Context
Vitamin A Supplementation (VAS) activities were first introduced in the Democratic Republic of the Congo (DRC) in 1998. Since 2019, UNICEF has supported the government to integrate VAS into routine primary health care. Between 2016 and 2021, VAS was implemented as part of the expanded child health days (ECHD) held nationwide twice a year.
Since 2021, two VAS delivery approaches have been adopted with funding from the Government of Canada. The first approach, supported by UNICEF, integrates VAS into routine services, while the second approach, supported by Helen Keller International, involves VAS through standalone community-based campaigns.
In 2023 and 2024, DRC faced multiple measles and polio outbreaks, prompting health authorities to integrate VAS and immunization campaigns. However, this approach presented challenges, including high costs and the need for additional personnel. UNICEF advocated for integrating VAS within existing structures without expanding human resources. In the second semester of 2024, the routine approach was maintained in UNICEF-supported provinces, while Helen Keller International continued with standalone VAS campaigns.
The main actors supporting VAS in DRC include the national nutrition programme (PRONANUT), UNICEF, Helen Keller International, and the Centre for Applied Research and Development (CRAD).
Increased coverage of VAS in girls & boys under age 5
In May–June 2024, 20,745,804 children aged 6 to 59 months (96.2%) received VAS, including 10,560,728 (93.8%) in areas supported by VINA and 10,185,076 (98.8%) in areas supported by Helen Keller International. In VINA-supported areas, 1,526,560 were aged 6 to 11 months (114.6%) and 9,034,168 were aged 12 to 59 months (91.0%).
Preliminary results from the November–December 2024 campaign indicate that 16,538,513 children (75.9%) received VAS, including 7,415,464 children in VINA-supported areas and 9,123,048 children in Helen Keller International-supported areas. The pilot for VAS delivery as part of the minimum package of activities at health facility level was launched in Wanie Rukula health zone in Tshopo province.
UNICEF’s advocacy efforts resulted in the Government of DRC agreeing to purchase 50% of deworming tablet needs for one VAS round in 2025. UNICEF also supported national forecasting exercises for Vitamin A and deworming tablets procurement, helping the government understand the low cost of these items and encouraging increased investment.
A pilot programme for integrating VAS into primary health care was launched in Wanie Rukula health zone. UNICEF provided motorcycles, tools, and supplies to support outreach and preschool consultations, enhancing health zone capacity to deliver VAS services.
In 2024, 78 health personnel from 39 health facilities and four health zone management team members in Wanie Rukula were trained on VAS delivery during preschool consultations. UNICEF also supported the training of 600 community health workers and members of 154 community animation cells (CACs) on VAS, infant and young child feeding (IYCF), and preschool consultation delivery.
A joint immunization and VAS mission conducted in November 2024 in Kinshasa and Kasai Central identified gaps in gender-responsive programming and emphasized the need for increased female healthcare representation and positive masculinity initiatives.
Increased empowerment in VAS programming for women with children under age 5
UNICEF supported a gender barriers analysis on immunization and VAS in six provinces (Ituri, Kongo Central, Kasai Oriental, South Kivu, Lomami, and Maniema). Preliminary findings highlighted social norms, economic barriers, and limited decision-making power among women as obstacles to VAS utilization.
50 U-Reporter girls received training on VAS and nutrition, conducting community awareness sessions and reaching 5,515 people.
The gender barriers analysis strengthened linkages between immunization, VAS, and other relevant programs for women and girls. Engaging female leaders and women’s groups improved awareness and created stronger connections between health and social protection programs.
50 U-Reporter girls conducted awareness sessions with 672 men and 341 boys in Kalémie to increase understanding of VAS and nutrition. Strategies to engage fathers in shared childcare responsibility will be developed based on the findings from the gender barriers analysis.
UNICEF conducted a post-distribution survey of VAS involving 126,310 people, with 37% of respondents being women and girls. 63% of respondents with children aged 6 to 59 months reported receiving VAS.
Lessons learned
- Integrating VAS with immunization is not the most effective approach for improving VAS coverage.
- Routine delivery of VAS through primary health care increases coverage and sustainability.
- Removing barriers through gender-sensitive programming can improve VAS access and health outcomes.
- Community mobilization and outreach are key to increasing acceptance and demand for VAS.
Key Challenges and mitigation measures
Challenges included security issues, reluctance to integrate VAS into routine services, and misuse of VAS supplies. UNICEF provided technical expertise, supported advocacy, and worked with provincial health authorities to address these challenges.
Lessons learned
- Integrating VAS with immunization is not the most effective approach for improving VAS coverage.
- Routine delivery of VAS through primary health care increases coverage and sustainability.
- Removing barriers through gender-sensitive programming can improve VAS access and health outcomes.
- Community mobilization and outreach are key to increasing acceptance and demand for VAS.
Key Challenges and mitigation measures
Challenges included security issues, reluctance to integrate VAS into routine services, and misuse of VAS supplies. UNICEF provided technical expertise, supported advocacy, and worked with provincial health authorities to address these challenges.