Context
Vitamin A deficiency remains a significant concern in the Central African Republic (CAR), where under-five mortality rates are among the highest globally, at 99 per 1,000 live births (MICS 2016). Chronic malnutrition remains critical at 37.9% (SMART 2022), with stunting rates exceeding 40% in eight of the country's 17 prefectures, and as high as 53% in some areas.
In 2024, with funding from Canada, CAR conducted two rounds of VAS campaigns. The first round in early 2024 reached 105% of the target, with 1,072,846 children (547,151 girls, 525,695 boys) receiving Vitamin A capsules. The second round in December 2024 reached 93% coverage, benefiting 948,520 children (483,745 girls and 464,775 boys). The first round was integrated into the polio and COVID-19 immunization campaigns, while the second round combined several strategies, including integration with the polio campaign in four regions, stand-alone campaigns in two regions, and a community engagement strategy in one region.
In April 2024, the heads of the 35 health districts convened for a strategic workshop to relaunch VAS in routine immunizations. As a result, 554 health facilities provided VAS in routine immunization sessions in 2024, reaching 141,360 children (72,094 girls and 69,266 boys).
Increased coverage of VAS in girls & boys under age 5
UNICEF CAR organized strategic training sessions with key stakeholders to improve equity in VAS coverage for boys and girls. Training included 11 staff (3 women, 8 men) from the Ministry of Health's Nutrition Services and 35 district medical chiefs (5 women, 30 men) on gender mainstreaming in immunization and VAS delivery.
Additionally, 57 community leaders (13 women, 44 men) were trained on engaging community members to support VAS interventions. Training for 49 members of national-level women’s groups focused on the importance of women’s participation in VAS and immunization programs. Supervisory missions were conducted quarterly in each health district and during VAS campaigns to monitor and improve the quality of service delivery.
Sustainability was enhanced through regular coordination meetings between the Ministry of Health, UNICEF, WHO, and other partners. These meetings ensured better integration of VAS into other health programs, reducing operational costs and increasing efficiency.
The integration of VAS into the polio campaign in the first half of 2024 demonstrated the effectiveness of a coordinated approach. Planning meetings ensured timely distribution of Vitamin A capsules and smooth campaign execution.
Training and mentorship sessions for Ministry of Health staff, district medical officers, and nutrition partners improved workforce capacity. The training covered gender roles, workforce representation, and mechanisms for addressing sexual harassment.
District health staff demonstrated improved knowledge and confidence in implementing VAS campaigns and addressing gender barriers in service delivery.
Increased empowerment in VAS programming for women with children under age 5
Training for 49 members of women’s groups highlighted the importance of women's participation in health and nutrition programs. This increased women's confidence and ability to advocate for VAS services and improved their understanding of gender barriers in health access.
Technical working group meetings between the UNICEF Nutrition, Health, and WASH teams strengthened intersectoral collaboration. Focus areas included hygiene, sanitation, and child feeding practices, with particular attention to reaching adolescent girls and young mothers.
UNICEF CAR trained 44 male community leaders on gender roles and the importance of fathers’ engagement in VAS. This encouraged greater male participation in childcare and health-seeking behavior for their children.
Women’s groups and youth networks were engaged to support VAS outreach and implementation. Training improved their leadership and ability to mobilize communities for VAS campaigns.
Lessons learned
- Integrating VAS into other health campaigns improved efficiency and coverage.
- Community engagement strengthened the sustainability and reach of VAS programs.
- Targeted gender training improved awareness and participation of women and men in VAS delivery.
- Improved collaboration with the Ministry of Health enhanced the operational framework for VAS.
Key Challenges and mitigation measures
Key challenges included delayed approval for the gender analysis, which postponed the timeline for adapting program interventions. Engagement of women’s groups was also constrained due to limited formal recognition and registration.
Mitigation measures included strengthening collaboration with the Ministry of Health and updating the mapping of women’s groups to improve engagement in future campaigns.