Existing Education System as a channel for the Improvement of Vitamin A
Supplementation Uptake in Njiru Dispensary, Nairobi Province Kenya
Improvement Report
Author(s): Joshua Kenyatta, Janet Muriuki, Linnet Otieno, Patricia Katunge
Topics: Maternal and Neonatal Child Health
Region: Africa, Sub Saharan, Kenya
Organization: Njiru Organic Farming Integrated
The Problem
Vitamin A deficiency (VAD) is a common problem among preschool children and is associated with high
mortality and morbidity. VAD has profound effects on the health of children including impaired immunity
(leading to severity of infections such as measles and diarrhea), poor growth and development, visual
impairment as well as iron deficiency anemia.
In Kenya, 30% of children aged 6-59 months received a vitamin A supplement in the six months preceding
the Kenya Demographic Health survey of 2008-2009. The Kenya Guidelines for Vitamin A supplementation
(VAS) through Early Childhood Development Centers (ECD) recommends twice yearly supplementation of
this age group. In the past VAD was primarily done at health facilities with peak times during the child
health and nutrition weeks (Malezi Bora). However children in ECDs were not reached through this
approach.
Njiru Dispensary is located in Njiru district; one of the nine districts in the Nairobi province. The dispensary
opened in 2009 and has been working with community health workers and community based organizations
to provide vitamin A supplementation to children. One such organization is Njiru Organic Farming
Integrated (NOFI), which started as an organization providing simple organic farming solutions to the
community but has now diversified its mandate to include health care. Its activities now include supporting
the community to access HIV/AIDS care and treatment as well as a focus on maternal and child health. They
also support 680 OVC to access improved health, food & nutrition support, shelter & care, child protection,
education, psychosocial support, and household economic strengthening services.
In January 2011, only a paltry 39 children between 12 to 59 months of age received vitamin A
supplementation (according to the district health information system) through Njiru dispensary despite this
strategy.
The intervention
In June 2011, the chairperson of the Njiru Organic Farming Integrated (NOFI) group attended a 5-day quality
improvement (QI) coaches training together with two district government officials. The QI training was
based on the Orphans and Vulnerable Children (OVC) QI service standards for Kenya using a QI approach
known as Improvement Collaborative. The training was a joint initiative of APHIAplus Nairobi-Coast and
Health Care Improvement Project, both USAID funded.
Following the quality improvement coaches training, NOFI trained and set up a 20 member quality
improvement team made up of representatives of OVC, caregivers, key community and religious leaders,
teachers and community health workers (CHWs). In line with the quality improvement guidelines they
selected three key areas that were the most challenging in their community; education, health, shelter and
care. Three teams were created to take care of these areas.
The education team had members who were CHWs attached to Njiru dispensary and were aware of the
challenge that the neighboring Njiru dispensary was facing with the distribution of vitamin A
supplementation. They encouraged the health facility to work through the school system in order to reach
the children.
The CHWs, health facility management team and head teachers decided to work together targeting private
and public schools. The four teachers in the QI team helped in mapping and selection of 13 schools that had
the highest number of under fives.
All children under five were registered using the normal school registers. Subsequently, a day was set aside
for a health worker to come and administer vitamin A. Once a child is provided with the supplement, their
name is checked off in the register and a note is handed to them to take to their parent indicating that the
child received the supplement. In addition to this, the child receives a small ink mark on their little finger.
Caregivers have prior knowledge of what the mark signifies. Those children who are not reached through
the school are reached through door to door intervention and Sunday schools in churches.
At the facility level, vitamin A tally sheets were used for the exercise as well as the children’s health cards.
All the 13 ECDs are maintaining the VAD register.
Results
There has been an improvement in the numbers of children receiving vitamin A supplementation since this
program began last year. In December 2011, through the schools, a total of 2655 children were reached
including 124 OVCs supported by NOFI. This is a significant improvement from the 39 recorded in January
2011.
Vitamin A Supplemental for Children above One Year of Age - 2011
3000
2655
2500
2000
1500
1000
478
500
39
78
January
March
391
120
218
163
September
November
0
June
July
August
December
In addition to providing vitamin A, the school system can be used to carry out deworming as well as
participate in national immunization campaigns for polio and measles. The last national campaign for polio
was carried out in December 2011 also reaching the same number of children under five within the thirteen
schools.
Lessons
Involving key members of the community in promoting their own healthcare is an effective model for
creating impact through targeting health services to those who need them most.
This model of engagement is also the cornerstone of the community strategy. The community strategy
works best if different partners at community level maintain commitment to community based health and
undertake initiatives that enrich or complement day to day tasks of the community health worker. It is
essential that CHWs are fully involved in such initiatives.
Before NOFI set up the quality improvement team, it was impossible to penetrate the school system
(especially private schools) for such activities. However, after engaging the teachers, key community and
religious elders in the team, they have been able to work through the schools and to a smaller level the
households and churches.
A well planned strategy leads to the unveiling of gaps that if addressed collectively benefits many and
especially those who need to be targeted. Efforts to improve the quality of service provided to the OVC
were able to reveal underlying challenges and when these challenges were addressed a large number of
children aged 12 months – 59 months benefited from VAS.