Nepal's vitamin A supplementation programme, 15 years on: Sustained growth in coverage and equity and children still...

Nepal's national vitamin A programme, that started in a few districts in 1993, was incrementally and systematically expanded to cover the targeted population - children ages 6-59 months - in all the 75 districts of the country over a decade. By 2001, four-fifths of the eligible children had received vitamin A supplementation. Based on data from the 2006 Nepal Demographic and Health Survey, this paper analyses the extent to which the levels and patterns of the programme's coverage have continued to sustain over time, and identifies the children who are still missed by the programme. The overall coverage in 2006 increased to 87.5% nationally, ranging between 80 and 93% (except for two population subgroups), indicating that the programme has been effective in eliminating large inequities in access and utilisation of programme services. The children still missed by the programme (12.5%) have been found to disproportionately represent the poorest of the poor families, mothers with no education, and residents of rural areas and certain ecological and development subregions. The programme is most likely to sustain its achievements thus far, assuming that programme support ingredients and inputs are not interrupted or affected adversely in any way. Emerging policy and programmatic issues are discussed.