Context
Vitamin A is vital for immune function, child health and development, particularly in Sierra Leone, where food insecurity and limited dietary diversity persist. Despite moderate progress in public health interventions, 17% of children under five still suffer from vitamin A deficiency (VAD) according to the 2013 Sierra Leone Micronutrient Survey, increasing their risk of severe health issues and mortality. Routine Vitamin A Supplementation (rVAS) initiated in 2017 addresses this gap by providing life-saving supplements to children aged 6–59 months through integrated health services outlined in the Basic Package of Essential Health Services (BPEHS). These services include catch-up immunizations, deworming, growth monitoring and promotion (GMP), promotion of infant and young child feeding (IYCF) practices, and family planning, forming a sustainable platform to improve VAS coverage. Outreach efforts also enhance access to VAS in hard-to-reach areas.
Since transitioning from mass campaigns to rVAS in 2017, Sierra Leone has achieved steady improvements in VAS coverage despite challenges at the facility and outreach level. Coverage initially fluctuated, with Semester 1 stabilizing at 50% in 2017–2018 and Semester 2 declining sharply to 26% by 2018. Both semesters saw further declines by Semester 1, 2020, but Semester 2 began recovering, reaching 48% that year. With the introduction of family MUAC testing for acute malnutrition, the coverage of VAS and other services also increased. Between 2021 and 2024, significant progress was observed, with Semester 2 consistently achieving higher coverage rates than Semester 1, ultimately converging at 78%–79% coverage in 2024. These trends reflect strengthened health systems and sustained efforts to improve child survival and nutritional outcomes across the country.
Increased coverage of VAS in girls & boys under age 5
In 2024, VAS delivery was prioritized through the integration of services with the Community Health Worker (CHW) and Expanded Programme on Immunization (EPI) programs. The CHW policy emphasizes providing VAS to children aged 6–59 months in hard-to-reach communities, including defaulter tracing and either supplementing them directly or linking them to Peripheral Health Units (PHUs) for supplementation. This approach targets approximately 25% of the total population of children aged 6–59 months.
In Semester 1, 2024, CHWs reached 26,947 children (2% of target), increasing to 47,010 children (3% of target) in Semester 2. Combined with facility-based and outreach services, the overall VAS coverage reached 79.5% (1,109,882 children) in Semester 1 and 82.7% (1,154,660 children) in Semester 2, reflecting significant progress in leveraging the CHW programme to enhance VAS coverage.
The VAS programme improved its coverage in 2024 compared to 2023 across both semesters. Coverage increased from 78.8% in Semester 1 of 2023 to 79.5% in Semester 1 of 2024, and from 76.7% in Semester 2 of 2023 to 82.7% in Semester 2 of 2024. This reflects enhanced service delivery and outreach efforts.
Key sustainability efforts included advocacy for increased government investment in nutrition programmes. The Government of Sierra Leone allocated USD 200,000 from the National Medical Stores Agency budget for additional RUTF in 2025. Vitamin A was also included in the revised national essential medicine list in 2021, reinforcing its sustainability within the health system.
In 2024, 1,642 health workers (824 male and 818 female) were oriented on VAS delivery and integrated health services during PIRVAS/PIRI rounds. Additionally, 221 chiefdom supervisors and 78 District Nutritionists were trained on data quality assurance for nutrition indicators. These efforts strengthened the capacity of health workers and CHWs to deliver VAS effectively and manage data accurately.
The DHIS2 platform was refined to capture disaggregated data by sex, age, and disability, improving data quality and facilitating evidence-based programming.
Increased empowerment in VAS programming for women
Routine health and nutrition counseling sessions at the facility and community levels were leveraged to empower women in making decisions regarding child health. The Mother-to-Mother Support Group guidelines were revised to formalize linkages with CHWs and strengthen women’s participation in VAS and child health services.
The revised Mother-to-Mother Support Group guidelines were validated in 2024, reinforcing the integration of VAS into broader health and nutrition services. Efforts were made to link VAS with deworming, immunization, and malnutrition screening for greater service impact.
Community engagement activities included targeted messaging to increase male participation in VAS and child health services. This approach aimed to shift social norms and increase shared caregiving responsibilities within households.
The Mother-to-Mother Support Group guidelines formalized the role of women-led organizations and female volunteers in supporting VAS delivery and child health services at the community level.
Lessons learned
Lessons from 2024 highlighted the importance of integrating VAS with immunization and other health services to enhance coverage and sustainability. Strengthening CHW capacity and promoting male involvement in caregiving contributed to improved VAS uptake and equity.
Key Challenges and mitigation measures
Challenges included limited access to health services in remote areas, inconsistent VAS data reporting, and supply shortages. These were addressed through enhanced data validation, decentralized supply planning, and expanded outreach efforts by CHWs.