Context
Vitamin A Supplementation (VAS) remains a key intervention in Benin to reduce under-five child mortality. VAS helps protect children from vitamin A deficiency, which can lead to blindness and increased vulnerability to severe infections. Despite ongoing efforts, Benin faces persistent challenges in transitioning from campaign-based VAS delivery to a more sustainable routine-based approach. Health system reforms, gender-based barriers, and inadequate integration of VAS into routine health services, particularly for children over 12 months, have limited progress.
In response to these challenges, Benin was selected for support under the Vitamin A in New Age (VINA) project, funded by Global Affairs Canada, for the period 2023 to 2025. The VINA project aims to enhance the coverage, equity, and sustainability of VAS delivery by adopting a gender-transformative approach. The key objectives of the project are to increase equity in VAS delivery for boys and girls, ensure the long-term sustainability of VAS programmes, and strengthen the capacity of health workers to deliver VAS effectively, with a focus on equity and gender. Additionally, the project seeks to empower women with children under five by improving their access to and utilization of VAS services and engaging fathers and other community stakeholders to share responsibility for childcare.
Increased Coverage of VAS in Girls & Boys Under Age 5
A significant achievement of the VINA project in Benin has been the increase in geographical and population coverage of VAS. In 2024, VAS coverage was expanded from six health zones (HZ) in 2023 to 17 HZ, reaching a total of 842,714 children aged 6 to 59 months — a significant increase from the 323,937 children reached the previous year. This expansion represents a major step towards ensuring that VAS services reach more children, particularly those in underserved and remote areas.
For children aged 6 to 11 months, VAS coverage increased from 71.4% in 2023 to 90.8% in 2024, demonstrating the success of routine delivery strategies integrated into the Expanded Programme on Immunization (EPI). Among children aged 12 to 59 months, VAS coverage rose from 6.7% in 2023 to 69.6% in 2024. This increase reflects the successful incorporation of VAS into routine health services and the enhanced capacity of health workers to reach children in this age group.
The use of Lot Quality Assurance Sampling (LQAS) to monitor VAS coverage has been instrumental in ensuring that the most deprived groups, particularly those in areas affected by the spillover of the Sahel crisis (e.g., Natitingou-Atacora and Alibori), are being reached. The LQAS data has provided valuable insights into coverage gaps and enabled health workers to target interventions more effectively.
The integration of VAS into other health platforms has further enhanced coverage. For example, the national immunization campaigns against measles and rubella have provided opportunities to deliver VAS alongside vaccinations, reducing operational costs and increasing efficiency. The cost of delivering VAS through integrated campaigns decreased from $19,314 for separate interventions to $3,295 for the integrated approach — an 83% reduction in total expenditure.
Increased Empowerment in VAS Programming for Women with Children Under Age 5
A key element of the VINA project is the empowerment of women to make decisions regarding their children's health and nutrition. In 2024, 38 Women’s Groups for Self-Promotion, Sanitation, and Nutrition (GFAAN) were established to provide women with the knowledge and resources needed to improve maternal and child health. These groups have played a central role in promoting VAS and other essential health services at the community level.
The GFAAN groups have also supported women in engaging in income-generating activities such as farming, food processing, and the production of vitamin A-rich foods. This has enabled women to access credit and improve household food security, which in turn supports better nutritional outcomes for children. The financial flows generated through small loans within these groups have reached 23,004,500 CFA ($36,857), benefiting 1,099 members, including 1,087 women.
Efforts to engage fathers and promote shared responsibility for childcare have also yielded positive results. In 2024, 79 fathers' clubs were established, involving 474 men in activities such as cooking demonstrations, group discussions, and home visits. These clubs have helped to challenge traditional gender norms that view childcare as solely the responsibility of women. As a result, VAS coverage in Tchatchou increased fivefold, reflecting the impact of increased male involvement in childcare and health-seeking behavior.
Community-level outreach and engagement have been further strengthened through the use of U-reporters and women-led volunteer initiatives. In 2024, 500 U-reporters conducted awareness campaigns via social networks and word of mouth, reaching nearly 1 million people. Women leaders, known as "Mères Lumières," conducted door-to-door awareness campaigns to encourage VAS uptake and educate mothers on the benefits of vitamin A and other essential health services.
Lessons Learned
Several key lessons have emerged from the implementation of the VINA project in Benin. First, the integration of VAS into routine health services and immunization campaigns has proven to be cost-effective and efficient. The reduction in delivery costs through integrated campaigns has highlighted the value of combining multiple health interventions within a single platform.
Second, the involvement of community-based structures, including women’s groups and fathers’ clubs, has played a critical role in increasing VAS coverage and improving health-seeking behavior. Women’s groups have provided a platform for economic empowerment and health promotion, while fathers’ clubs have helped to challenge traditional gender norms and increase male involvement in childcare.
Third, the use of LQAS to monitor VAS coverage has enabled health workers to identify and address coverage gaps more effectively. This has been particularly important in reaching underserved and hard-to-reach populations.
Key Challenges and Mitigation Measures
Despite the progress made, several challenges have been encountered. One major challenge has been the potential overlap of VAS coverage data due to the use of multiple delivery mechanisms within the same period. To address this, health zones have been advised to report VAS coverage data separately for each delivery mechanism to avoid double-counting.
Another challenge has been the delay in conducting a gender analysis due to difficulties in recruiting a qualified consultant. Efforts are underway to resolve this issue through targeted outreach to potential candidates.
Finally, ensuring the long-term sustainability of VAS programming remains a challenge due to limited funding. Advocacy efforts are ongoing to secure additional resources and strengthen the integration of VAS into the national health system.
Visibility Links
A case study on Benin’s gender-transformative approaches, including the role of IYCF support groups, GFAAN, and fathers' clubs, is currently being developed in partnership with Ladysmith. This case study will provide valuable insights into the effectiveness of these approaches and inform future programming.
Photos and additional evidence documenting the impact of the VINA project in Benin are available upon request.