Context
Vitamin A supplementation (VAS) is a powerful intervention to address food insecurity and malnutrition in South Sudan, where only 16.5% of children receive Minimum Dietary Diversity and 2% receive a minimum acceptable diet. This poor dietary quality highlights the need for Vitamin A supplementation to prevent vitamin A deficiency and improve child health outcomes. South Sudan faces one of the highest child mortality rates globally, with 98.8 deaths per 1,000 live births.
In 2022, the Ministry of Health, with technical support from UNICEF and operational support from Global Affairs Canada (GAC), reached 2,439,217 children (1,141,408 boys and 1,297,809 girls) with VAS in Semester 1 (92% coverage) and 2,377,169 children (1,119,924 boys and 1,257,245 girls) in Semester 2 (89% coverage) across all 80 counties and three administrative areas (Abyei, Pibor, and Ruweng).
In 2023, with support from the VINA Grant, 2,194,040 children (1,033,497 boys and 1,160,543 girls) received VAS in Semester 1 (79% coverage), and 2,370,373 children (1,161,483 boys and 1,208,890 girls) in Semester 2 (85% coverage). This included integrated interventions such as deworming for children aged 12–59 months and MUAC screening for children aged 6–59 months.
In 2024, South Sudan conducted two national VAS campaigns. The first campaign in June reached 2,480,060 children aged 6–59 months (86% coverage), including 1,264,831 girls and 1,215,229 boys. The second campaign in December reached 2,541,669 children (88% coverage). These campaigns were integrated with deworming and MUAC screening, helping to identify malnourished children and facilitate early referral for treatment.
Increased Coverage of VAS in Girls & Boys Under Age 5
In 2024, UNICEF collaborated with 29 implementing partners to strengthen equity in VAS coverage. Bottom-up microplanning was conducted in 42 counties, focusing on 13 counties with coverage below 50% and 29 counties with coverage between 50% and 80%.
Community engagement played a significant role in increasing equity. A total of 1,740 social mobilizers, 7,358 community nutrition volunteers, and 1,200 health workers were trained. Additionally, 12,855 mother-to-mother support groups actively promoted the benefits of VAS through household visits and public campaigns.
Social mobilization strategies included public address systems, megaphone announcements, and community meetings with local leaders. Radio jingles in local languages were broadcast, and information was disseminated through religious and community leaders.
UNICEF supported government leadership to coordinate the two national campaigns. Supplies were pre-positioned in March and September to ensure timely delivery. The Boma Health Initiative (BHI) played a key role in improving sustainability, with 6,186 Boma health workers paid by the government.
Efforts to integrate VAS into the health system are ongoing. The Health System Transformative Project funded by the World Bank aims to hire 1,400 nutrition workers and nutrition assistants to strengthen service delivery.
UNICEF also supported digitalization of VAS data reporting through the introduction of 1,000 tablets, which will improve data collection and analysis starting in 2025.
In 2024, 16,126 personnel were trained, including 1,200 health workers, 1,740 community mobilizers, 7,358 community nutrition volunteers, and 6,186 Boma health workers. Training sessions covered VAS delivery, deworming, MUAC screening, and gender-sensitive service delivery.
The proportion of female community nutrition volunteers increased from 30% in 2023 to 40% in 2024 due to targeted efforts to increase women's participation.
Increased Empowerment in VAS Programming for Women
Increased participation of women in VAS campaigns was achieved through mother-to-mother support groups and community-level engagement. A total of 169,444 women in 12,855 support groups actively supported VAS campaigns.
Community meetings were held with male and female leaders to raise awareness and promote joint decision-making on child health.
Lessons Learned
- Government leadership and ownership are critical for successful VAS campaigns.
- Integrating multiple interventions during VAS campaigns increases coverage and cost-effectiveness.
- Leveraging existing nutrition programme funds supports efficiency and better outcomes.
Key Challenges and Mitigation Measures
- Flooding and insecurity affected campaign delivery. Supplies were pre-positioned early to ensure distribution.
- Movement from Sudan increased demand for services.
- Inflation increased operational costs by 25%. UNICEF adapted by using low-cost transport methods and securing additional funding.