Delivering Vitamin A Supplements to Children Aged 6–59 Months: Comparing Delivery through Campaigns and through Routine Health Services in Senegal

Abstract

BackgroundUsing twice-yearly campaigns such as Child Health Days to deliver vitamin A supplements has been a key strategy over the last 2 decades, and was an important component in helping reach the Millennium Development Goals in child health. As countries move to strengthen their routine health services under the Sustainable Development Goals, efforts are underway to shift supplementation from campaign to routine delivery.ObjectiveThe aim of this study was to compare cost, coverage, and user satisfaction between twice-yearly campaigns and routine delivery of vitamin A supplements in Senegal.MethodsInformation was collected on cost, coverage, and user satisfaction with both types of delivery, using administrative data, interviews at various levels in the health system, and focus group discussions with caregivers. Both qualitative and quantitative information were obtained, for 2 regions using routine delivery and 2 regions using campaign delivery.ResultsRoutine delivery receives fewer dedicated resources. Coverage is lower, especially of children >12 mo of age. Districts undertake outreach (“mini-campaigns”) to try to improve coverage in regions using routine delivery, in effect using a hybrid approach. Some mothers prefer the administration of supplements at a health facility as it is perceived as more hygienic and involving professional health workers, but others, especially those living further away, prefer house-to-house delivery which was the norm for the campaign mode.ConclusionsAdvance planning for the shift to routine delivery is important in maintaining coverage, as is strengthening the primary health care system by having an appropriate ratio of salaried workers to population. When the system relies heavily on volunteers, and the small incentive payments to volunteers are discontinued, coverage suffers. Routine delivery also relies on good record-keeping and hence literacy. Community understanding of, and support for, supplementation are even more important for routine than for campaign delivery.

Uptake of routine vitamin A supplementation for children in Humbo district, southern Ethiopia: community-based cross-sectional study

“…Nevertheless, starting from 2011 due to sustainability concerns, the program was integrated into the routine HEP [13]. However, there had been concerns that the transition of the VAS program from campaign-based to routine service delivery may result in decline in VAS coverage [13,17]. According to the World Bank data, VAS coverage in Ethiopia remained above 80% between 2006 and 2011.…”

Uptake of routine vitamin A supplementation for children in Humbo district, Southern Ethiopia: Community-based cross-sectional study

“…Nevertheless, starting from 2011 due to sustainability concerns, the program was integrated into the routine HEP [13]. However, there had been concerns that the transition of the VAS program from campaign-based to routine service delivery may result in decline in VAS coverage [13,17].…”

Availability, Management and Use of Priority Life-Saving Medicines for Under-Five Children in Two Health Districts in Senegal: A Cross-Sectional Study

“…WHO recommends bi-annual supplementation for this age group [29]. MHSA integrated this inter-vention with other health services such as vaccination and weighing [30]. So, breaking up vitamin A could lead to missed opportunities for supplementation.…”