National Vitamin A Supplementation Programme (NVASP)
Introduction
- Flagship public health intervention under National Health Mission (NHM), Child Health Division, Ministry of Health & Family Welfare (MoHFW), Government of India
- Launched in 1970s; revised & strengthened as part of RMNCH+A strategy to combat Vitamin A deficiency (VAD)
- VAD is major preventable cause of childhood blindness, increased morbidity & mortality from measles & diarrhea
- Provides prophylactic mega-dose oral Vitamin A to prevent subclinical & clinical deficiency in under-5 children
- Universal coverage approach β no screening required; biannual fixed-day strategy
Objectives
- Prevent & control Vitamin A deficiency disorders (night blindness, Bitotβs spots, corneal xerosis/ulceration, keratomalacia)
- Reduce under-5 mortality & morbidity (especially measles case-fatality, diarrhea severity)
- Improve child survival, growth & immunity
- Achieve >90% coverage of 9 doses in 9β59 months age group
- Integrate with routine immunization, deworming, growth monitoring & nutrition programs
Target Group & Dosage Schedule (Current NHM Guidelines)
- All children 9β59 months (universal coverage)
- Total 9 doses till 5 years of age:
| Age Group | Dose (IU) | Volume | Timing / Frequency |
|---|---|---|---|
| 9 months | 100,000 | 1 ml | With MR-1 vaccine |
| 16β23 months | 200,000 | 2 ml | With DPT booster / MR-2 |
| 24β59 months | 200,000 | 2 ml | Every 6 months (biannual rounds) |
- First dose at 9 completed months (co-administered with measles/MR vaccine)
- Subsequent doses every 6 months up to 59 months
- Oral oil-based preparation (100,000 IU/ml syrup)
- Not given below 6 months or above 5 years routinely
Implementation Strategy
- Delivery Platforms:
- Routine Immunization sessions (fixed & outreach)
- Village Health Sanitation & Nutrition Days (VHSND)
- Anganwadi Centers (ICDS)
- ASHA home visits & MCP card tracking
- Special biannual Vitamin A supplementation rounds (2 fixed days per year)
- Service Providers: ANM, ASHA, AWW β trained on administration, contraindications & recording
- Supply Chain: Vitamin A syrup supplied free through NHM; cold-chain not required (stable at room temperature)
- Contraindications: None for prophylaxis; defer only in acute illness with vomiting or known hypervitaminosis
- Counseling: Mothers advised on side-effects (transient vomiting, bulging fontanelle β rare), benefits & next due date
Integration with National Programs
- Routine Immunization & MR campaign: First dose linkage mandatory
- National Deworming Day: Often co-administered with Albendazole
- MCP Card: Recording of each dose with date & batch number
- POSHAN Abhiyaan & Anemia Mukt Bharat: Synergistic with micronutrient supplementation
- IMNCI & HBNC: VAD screening & supplementation in sick-child management
- Rashtriya Bal Swasthya Karyakram (RBSK): Referral of clinical VAD cases
- Facility-based care of SAM: Therapeutic Vitamin A as per WHO protocol for severe acute malnutrition
Monitoring & Evaluation
- Indicators: Coverage of β₯2 doses in last 6 months (NFHS-5: ~71% national average)
- Tools: MCP Card, RCH portal / MCTS, HMIS reporting, rapid coverage evaluation surveys
- Supervision: District & block monitoring; supervisory checklists
- Adverse event reporting: Through pharmacovigilance system (rare)
Impact & Evidence
- Significant decline in clinical VAD & childhood blindness
- Reduces all-cause under-5 mortality by 12β24% in deficient populations (WHO evidence)
- Contributes to Indiaβs progress towards SDG 2 & 3 targets
- Cost-effective intervention (high return on investment)
- Current focus (2024β26): Improve last-mile coverage in hard-to-reach areas, urban slums & migratory populations; linkage with digital tracking