Scaling Up Vitamin a Supplementation in India: Much Progress, Some Challenges.

ABSTRACT

Objectives: Preventive vitamin A supplementation (VAS) is an proven child survival intervention. Since 2006, the National and State Governments of India supported by UNICEF and other development partners have made combined efforts to strengthen the implementation of biannual VAS rounds. This presentation reviews the VAS programme in India, aiming to characterize the coverage at national and state levels since 2006, and identify better practices, enabling factors, and bottlenecks. Methods: We carried out a thorough analysis of the VAS programme coverage data, a review of relevant literature, field observations and interviews with key stakeholders. Results: The national full VAS coverage increased from 33% in 2006 to 63% in 2012, with a record 61 million children protected in 2012. However, the programme is implemented in different ways in different states, with variable degrees of success. The coverage has remained high (≥80%) in Bihar and Odisha, while it underwent significant fluctuations in Karnataka and Tamil Nadu. A few states have had persistently low coverage (<50%). Notably, programme coverage has significantly increased in the districts with the highest concentration of poor households, scheduled caste, and scheduled tribe populations. The critical success factors for the VAS programme include strong leadership of the government, a stable procurement mechanism of VAS, effective micro-planning, and flexible dosing mechanisms to cover hard-to-reach areas. Conclusions: Despite the remarkable progress in improving the coverage and equity of the VAS programme, a large number of Indian children - potentially the most vulnerable and undoubtedly the hardest-to-reach - are not yet benefitting from this life saving intervention.