RESUMO
Objectives: In Haiti, limited coverage of Vitamin A supplementation (VAS) in children under 5 years of age is associated with a weak and fragmented health system. To address this, the government and partners implemented a process to identify and remedy problems and bottlenecks. Methods: Evaluative activities that were conducted include: 1) participative and de-centralized stakeholder workshop to assess the Child Health Week (CHW) platform for distributing VAS; 2) NGO-mapping conducted in all 10 Haitian departments; and 3) interview-based and observational supply chain assessment. Results: Each assessment highlighted enabling factors and barriers for improving coverage of VAS in Haiti. 1) The CHW workshop identified weak national program coordination and ownership, and bottlenecks in data collection and reporting. The existence of trained departmental data managers was identified as an opportunity to improve VAS Program reporting. 2) The NGO mapping identified 43 organizations currently involved or interested in getting involved in the VAS program, which can serve to extend program reach. Inadequate knowledge of VAS protocols by NGO personnel was limiting their potential involvement. 3) The supply chain assessment identified inadequate forecasting, a fragmented stock management system, and under-utilized supply warehouses. New stock management tools and opportunities for shared transportation represent potential areas to improve the supply chain. Conclusions: Strengthening the health system in Haiti remains a long term goal. These three assessments identified short term strategies - including synergies with existing health resources and utilizing the capacity of NGOs - that could help improve coverage of the national VAS program.