Intensified Monitoring of Vitamin A Supplementation Programs in Hard-to-Reach Districts and Urban Slums of Pakistan Results in Improved Coverage

Abstract

Objectives: Although national coverage of VAS is high in Pakistan (>95%), large pockets of low coverage have been identified. A VAS coverage survey conducted by the Micronutrient Initiative (MI) in 2010 identified the reasons for low coverage as inadequate attention to VAS during training, stock-outs of VAC with frontline workers, and insufficient VAS monitoring. In response, an intensified monitoring and training strategy was initiated in low-coverage areas. This abstract describes this strategy and its results on VAS coverage. Methods: The program was piloted in April and October 2012 rounds of National Immunization Days (NIDs) in 22 hard-to-reach and low coverage districts of Balochistan and Khyber Pakhtoonkhwa and slums of two cities. The strategy comprised of increased attention to VAS during NID training of health workers and managers, enhanced measures to ensure adequate supplies of VAS throughout the supply chain, improved tracking of children missed from VAS dosing (including door markings and addition of VAS-specific columns on tally sheets). A baseline survey (March 2012) and endline survey (November 2012) was conducted to measure VAS coverage. Results: VAS coverage increased from 48% to 59% (baseline) to 90% to 96% (endline) in study sites. The difference in coverage between VAS and polio vaccinations also narrowed during the project period. The incidence of stock-outs of VAS and proportion of parents reporting vaccination teams not visiting their homes also declined. Conclusions: The improvements demonstrated through these strategies in these pilot areas garnered sufficient attention that now they will be adopted in all the provinces/areas by the government of Pakistan.