Context
Côte d'Ivoire demonstrates a strong political commitment to combating malnutrition, making nutrition a top priority. This dedication is reflected through the strengthening of institutional and regulatory frameworks, the expansion of nutritional interventions in health facilities, and the implementation of multisectoral community approaches to nutrition. Significant national investments have supported these efforts.
In 2024, the National Multisectoral Nutrition Plan 2024-2027 was adopted to ensure optimal nutritional status for the population, supporting inclusive growth and development. However, the 2021 Demographic Health Survey (DHS) revealed persistent challenges, including child food poverty (76%) and anemia among adolescents and women (61%), along with significant socio-economic and geographical disparities.
Vitamin A deficiency (VAD) among children aged 6 to 59 months was estimated at 24.1% in 2007. Despite government willingness to conduct a micronutrient survey, no recent data is available. Mortality rates have decreased over the past 20 years, with the infant mortality rate dropping from 181‰ to 74‰ (DHS 2021).
Increased coverage of VAS in girls & boys under age 5
UNICEF supported the Ministry of Health to improve VAS equity through targeted interventions in low-performing districts. A gender analysis study of VAS was initiated at the end of 2024 to understand gender disparities and improve access for children aged 6 to 59 months.
Operational support for VAS included improving routine VAS services, enhancing planning, and increasing outreach activities in 12 low-performing health districts. Coaching and training for health workers, along with social mobilization efforts, increased routine VAS coverage from 27% to 80% in these districts.
UNICEF also supported two sub-national VAS campaigns in 40 health districts. U-Reporters played a key role in raising awareness and real-time monitoring, contributing to increased acceptance and improved quality of VAS delivery.
A cost-effectiveness study was conducted in collaboration with Helen Keller International (HKI) to improve VAS sustainability. The study, carried out in two districts, estimated the cost per child at 588 CFA ($1.32) and recommended strengthening the integration of VAS into routine health services.
Efforts to enhance VAS communication and capacity-building for health workers were identified as key strategies for improving sustainability. Supply chain support ensured consistent availability of VAS, minimizing stockouts and improving service reliability.
In 2024, 312 health workers and 849 community health workers were trained on VAS implementation and gender-sensitive delivery. The training improved the ability of health workers to address gender-related barriers and increased the quality and reach of VAS services.
Support for health workers included advanced strategies, operational planning, and community outreach to improve access for underserved populations.
Increased empowerment in VAS programming for women with children under age 5
UNICEF strengthened community-based programs to improve women's decision-making power in VAS access. Support for 125 women's groups equipped them with skills to deliver VAS messages and improve child nutrition practices.
Through Early Child Development (ECD) programs, 7,670 children accessed essential nutrition services, including VAS.
UNICEF supported regional multisectoral coordination mechanisms, including monthly meetings with local authorities. This increased collaboration between health, social protection, and education sectors to strengthen VAS delivery.
Community engagement efforts targeted men’s participation in VAS. 320 ‘grin’ sessions were conducted, engaging 1,133 men to improve their understanding of infant feeding and increase their support for women in childcare.
UNICEF supported 300 U-Reporter volunteers aged 10 to 15 to raise awareness and monitor VAS campaigns. Youth engagement through real-time monitoring and communication strengthened the reach and quality of VAS delivery.
Lessons learned
- Integration of VAS into routine health services improved access and reduced costs.
- Gender-sensitive training for health workers improved the reach and acceptance of VAS.
- U-Reporters and youth engagement enhanced the real-time monitoring and acceptance of VAS.
- Community outreach through local leaders and health workers increased acceptance of VAS and improved equity.
Key Challenges and mitigation measures
Challenges included difficulties in reaching children aged 12 to 59 months due to limited health system contact points. Lack of district ownership of VAS services and insufficient visibility on VAS funding also posed challenges.
Mitigation measures included targeted outreach strategies, enhanced supply chain management, and expanded gender-sensitive training.