Journal Article

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

Susan Horton, Lauren S Blum, Mamadou Diouf, Banda Ndiaye, Fatou Ndoye, Khadim Niang and Alison Greig

in Current Developments in Nutrition

Published on behalf of American Society for Nutrition

Volume 2, issue 4 Published in print April 2018 |
Published online January 2018 | e-ISSN: 2475-2991 | DOI: https://dx.doi.org/10.1093/cdn/nzy006

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Abstract

Background

Using 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.

Objective

The 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.

Methods

Information 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.

Results

Routine 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.

Conclusions

Advance 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.

Keywords: cost; coverage; health systems; nutrition; child health; community mobilization; vitamin A supplements; Child Health Days

Journal Article.  7662 words.  Illustrated.

Subjects: Medicine and Health ; Dietetics and Nutrition ; Biochemistry ; Food Microbiology ; Gut Microbiology

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