Reaching Zero-Dose Children: Delivering Vitamin A Supplementation (VAS) to Children 6-59 months in Hard-to-Reach Settings of Nigeria

Background and Objective: Two-dose VAS coverage in Nigeria remains very low (41%). The inequity is more glaring in hard-to-reach settings (HTRS), worsened by the impact of COVID-19 pandemic. Nutrition International supported the government in Rivers, Cross Rivers and Sokoto states through its Covid-19 Emergency Response project to deliver two rounds of VAS in HTRS between September 2021 to June 2022. The objective is to reach eligible children in HTRS with VAS through extended outreach of the bi-annual maternal newborn and child health weeks (MNCHW). Methods: Advocacy with state-level policy and decision makers was undertaken to increase commitment to extend VAS to the vulnerable children in HTRS. Mapping and categorization of hard-to-reach communities with security challenges, inaccessible/difficult road networks were conducted with the state MNCH teams using a participatory bottom-up micro-planning. The state consolidated micro plans were updated with this information ensuring HTRS were included and used to prioritize and deploy adequate human resources, commodities, data tracking tools and transport logistics to these areas. About 2,545 front-line health workers (FHW) and community resource persons drawn from the HTRS were trained and deployed to over 1,000 outreach sites across the three States. Town announcers and guides were mobilized to generate demand and facilitate safe entrance into these communities. 40 independent monitors were also trained and deployed to give real-time reports, including daily data reviews using WhatsApp platform. Results: A total of 1,312,089 (90%) children 6-59 months received two -doses of VAS in HTRS across the three states. Of these, 787,769 children are additional due to the project. Conclusion: This approach resulted in reaching children who are frequently missed with the MNCHWs in each of the states and in some cases had never been reached with VAS.