Context
In 2024, UNICEF continued to support the Government of Madagascar in transitioning Vitamin A Supplementation (VAS) for children aged 6 to 59 months from Mother and Child Health Week (MCHW) campaigns to routine services. This transition was a key component of the 2024-2026 national roadmap for Vitamin A supplementation in primary health care and community sites.
The nationwide polio immunization campaign held in July 2024 provided an opportunity to scale up Vitamin A distribution, increasing national coverage from 14% in the first semester to 92% in the second semester (52% girls and 48% boys). This marks a substantial improvement compared to 2023, when coverage stood at 26% and 54% in the first and second semesters, respectively.
A gender barriers study conducted in 2024 provided valuable insights into challenges faced by women, including limited mobility, restricted access to resources and decision-making, and heavy domestic workloads. These structural barriers were compounded by the remoteness of health centers and high illiteracy rates among women. Recommendations from the study emphasized the need to transform existing gender dynamics to improve VAS coverage.
To strengthen evidence-based programming, UNICEF and partners supported a national micronutrient deficiency survey. The findings, expected in 2025, will provide crucial data on deficiency patterns by age, sex, residence, and socioeconomic status, enabling more tailored and sustainable VAS service delivery.
Increased coverage of VAS in girls & boys under age 5
The transition plan developed in December 2023 by the Ministry of Health was rolled out in 2024, ensuring the integration of new indicators, including disaggregation of VAS data by sex and age groups in DHIS2. Data entry forms were created and integrated into the routine reporting system, and community registers were updated.
A bottleneck analysis in June 2024 identified key challenges, including limited training of health workers (12% trained), geographic accessibility issues, and low community mobilization. A catch-up campaign in July 2024, integrated with a nationwide polio vaccination campaign, increased VAS coverage from 14% in the first semester to 92% in the second semester.
By the second half of 2024, 100 out of 114 districts (88%) achieved over 80% coverage, with no district falling below 50%. In VINA-targeted regions, 22 out of 27 districts met the 80% coverage target, while the remaining districts recorded coverage rates of 62% in Ambovombe district and 76% in Ankazoabo district.
Efforts toward the sustainability of VAS in Madagascar included integrating VAS into health services coordination meetings at regional and district levels. An operational guide issued by the Secretary General of the Ministry of Health emphasized the integration of VAS into routine services.
UNICEF secured an agreement with the national medical store (SALAMA) to manage VAS supplies. This strengthened the logistics platform, improving the collection and tracking of VAS orders. UNICEF also expanded collaboration with Helen Keller Intl to support VAS programs in eight additional regions.
UNICEF supported training sessions for health workers on VAS data management, forecasting, and supply management. Training targeted health workers and community volunteers in four key regions: Atsimo Atsinanana, Anosy, Androy, and Atsimo Andrefana.
In Anosy, 117 health workers (78 women, 39 men) and 121 male community volunteers were trained. Male volunteers were specifically targeted to influence men in their communities and promote VAS uptake.
Increased empowerment in VAS programming for women with children under age 5
A gender barriers study highlighted challenges such as limited mobility and access to resources. A comprehensive strategy was developed to empower women through increased participation in decision-making and greater access to health services.
30 Local Coordination Structures (SLCs) were revitalized, engaging 1,145 members (37% women) to improve advocacy and service delivery.
UNICEF supported cash transfers for children and pregnant women in vulnerable communes. A centralized data system was established to track deprivations faced by children and women, aiding referrals to nutrition, WASH, and child protection services.
A Social Behavior Change for Action (SBC4A) strategy was developed to promote positive masculinity and increase male involvement in childcare. Community forums engaged 1,470 participants, including 31% women and 12% young women, fostering collaborative solutions.
UNICEF conducted national and regional Human-Centered Design (HCD) training sessions for 188 participants (94 women). Stakeholders developed nine prototypes for locally integrated nutrition solutions, which will be tested in 2025.
Lessons learned
- Strengthening logistics and forecasting ensured consistent VAS supply.
- Integrating VAS into routine health services improved coverage and sustainability.
- Gender-sensitive training increased participation and improved outreach.
- Collaborative approaches with local partners enhanced coordination and impact.
Key Challenges and mitigation measures
Challenges included supply shortages, data inconsistencies, and low community participation. Improved logistics, better data management, and enhanced community outreach addressed these challenges.