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The Nepal National Vitamin A Program: prototype to emulate or donor enclave?
1Social Sectors Development Strategies, Sturgeon Bay, Wisconsin, USA. jfiedler@mail.wiscnet.net
Insights
Nepal
Area of Science:
- Public Health
- Nutrition
- Global Health
Background:
- Vitamin A deficiency affects over 250 million children globally.
- Nepal faces a significant public health challenge due to vitamin A deficiency, causing child mortality and blindness.
- The Nepal National Vitamin A Program (NVAP) was initiated to address this critical issue.
Purpose of the Study:
- To evaluate the Nepal National Vitamin A Program (NVAP) as a model for public health intervention.
- To assess the effectiveness, cost-effectiveness, and sustainability of the NVAP.
- To highlight the role of Female Community Health Volunteers (FCHVs) in program success.
Main Methods:
- Nationwide distribution of high-dose vitamin A capsules to children aged 6-60 months twice annually.
- Leveraging and empowering a network of Female Community Health Volunteers (FCHVs) for capsule delivery.
- Community mobilization involving various sectors and political representatives to support FCHVs.
Main Results:
- The NVAP has achieved nationwide coverage, significantly reducing child mortality and blindness.
- The program is highly cost-effective, with a cost per averted death of $327.
- NVAP saves the Nepalese government $1.5 million annually by reducing the incidence of diarrheal diseases and measles.
Conclusions:
- The Nepal National Vitamin A Program is a successful, cost-effective, and sustainable public health intervention.
- Empowerment of community health volunteers is crucial for program success.
- The NVAP serves as a replicable model for addressing vitamin A deficiency in other countries.
Abstract:
More than 250 million of the world's children suffer from vitamin A deficiency. Nepal is one of 60 countries in which this deficiency constitutes a significant public health problem. Each year in Nepal, vitamin A deficiency is responsible for the deaths of 9000 children and for 2500 children becoming permanently blind. The Nepal National Vitamin A Program (NVAP) was begun in 1993 in eight of the country's 75 districts. By the end of 1997, the programme covered 32 districts, and by 2003 its coverage will be nationwide. The Nepal NVAP is considered by many to be a highly successful, model programme. It consists primarily of distributing high-dose vitamin A capsules to all children 6 to 60 months of age during twice-yearly campaigns. The capsule distribution is carried out by a previously existing network of Female Community Health Volunteers (FCHVs) that has been reinvigorated by the highly visible and universally acclaimed success of the NVAP. An important strategy of the programme has been the empowerment of the FCHVs, which has been accomplished by organizing, training and motivating community workers and other representatives from education, agriculture and other sectors, as well as political representatives, to support the FCHVs. The annual cost of the NVAP is US$1.7 million. It costs $1.25 to deliver two vitamin A capsules to each participant. The cost per averted death is $327. The NVAP reduces the incidence and severity of diarrhoeal disease and measles, which in turn reduces the need for Ministry of Health services, thereby annually saving the Government of Nepal $1.5 million. Factoring in these cost savings, the net annual cost of the current NVAP is $167,000, and the net annual cost of the permanent, nationwide programme is estimated at $1.1 million. The NVAP is a highly cost-effective programme. The article concludes with a discussion of the sustainability and replicability of the programme.