Helen Keller Intl launched programs to deliver vitamin A supplementation to children in the 1970’s. We have pioneered this important work worldwide. Vitamin A provides young children with a critical nutrient to build healthy immune systems and strong vision. Research shows that providing doses of vitamin A supplementation twice a year to children from six months to five years of age can reduce child mortality by almost a quarter. We now deliver vitamin A to millions of vulnerable children annually in twelve countries in West, Central, and East Africa.
David Doledec is Helen Keller Intl’s Country Director in Kenya as well as the Manager of our vitamin A supplementation program across Africa. Originally from France, he now lives in his adopted city of Nairobi with his wife and three sons. David spoke with us recently about how we are adapting our work to ensure safe delivery of vitamin A during the COVID-19 pandemic.
Q: How has COVID-19 impacted our delivery of vitamin A supplementation in the West and East African countries where we work?
A: COVID-19 has significantly disrupted the health systems of these countries. In six of them (Burkina Faso, Cote d’Ivoire, Guinea, Kenya, Niger, and Nigeria), we had planned to deliver vitamin A supplements in May, in partnership with health departments and local partners. We would have done this through national door-to-door campaigns that would have reached millions of children. But, everything was postponed after the World Health Organization recommended suspending all mass campaigns in order to keep everyone as safe as possible.
Thankfully, we didn’t have to pause for long. Instead, once safety protocols had been developed, we were able to return to delivering vitamin A supplements from late June through August. We are now supplying protective equipment and hand sanitizer in bulk to all of the volunteers and partners who are in close contacts with the families we are serving. This is all new in the time of COVID. We didn’t need to do that before.
In other countries like Cameroon and Mozambique, we organize routine supplementation as opposed to campaigns. This means that the supplementation is delivered on a rolling basis, in a health facility as part of an integrated package of care. When the pandemic started, health systems redirected their efforts and resources towards COVID-19 preparedness and response. Ensuring that children were getting their routine vitamin A supplementation on schedule became less of a focus.
Combined with the fact that people were avoiding health facilities out of fear of contracting COVID-19, routine vitamin A supplementation rates dropped significantly.
Q: How is all of this impacting the people we serve?
A: Vitamin A supplementation helps boost immunity and is proven to reduce child mortality. If we increase the time between vitamin A supplements by more than six months, the positive effects on children’s immunity starts to disappear. The longer we wait, the greater the frightening risk of serious illness.
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Before this summer’s “catch-up” campaigns, the last period when we were able to reach huge numbers of children was October 2019. It was urgent that we start delivering vitamin A as soon as it was safe enough, to ensure that children had all of its protective benefits.
Q: Are there any populations with whom we work that are particularly vulnerable in the new context of the pandemic?
A: Children under five are very vulnerable, as they always have been. They may not be very vulnerable to COVID-19 – although we do not know for certain exactly how it impacts them. But in the countries where we are, these young children are in general more vulnerable to disease. The fact that they are visiting health centers less often during the pandemic puts them at greater risk.
Q: How is your team keeping safe and helping the people you serve stay safe during this crisis?
A: The main idea is to respect the WHO recommendations around social distancing and infection control measures. This means that health workers need to limit their proximity to the family members and children they are serving. Health workers no longer enter households to provide vitamin A to children. And, they wear masks.
If for some reason there is no mask available, the health worker can instruct a parent how to put the dose in the child’s mouth. In most cases, the worker will have a mask. In this case, he or she will keep six feet of distance and only come close to the child when putting drops in his or her mouth. This only takes a couple of seconds. Then they step back to six feet of distance. Wearing a mask is compulsory, as is using hand sanitizer before and after each visit.
Those are the major changes in how we are providing vitamin A supplementation. But, then we also have a long list of smaller requirements. For example, we are now purchasing all equipment locally so that it doesn’t pass through too many hands. Training is done outside, in small groups of ten people at most, well separated from each other. There will be frequent handwashing. We are organizing one-way pathways in health centers so that people don’t cross paths. Things like that. It’s really all about distance and hand hygiene.
We’ve created guidelines that explain how to organize health campaigns in the context of COVID-19. First, we have contributed to guidelines that are shaping how all global health organizations provide vitamin A through our collaboration with the Global Alliance for Vitamin A (GAVA). Then, we have also crafted a very detailed set of guidelines for our work staff and partners.
We are including all these special measures in safety trainings that will happen before the distributions.
Q: What is Helen Keller Intl doing to mitigate the impact on clients?
A: We organized “catch-up campaigns” in several countries. These provided vitamin A supplementation to the children who had to miss their doses during COVID. We are also advising governments on how to best organize both catch-up campaigns and vitamin A delivery through routine health services. We are providing financial resources for local health providers to help pay for these adjustments. Financial constraints, we know, often get in the way of delivering life-saving vitamins to children. And Helen Keller is offering technical support, including the guidelines I mentioned. The purpose of our work is to ensure that countries can implement safe vitamin A campaigns and reach the most children as possible – and as soon as possible.
As for routine vitamin A distribution – that never stopped. It’s just that people reduced their visits to health centers, out of fear of COVID-19. Health workers were too busy responding to the COVID threat to address the decline in coverage. Now, we are ramping routine supplementation back up. We are encouraging people to come back in. We are assuring them that we are following WHO and GAVA guidance to keep people safe. And we are also considering whether we can boost routine coverage with a hybrid of routine and campaign delivery. In other words, can we use community volunteers to go door to door to compensate for the gap in coverage that we have seen? It’s a discussion that is happening on a country by country basis. It will depend on resources and capacity.
Q: Are any of the programs returning to normal any time soon?
A: Unfortunately, we are not expecting to return to normal for a very long time. Maybe what was once considered normal will change forever. As long as there are still cases of COVID-19, we will have to take precautions. So, our focus is on working with governments to support new types of delivery, new forms of campaigns, new types of infection control measures.
Q: What gives you hope in this challenging time?
A: What makes me optimistic is that people are extremely resilient. African governments in general have reacted strongly, early, and efficiently. The impact of the crisis on public health in many of the countries where we work has been more limited than many people feared. All this is quite good news. We won’t be returning to normal any time soon. But, I am optimistic that we are creating a new normal. We will get through this together.