Context
Vitamin A Supplementation (VAS) was integrated into the Extended Programme on Immunization (EPI) in all health districts in Malawi in 2022. However, from 2023 onwards, health management information system (HMIS) data indicated that the national coverage of VAS was sub-optimal. Most caregivers stop taking their children to under-five clinics after they receive all scheduled vaccines, contributing to low VAS coverage.
With funding from Canada, the Ministry of Health (MoH), UNICEF, and other partners developed new guidelines for the integration of VAS into community platforms, including community-based childcare centers (CBCCs), to improve uptake. UNICEF conducted a gender bottleneck analysis which highlighted barriers such as low male participation in childcare and decision-making. In response, a gender transformative approach will be introduced in 2025 to challenge restrictive norms and promote greater shared responsibility for child health.
In the reporting period, gender-sensitive Information, Education, and Communication (IEC) materials were developed and are set for distribution in the second quarter of 2025.
Increased coverage of VAS in girls & boys under age 5
To increase equity in coverage, joint monitoring and mentoring was conducted between the Ministry of Health, UNICEF, and partners, including Nutrition International. The monitoring focused on identifying strengths and shortcomings in frontline worker capacity in delivering VAS.
Although VAS has been integrated into the immunization program, frontline workers sometimes forget to bring VAS capsules to outreach clinics, depriving children of supplementation. UNICEF will conduct regular monitoring to ensure VAS capsules are consistently available.
In 2024, a total of 69,839 children (35,618 female; 34,221 male) aged 6-11 months were supplemented with Vitamin A in the first semester, representing 58% of the target population in the 10 targeted districts. In the second semester, 89,211 children (45,498 female; 43,713 male) were supplemented, representing 65% of the target.
For children aged 12-59 months, 159,721 children (81,458 female; 78,263 male) received Vitamin A in the first semester (37% coverage), and 167,916 (85,637 female; 83,279 male) in the second semester (40% coverage). Nationally, 634,011 children under 5 were supplemented in the first semester (47% coverage) and 594,436 in the second semester (42% coverage). No district reached the target of 80% coverage.
UNICEF supported the Ministry of Health in conducting a deep dive on VAS delivery with technical experts from national and district levels. The review confirmed that delivery of VAS through routine services remains the most effective and sustainable approach.
In 2025, UNICEF will continue to support the Ministry of Health by increasing VAS delivery platforms to include ECD centers in four districts: Nsanje, Chikwawa, Zomba, and Mulanje. This initiative will complement the support from Canada in Nsanje district.
To enhance workforce capacity, UNICEF supported the Ministry of Health in facility-level mentoring of frontline workers in three targeted districts. The mentoring sessions focused on addressing challenges in administering Vitamin A, aiming to improve the consistency of VAS delivery.
In 2025, UNICEF will continue to monitor integrated VAS delivery and implement measures to fill capacity gaps.
Increased empowerment in VAS programming for women with children under age 5
A gender bottleneck analysis revealed that joint decision-making between spouses is associated with higher uptake of VAS and immunization services. Households where men controlled decisions had lower access to VAS.
In 2025, UNICEF will conduct gender-transformative social behavior change interventions to encourage shared decision-making in child health.
In 2024, UNICEF supported the training of frontline workers on the provision of VAS through community platforms such as CBCCs in 10 targeted districts. This initiative enabled the Ministry of Health to reach more children aged 3 to 5 years who typically do not attend under-five clinics.
The gender bottleneck analysis identified strong gendered norms, where men are seen as providers and women as caregivers. Fathers often face a choice between earning an income and participating in child health care.
In 2025, gender-transformative social behavior change interventions will be introduced to increase men’s participation in childcare.
Activities to engage women-led, youth-led, and women volunteers in community-level VAS programs will begin in 2025, based on the gender bottleneck analysis.
Lessons learned
- Integrating VAS into non-health platforms such as ECD centers increases access to older children.
- Joint decision-making between spouses enhances VAS uptake.
- Improved data recording and reporting are essential for increasing VAS coverage.
- Stronger community engagement is key to increasing VAS acceptance.
Key Challenges and mitigation measures
Challenges included low coverage of VAS and poor data quality in health management information systems. UNICEF will support the Ministry of Health in strengthening frontline worker capacity in data recording and reporting.
A program review workshop will be conducted to enhance inter-district learning and address challenges in VAS delivery.