Context
The Mozambique Ministry of Health (MoH) Vitamin A Supplementation (VAS) programme aims to improve the survival and well-being of children under five through the delivery of cost-effective life-saving nutrition and health services. Since 2016, UNICEF has supported the Government to strengthen the integration of nutrition interventions into immunization through the Reaching Every Community (REC) strategy and other service delivery platforms, including fixed sites, outreach, and community health workers (CHWs).
From 2017 to 2021, guidelines, IEC materials, and job aids on VAS and deworming (VASD) were developed and distributed nationwide. A new database platform (HMIS-2) was introduced to improve monitoring and evaluation of key routine indicators. In 2021, geospatial data were integrated in the REC approach in two districts, improving the relocation of service delivery points and enhancing community access to health and nutrition interventions. This approach will be expanded to more than 46 districts in 2024 and 2025.
In 2023, implementation research on VAS and immunization in routine services was undertaken in five provinces. The study revealed that both users and health care providers perceived that it was women’s responsibility to take children to health facilities for VAS and other health services. The research also identified barriers to VAS uptake at household, community, and health facility levels. Preliminary data for 2024 showed a decline in VAS coverage among children aged 6–59 months, from 90% in 2023 to 71% in 2024, highlighting the need to address gender-related barriers.
Increased coverage of VAS in girls & boys under age 5
Results on national VAS coverage in 2024 show that 3,749,292 children aged 6–59 months (71%) received a vitamin A capsule in the first semester and 4,213,355 (71%) in the second semester.
To enhance coverage, the REC strategy was expanded to target children in hard-to-reach districts by combining routine immunization with VAS. Additional funding from immunization donors supported the scale-up of the REC strategy without using VINA funds. UNICEF facilitated the production and distribution of IEC materials and job aids on VAS for 25 target districts, which are on track for completion by the end of 2025.
UNICEF supported the provincial health departments of targeted provinces to develop costed workplans for integrated vitamin A interventions. These workplans served as the foundation for the roll-out of the VINA programme in priority districts.
UNICEF provided technical support to provinces on communication content production, including a 25-minute film produced in Sofala province to promote the importance of vitamin A supplementation and deworming. This film will be disseminated through mobile multimedia units in early 2025.
In December 2024, UNICEF and the Ministry of Health held a five-day workshop to review the RED-REC strategy, including VAS and deworming, and the digitalization of routine data.
UNICEF supported the revitalization of 30 health committees in Zambezia province, reaching 732 members (403 male and 329 female). In Sofala, five health committees were trained, reaching 75 members (33 women). These committees play a critical role in strengthening health promotion and community engagement.
Increased empowerment in VAS programming for women with children under age 5
A gender analysis highlighted barriers to VAS uptake, including social norms and unequal caregiving responsibilities. The study showed that higher VAS uptake is associated with joint decision-making between spouses.
UNICEF will support the implementation of gender-transformative social behavior change interventions in 2025.
In 2024, UNICEF supported the integration of VAS and WASH programmes to reduce domestic burdens on women and girls. Coordination mechanisms for nutrition and WASH are expected to be completed in 2025.
Educational videos and community outreach activities promoted shared caregiving responsibilities. Messages focused on the importance of VAS, encouraging fathers to engage in child health and nutrition activities.
Community health workers and volunteers were trained on addressing gender barriers to VAS delivery. Community theatre performances engaged large audiences, improving awareness and acceptance of VAS.
Lessons learned
- Expanding the REC strategy increased VAS access in hard-to-reach districts.
- Community mobilization and health promotion improved acceptance of VAS.
- Targeted social behavior change interventions increased male engagement.
- Strengthening health committees enhanced local ownership of VAS programmes.
Key Challenges and mitigation measures
Challenges included delays in training due to immunization campaigns and political unrest. UNICEF will conduct capacity-building for nutrition staff and CHWs in 2025 to improve gender-responsive service provision.