Innovations in Reaching Out to the Most Vulnerable Population with Vitamin a Supplementation in Bihar, India.

ABSTRACT

Objectives: The state of Bihar historically has reported a high prevalence of vitamin A deficiency. Yet, in 2006 only 26% of preschool children were receiving vitamin A supplements (VAS) biannually. This presentation reviews the innovative strategy implemented by the Government of Bihar with UNICEF support to improve VAS coverage by reaching out to all children, including the most vulnerable in the hard-to-reach communities. Methods: More than 80,000 anganwadi centres and 11,000 primary health centres have been mapped out to become the core distribution sites of the biannual VAS rounds. Every primary health center is required to map all the underserved communities in their catchment area. The underserved and hard-to-reach communities are clustered and 3,500 temporary sites have been created to deliver VAS. Results: The village-based frontline workers and volunteers have been trained to administer VAS to children and counsel mothers on how to improve the vitamin A content of their children's diet. Additionally, left-behind communities are mapped annually and reached out through additional sites. Intensive communication and mobilization drives are undertaken at all levels to raise awareness about the benefits of VAS and mobilize communities. As a result, the full VAS coverage increased to 96% in 2012. Conclusions: The Government of Bihar has demonstrated that it is feasible to implement a successful and inclusive VAS programme in India, that reaches all children if efforts are made to understand who the most vulnerable children are and where they live, and if political decisions are made to assign the required human and programme resources.