RFP-4: Mali

In 2007, OCHRC awarded RFP-4 to the Child Survival Research and Documentation Centre – CREDOS, Bamako, Mali to carry out an assessment of the effectiveness of semiannual vitamin A capsule distribution through national nutrition week, Semaine d’Intensification des Activités de Nutrition (SIAN). The grant was funded under the 4th call for proposals from OCHRC issued in order to understand the effectiveness of large-scale child health and nutrition interventions.

This study aimed to fulfill the abovementioned information gaps by providing detailed evaluation of the delivery process; the impact of the SIAN on vitamin A deficiency (VAD) and related outcomes, and consumption of vitamin A rich foods in Mali. To gather data, a surveillance consisting of direct observations, focus groups and individual interviews were carried out in four randomly selected health districts.

The data were collected and analysed in terms of strengths and weaknesses of planning process, actual coverage and vitamin A deficiency-related outcomes. For process evaluation the study examined the delivery channels of vitamin A distribution through series of interviews to investigate the reason for successes and failures. To asses the prevalence of VAD-related outcomes, the study carried out physical examination including anthropometric measurements in children and in-depth interviews at household level with mothers.

The study identified strengths and weaknesses of the adopted planning process and, coverage and VAD-related outcomes. The major weakness of the planning process for the semi-annual distribution of vitamin A was that it was a top-down process within the government. The decision makers did not coordinate with operational level functionaries and therefore faced a number of obstacles due to lack of communication. This resulted in a shortage of capsules during campaign, delay in fund mobilization, and low turnout of the targeted population and a lack of trained capsule distributors. Due to an inadequate communications strategy, men, who are decision makers in the family, had poor knowledge of SIAN’s advantage and women found it difficult to identify key components of SIAN from radio messages. The strength of the planning process included a great interest by all the development partners of SIAN in the supplementation programme and an active participation in the planning process. The Union of National Radio and Television Organizations of Africa (URTNA) joined the campaign to increase awareness. The door-to-door capsule distribution was vital in reaching the objective given the low turnout. In terms of financial feasibility, the decision to pre-fund SIAN’s user fee was effective. The strength of coverage and VAD-related outcomes were high coverage of targeted children and postpartum women. Unfortunately use of iodized salt and exclusive breastfeeding remained low, as the capsule distributors could not convey the usefulness to the parents. Compared to the other regions of Mali, the children of Bamako had low vitamin A coverage. SIAN could not provide full coverage as it had originally intended and there is still a high prevalence of VAD-related diseases.

The study recommended that both strategic and operational planning needs to be emphasized by Division Nutrition (DN) and Direction Nationale de la Santé (DNS) in order to improve the effectiveness of the nationwide campaign. By examining the reasons for not being able to reach certain target groups and the low coverage in Bamako, it is necessary to make changes in the plan and provide appropriate training to capsule distributors. Learning from the successes, DN and DNS should consider fine-tuning the door-to-door distribution strategy, as women were not attending in expected numbers. It should identify factors or reasons for the inability of people to understand the content of overall health messages and make adjustments to the way information is provided.

Currently, the publication of a monograph based on this study is in progress and scheduled to be available by mid 2009.