National Vitamin A Program (NVAP)
In Nepal, two separate research projects have been conducted to determine the impact of high dose (200, 000 I.U.) vitamin A supplementation on child health and mortality: Nepal Nutrition Intervention Project-Sarlahi (NNIPS -1) conducted by Johns Hopkins University (West, ET. Al. 1991) and the Jumla Community Health Project conducted by JSI (Daulaire ET. Al. 1992). Both these studies showed a significant reduction (26 -30%) in child mortality rates for children 6 – 60 months through regular vitamin A supplementation.
In the early nineties, the under five-mortality rate in Nepal was 165 per thousand live births thereby, motivating the government to adopt a program which could lead to a significant reduction in child deaths. The result of supplementation of vitamin A to 6-60 month old children has encouraged the government to establish the National Vitamin A Program in the Nutrition Section of the Child Health Division in the Ministry of Health and Population.
The Ministry of Health and Population, Nepal Government and key partners working on child health programs (WHO, UNICEF, USAID, NGOs and PVOs) participated in a workshop in Kathmandu in 1992 to develop a policy, objective and strategy for implementation of National Vitamin A Program. Representatives from related sectors and Ministries (agriculture, education, local development) also attended to identify solutions to address Vitamin A Deficiency (VAD) through many different channels, incorporating long and short-term strategies.
Based on the suggestions of the workshop the Ministry of Health and Population framed a national policy for the elimination of Vitamin A Deficiency in Nepal with the following objectives:
- To supplement all children aged 6 – 60 months of age with high dose vitamin A capsules twice a year;
- To treat cases of xerophthalmia, measles, prolonged diarrhea and severe malnutrition with vitamin A capsules and supplement high dose vitamin A capsules to postpartum mothers within six weeks of delivery; and
- To improve the food habits and consumption of vitamin A rich foods through nutrition education.
Implementation Activities
With a view to provide support in virtually eliminating VAD, a serious public health problem of national interest, USAID/Nepal agreed to fund the implementation of the Ministry of Health and Population’s National Vitamin A Program (NVAP) through a Technical Assistance Group later called “NTAG” (Nepali Technical Assistance Group) in 32 priority districts from 1993 to 1997. UNICEF offered to supply Vitamin A capsules and Information, Education and Communication (IEC) materials.
After the highly successful implementation of the program in the original 32 priority districts, the MOHP decided to expand the program to all 75 districts of the country as surveys had indicated vitamin A deficiency was a nationwide problem.
The nationwide expansion of National Vitamin A Program was to be completed by the year 2001/2002 with the addition of approximately 10 new districts per year. The technical support for this expansion was subcontracted by JSI to NTAG to ensure continuity in the approach to expansion.
In order to expand the NVAP to cover other districts of Nepal where the VAD was also considered a serious public health problem, according to the WHO standard, the second phase of National Vitamin A Program was initiated from July 1997.The expansion proceeded as planned until July 1998 to June 1999. During the period of July 1999 to June 2000 there was a shortage of fund for NVAP because of unanticipated funding cutback. The continued support from USAID and UNICEF would have been inadequate to expand the National Vitamin A Program as planned. The AusAID support from July 1999 to training component of the program has ensured continuity of the program without interruption. Over the years, NVAP expanded in a phase wise basis and covered all 75 districts by October 2002.
Every year, more than 51,470 Female Community Health Volunteers (FCHVs) supplement high dose vitamin A capsule to approximately 2.7 million children aged 6-59 months and de-worming tablets to 2.3 million children aged 12-59 months all over the country twice a year (April and October). (Source: DoHS, Annual Report, 2073/74)
The integration of de-worming to children aged 2-5 years with bi-annual vitamin A supplementation program was initiated in the year 1999. De-worming program has already covered 75 districts of the kingdom from October 2004. From FY 2004/05 onwards children aged 1-2 years have also been provided half of de-worming tablet during vitamin A capsule supplementation.
The NVAP has maintained the capsule coverage above 85% since 1993, which has helped to reduce the prevalence of bitot’s spots (0.33%) to a level below WHO cutoff points. The program has been estimated to be averting over 20,000 child deaths every year.
NVAP has been recognized as one of the successful as well cost effective model which has used innovative and untraditional approaches of motivating community volunteers and mobilizing community people along with family members to increase the program coverage and also to maintain high capsule coverage through MOHP network supported by a local NGO. The network set up by NVAP has been used to scale up different child health services in Nepal e.g., CB-IMCI, Postpartum Dosing, Iron Supplementation, etc. NVAP’s innovative approaches could be one of the models to implement the vitamin supplementation program.
After the completion of NVAP expansion phase, NTAG is currently providing technical support to Nutrition Section, Family Welfare Division, MOHP under Suaahara II program.