Context
Vitamin A Supplementation (VAS) for children aged 6–59 months has been integrated into national health policies in Togo since 2005. This intervention is regularly delivered in two ways:
(i) Routinely through the Expanded Programme on Immunisation (EPI): Initially, only children aged 6–11 months were targeted through the Measles-containing-vaccine first-dose (MCV1) vaccination. However, in 2023, as part of efforts towards the sustainability of the VAS programme, this target was extended to children aged 12–23 months. A memo from the Ministry of Health has invited districts to seize the opportunities offered by Measles-containing-vaccine second-dose (MCV2) vaccination and growth promotion services to deliver Vitamin A to children up to the age of 23 months. Efforts are being made to implement this directive effectively, despite a slow start.
(ii) Mass campaigns: From 2017–2022, child health days (CHDs) that included deworming, immunisation, and other child survival services helped to reach more than 90% of children each year. However, these CHDs are very expensive and therefore not sustainable. To maintain VAS achievements, a less costly approach, namely Vitamin A Supplementation-enhanced routine (VASr), was tested in the second half of 2023 with the support of VINA funding. This enabled 79% of the children aged 6–59 months to be reached. The VASr involved providing supplies to community health workers (CHWs), who were given a one-month period to deliver Vitamin A to targeted children in their respective communities. In 2024, the strategy was improved by building on lessons learned from the first experience.
In the first semester of 2024, the first round of supplementation reached 1,490,297 children aged 6–59 months (775,423 girls and 714,874 boys), representing 91% coverage in targeted districts, and 1,323,443 children aged 12–59 months (681,779 girls and 641,656 boys), representing 93% coverage in targeted districts with VAS and deworming.
Challenges remain, including a lack of domestic national funding for VAS, reliance on international donors, and high costs associated with VAS, requiring further exploration of more efficient strategies.
Increased coverage of VAS in girls & boys under age 5
During the reporting period, an evaluation of the VAS approach was conducted with all stakeholders. The evaluation identified strengths and weaknesses, which were used to refine the strategy. The number of CHWs mobilised was increased, and the needs of urban areas were better addressed. In Grand Lomé, a strategy that included Child Health Days was adopted.
The first round of VASr in 2024 reached 91% coverage in targeted districts, compared to 79% in 2023. Special emphasis was placed on low-performing districts, which benefited from support in implementing and supervising the supplementation rounds. This resulted in 100% of targeted health districts achieving at least 80% coverage.
Integration of VAS into primary healthcare continued through a memorandum shared with all health districts. Growth monitoring and vaccination cards were revised to integrate VAS for children up to 23 months of age. As a result, 248,742 children aged 6–23 months received VAS through routine services in semester 1 of 2024 and 289,148 children in semester 2.
Two nutrition programme reviews were conducted by the Ministry of Health with UNICEF support. The Child-Friendly-Community/Real-Time-Monitoring (CFC/RTM) approach was proposed as a way to deliver Vitamin A at low costs in the Savanes region. This involved providing CHWs with lists of children and pregnant and lactating women, allowing them to deliver a comprehensive package of health and nutrition services at the community level.
UNICEF held an event with 23 journalists to raise awareness about VAS, aiming to strengthen advocacy and secure domestic funding.
UNICEF trained 778 CHWs (153 women and 625 men) to deliver a full package of community nutrition services. Between 2023 and 2024, a total of 1,302 CHWs (21% women) were trained in Savanes, Kara, and Maritime regions. This contributed to raising awareness among 188,617 caregivers (including 19,975 men) on good nutritional practices, including VAS.
Increased empowerment in VAS programming for women with children under age 5
66 mother support groups were set up, with 582 mothers and 78 men trained to promote maternal and child nutrition. These groups reached 29,856 individuals (20,777 women and 9,079 men) with key messages on nutrition.
Collaboration with the WASH sector provided 13 boreholes equipped with hybrid solar and manual pumps, giving 28,000 people access to drinking water.
The “Papa Champion” initiative trained 240 fathers in 12 priority districts. They will begin implementing activities related to nutrition and VAS in 2025.
Lessons learned
Allowing districts to organise themselves to reach children under VAS led to better integration with other health programmes and increased coverage.
Key Challenges and mitigation measures
Challenges include delayed CHW payments, limited domestic funding, and lack of training tools. Negotiations and strategic adjustments helped address these issues.