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 – no screening required; biannual fixed-day strategy

Objectives

• Prevent & control Vitamin A deficiency disorders (night blindness, Bitot’s 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 9–59 months age group
• Integrate with routine immunization, deworming, growth monitoring & nutrition programs

Target Group & Dosage Schedule (Current NHM Guidelines)

• All children 9–59 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
  16–23 months	200,000	2 ml	With DPT booster / MR-2
  24–59 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 – 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 – 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 ≥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 12–24% in deficient populations (WHO evidence)
• Contributes to India’s progress towards SDG 2 & 3 targets
• Cost-effective intervention (high return on investment)
• Current focus (2024–26): Improve last-mile coverage in hard-to-reach areas, urban slums & migratory populations; linkage with digital tracking