Process evaluation of an EPI-integrated vitamin A capsule delivery programme in KAT zone, southern Ethiopia

Abstract

Background: As an intermediate strategy to control vitamin A deficiency, which is one of the major nutritional problems in Ethiopia, the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health initiated a national vitamin A supplementation programme utilising oral delivery of vitamin A in mid-1995. The aim was to improve vitamin A status by providing vitamin A to all children under 5 years and to lactating and pregnant women in accordance with the schedule and dosage recommended by the World Health Organisation (WHO). Process evaluation of the programme was conducted in June 1997. Objectives: To evaluate the progress of the programme, identify constraints and forward suggestions to improve programme implementation. Methods: The southern region of Ethiopia was selected deliberately, while KAT (Kambatta, Alaba and Timbaro) zone was selected randomly. Two districts in KAT zone were selected randomly and all health institutions in these districts and about 40 systematically selected mothers living around the health institutions were included in the study. Discussions regarding various aspects of the programme were entered into with relevant officials at the regional health office, zonal health office and institution offices. A questionnaire addressing maternal awareness of the programme and maternal knowledge regarding vitamin A was administered by trained nurses. Results: Results indicate that the institutions in the two districts received only 10.2% of their total requirement of 50 000 IU vitamin A capsules and none of the 10 000 IU capsules. Of this meagre amount received, about 50% was reported to have been delivered, but there was no documentation of the distribution available to support this claim. Training, teaching materials and workshops were inadequate, and lack of awareness was therefore mentioned as a major problem by most respondents. Lack of adequate resources, especially lack of adequate health personnel and budget, was mentioned as a crucial problem by those health institutions that had attempted to implement the programme. No supervisory or monitoring mechanisms had been instituted. Maternal understanding of the importance of vitamin A was poor. Only 18.7% of the mothers could name at least one food rich in vitamin A and only 6.1% knew the consequences of vitamin A deficiency. Only 2.8% of the mothers reported that at least one of their children had received vitamin A supplementation. Conclusions and recommendations: Based on these results it is difficult to conclude that the programme achieved its objectives. Lack of awareness at all levels of the health care delivery system and inadequate resources (staff and logistics) appear to have been the major constraints. Therefore, promotion of awareness among all concerned stakeholders including mothers, involvement of the non-health sector, and provision of adequate financial and logistical support are highly recommended for the effective implementation of such a programme.