Genesis study charts cost-effective path for Vitamin A delivery

A recent Genesis Analytics study, conducted with UNICEF's West and Central Africa Regional Office, UNICEF Country Offices, and government partners, has analysed Vitamin A supplementation (VAS) delivery in four African countries: Liberia, Togo, Niger, and the Democratic Republic of Congo (DRC).

The research provides evidence-based solutions designed to enhance child survival outcomes. These recommendations aim to help governments maximise the impact of their limited resources for greater public health benefit.

Vitamin A deficiency remains a major risk factor for child mortality in sub-Saharan Africa, where achieving high-coverage supplementation remains challenging. Many countries face pressure to improve coverage while operating within constrained budgets. 

This study helps address these challenges by analysing the costs and health outcomes associated with different delivery modalities, including routine facility-based delivery, mass campaigns and blended approaches..

The analysis used a cost-effectiveness approach, measuring the relationship between programme costs and health outcomes expressed as Disability-Adjusted Life Years (DALYs). For each country, more than 650 possible delivery scenarios were modelled by varying age groups, urban/rural settings, and the mix of campaign vs. facility delivery. 

Using these results, the team constructed an efficiency frontier  - a set of scenarios that deliver the lowest DALYs for any given level of cost. Importantly, the frontier does not compare countries to each other. Instead, it highlights which delivery configurations within each country offer better value for money relative to the current baseline.

The way forward

Key findings indicate that prioritising children aged 6–23 months is an efficient strategy when budgets are tight, given their higher vulnerability to illness and mortality. The frontier analysis allows each country to compare its current delivery model with a wide set of alternative configurations, highlighting whether the baseline is efficient or whether other combinations of campaign and facility delivery could achieve better outcomes for the same or lower cost. 

For example, in the DRC - where the baseline model relies heavily on campaign delivery - the frontier identifies several alternative mixes that deliver similar or greater health impact at lower cost by rebalancing campaign and facility distribution across age groups. Across countries, many of these cost-effective frontier scenarios also point to substantial savings, such as reductions of around 35% in the DRC and 43% in Niger, while maintaining reasonable levels of impact.

The study translates these findings into actionable recommendations, including harmonising coverage measurement methodologies, strengthening financial data monitoring, and optimising the balance between campaign and facility-based delivery. 

It particularly emphasises the importance of strengthening routine health systems in countries heavily reliant on campaigns to ensure long-term sustainability.

The analysis demonstrates that while considerable cost savings can be achieved through optimised delivery strategies, decision-makers must carefully consider the trade-off between cost reduction and coverage levels when selecting implementation approaches.

The VAS decision tool accompanying the study enables countries to explore these scenarios directly, helping inform planning, transitions between delivery platforms, and engagement with funders.