 41 districts that had transitioned to routine delivery at the time of this study, VAS coverage frequently falls short of the 80% semesterly coverage goal. Further, minimal data is available to illustrate how to best transition VAS delivery to a routine approach.

Research Objectives

  1. Identify barriers in the delivery of routine VAS at all levels of the health system using the Consolidated Framework for Implementation Research.
  2. Determine VAS coverage among children 6 to 59 months of age in districts that provide this intervention through routine health facilities.
  3. Identify specific strategies to improve the implementation of routine VAS.

View the slides and report for detail on the research methods.

28 health districts in the Northern and Central region that have transitioned to routine Vitamin A supplementation

Results

Summary

This study assessed the effectiveness of transitioning vitamin A supplementation (VAS) delivery to the routine health care system in 28 districts of Côte d’Ivoire. While study participants characterized the VAS routine delivery model as sustainable, they highlighted the following key areas for improvement…

Scroll down for more key findings. 

In Côte d’Ivoire, micronutrient deficiencies are a public health problem. But VAS+D remains a vital intervention for children aged 6 to 59 months: regular vitamin A intake could reduce infant mortality by 24%. 

Key Findings

  • Communication about monthly coverage goals was a primary challenge to implementing the routine VAS delivery model. Often, health posts and community health workers were unaware of targets set at the district level.
  • Widespread shortages of VAS capsules posed another significant obstacle. Insufficient monitoring tools resulted in limited accuracy of coverage data, which further exacerbated this challenge.
  • Community awareness was generally low regarding VAS availability as part of routine health care and the benefits of such interventions.
  • Community health workers were highly committed to delivering VAS. Positive feedback from their supervisors and the community contributed to this motivation. However, implementation of the routine VAS delivery model increased the workloads of community health workers without offering additional compensation.
  • Within the healthcare system, communication about VAS delivery was strong, but study findings revealed that communication with partners warranted improvement.

“I think what needs to be done is communication. I take the case of schools and preschools; there are days when we arrive [to sensitize about VAS] and the teacher refuses because she says she has not received a word from her hierarchy and if her inspector has not given her authorization, she does not accept. So communication is needed to facilitate the task of the actors. We need to give this information in real time so that everyone can do their part.”

  • Create a system for developing and monitoring monthly VAS targets to ensure that health posts and community health workers understand coverage goals and can use corrective approaches to reach these objectives, as needed.
  • Increase intersectoral collaboration. This enhanced coordination should include leveraging partners’ platforms to reach the intended population and involve all partners in district-level coordination meetings.

Photo Credit: University of the Andes