Nepal has achieved amazing reductions in child mortality rates in the past ten years - an accomplishment that has largely gone unheralded. One reason for this may be the quiet success of affordable programs such as the Ministry of Health and Population’s National Vitamin A Program, which provides high-dose vitamin A supplementation twice a year to children in all of Nepal’s 75 districts. The nation-wide supplementation that will take place this Friday, November 2nd and Saturday, November 3rd is an occasion to recognize the tremendous impact that this program, and the Female Community Health Volunteers who implement it, have on Nepal’s children.

Established in 1993 and co-funded by the Government of Nepal, USAID, UNICEF and AusAID, the National Vitamin A Program has rapidly grown to cover the entire country, making supplementation available to all Nepali children ages 6 months to five years. Surveys conducted after each supplementation round have found coverage rates over 95%. USAID estimates that approximately 15,000 child deaths are now being averted each year in Nepal through this intervention alone, contributing to the dramatic 45% nation-wide reduction in child deaths since 1996. At a cost of about one rupee per capsule, Vitamin A supplementation is also one of the most cost-effective child health interventions available anywhere.

This expansion would have been impossible without the hard work and dedication of Female Community Health Volunteers, of whom 49,000 have been trained. Volunteers in each district identify and register all eligible children and provide them with the correct dose of vitamin A during each 2-day supplementation round. With support from some 110,000 other health and development workers, teachers and community leaders, Volunteers reached 3.65 million eligible children during the April 2007 round.

Volunteers also conduct nutrition education to promote the consumption of vitamin A rich foods, helping to reduce vitamin A deficiency in older children and in women of childbearing age, and to sustain the impact of supplementation for younger children. Now, eligible children also get de-worming tablets with supplementation.

Having earned the respect and recognition of communities through their tireless, unpaid work to save lives, Volunteers’ influence has grown in other areas of community health. They have become important health educators of other women and children in their communities and reliable providers of basic health services. Volunteers implement programs such as family planning services, antenatal care for mothers, treatment of childhood diarrhea, regular childhood immunizations, and national polio immunization days, all of which have a direct impact on child survival. Volunteers also provide oral re-hydration salts, condoms, pills, vitamin supplements and first aid.

Nepal owes its success in accurate and thorough distribution of Vitamin A and in greatly reducing deaths in children to the dedicated women of Nepal who have assumed responsibility for bringing treatment to their own communities. USAID is confident that the role of Volunteers in community health will continue to expand in the future. This Friday and Saturday, we celebrate the Ministry of Health and Population’s National Vitamin A Program and the Female Community Health Volunteers for their sustained commitment and extend our deepest thanks to them for their outstanding work.

Beth S. Paige,
Director, USAID/Nepal