Vitamin Angels Embraces the Direct Health-Care Sector Nutrition Interventions Described in The Lancet Series on Maternal and Child Undernutrition Progress

By Clayton Ajello, DRPH, MPH, and Kristen Hurley, PhD, MPH

The Vitamin Angel Alliance

Vitamin Angels (VA) continues to expand access to evidence-based nutrition interventions in a sustainable manner by providing:

  • Technical and advisory services to large health care systems – both governmental and non-governmental – that seek to add or strengthen existing nutrition services,
  • Technical assistance to VA partner organizations during design and implementation of nutrition programs, and
  • Selected support for the provision of commodities that allow for the delivery of evidence-based nutrition services by our partners.
     

Evolving Capabilities

Many know VA primarily as a supplier of commodities to non-governmental organizations (NGOs). Indeed, VA focused, initially, on strategic deployment of the evidence-based intervention, high dose vitamin A supplementation, starting in earnest in 2007. Many are less familiar with VA’s gradual, but purposeful, transition over the subsequent decade, during which VA built out a package of technical assistance needed by NGOs to activate or strengthen the delivery of vitamin A supplementation.  Simultaneously, VA explored and extended its support for other nutrition-specific interventions including promoting optimal infant and young child feeding practices, implementing deworming programs, and exploring introduction of micronutrient powders for young children; while also extending commodities support and access to a toolbox of learning solutions to national ministries of health.

After a comprehensive program evaluation was completed in 2013, VA embarked on a strategic re-think of its activities through a continuous, multi-year process of self-assessment, re-structuring, and capacity building. These efforts have focused on building VA’s capacity to deliver a wider range of evidence-based nutrition interventions to our target group of very hard-to-reach women and children up to the age of 5 years that included:

  • Building VA’s capacity to insert itself earlier and more proactively in the planning cycles of national health services by offering to support behind the scenes advocacy and technical advisory services that help create awareness and build consensus about the need to extend selected nutrition services to the hardest-to-reach women and children.
     
  • Building and investing in a longer-term plan to build VA’s capacity to provide the technical assistance needed by our partners to deliver impactful services to the very hardest-to-reach women and children.
     
  • Growing, strengthening, and professionalizing VA’s supply chain management to ensure that where VA provides its partners with selected pharmaceutical and nutritional supplement products, that these are manufactured consistent with internationally recognized manufacturing (cGMP) and pharmacopeial standards, and delivered consistent with best practice.
     

Our ongoing self-assessment and capacity-building has enabled VA to achieve several milestones in recent years as shown in the bullets below.

Milestones
 

  • 2015: VA’s Board of Directors approved a forward-looking policy to examination of the evidence supporting of multiple micronutrient supplementation and to systematically explore the feasibility of introducing multiple micronutrient supplementation (MMS) for pregnant women among influencers and champions within VA’s network of NGO health systems partners.
     
  • 2016: VA develops and tests an e-learning platform for training service providers anywhere to deliver vitamin A supplementation and deworming services. VA received the 2017 Brandon Hall Group Human Capital Management Excellence Award for our e-Learning courses. VA continues to use this global platform to deliver courses in multiple languages.
     
  • 2017: Design and launch supplementary feeding programs for marginalized young children aged 2-5 in the United States and the United Kingdom.
     
  • 2017: VA commits to a major multi-year effort to raise-awareness to MMS, build consensus for MMS use, advocate for its inclusion in antenatal care services.
     
  • 2018: VA partners with Kirk Humanitarian to identify a high-volume manufacturer for MMS in the United States able produce an MMS product to a defined standards of quality based on internationally recognized manufacturing and pharmacopeial standards.
     
  • 2018: VA commences comprehensive effort to build capacity to begin to apply implementation science to the task of effectively introducing and scaling MMS. By 2020, VA initiates MMS-related implementation research in 8 countries and continues to build out its implementation science unit to support introduction and strengthening of any evidence-based nutrition intervention.
     
  • 2019: VA in collaboration with Kirk Humanitarian, the Micronutrient Forum and the New York Academy of Sciences, develops and generates an expert consensus specification for the manufacture of MMS
     
  • 2019 – 2020: VA embarks on an effort to re-imagine its monitoring and evaluation framework and begins transition to incorporate measurement of program outcomes and estimates of program impact.
     

Introduction and Scaling Nutrition Interventions Using Implementation Science

As VA continues to introduce evidence-based nutrition interventions, it will continue to expand and apply the principles of implementation science to: i) create awareness to new interventions, build consensus among stakeholders for the introduction of nutrition interventions, and assist systems to develop appropriate policies and program plans to operational new nutrition interventions, ii) design and test implementation strategies for introduction of interventions in concert with stakeholders to ensure accessibility, affordability, awareness, availability, acceptability, and equity of interventions as they are being introduced and scaled, and iii) assist health systems to plan for the scaling of nutrition interventions.

 

Some Things Don’t Change

Throughout its growth phases, VA has remained constant in one way. Our mission has been to help at-risk populations in need – specifically pregnant women, new mothers, and children under five – gain access to life changing vitamins and minerals. By focusing our work on assuring that nutritionally vulnerable populations have access to vitamins and minerals in the form of evidence-based nutrition interventions, we promote health and economic equity across the lifespan of the populations we seek to serve – which is at the core of VA’s vision. VA’s key contribution is its unique focus and success on connecting services to nutritionally vulnerable populations that are hard-to-reach – whether they are so classified by national health services or NGO health services.

 

Equipped to Support Direct Health-care Sector Nutrition Interventions

During the last five years, VA has begun to consolidate its overall approach to connecting a package of evidence-based nutrition interventions with hard-to-reach populations that face barriers to obtaining nutrition services using implementation science. VA embraces the compendium of proven, direct health-care sector interventions (previously known as nutrition-specific interventions) recently described and shown in Figure 1.

Figure 1. Revised Framework for the Classification of Nutrition Interventions¹

Applying Direct Health-care Sector Interventions for Sustainable Impact Among Hard-to-Reach Women and Children

In coming years, VA’s work will continue to expand its support to large health care systems, whether they be government or NGO sector systems for a more comprehensive set of direct health-care sector interventions identified in Figure 1 that are appropriate for women and children up to 5 years of age. Our approach will continue to be driven by the application of implementation science to support systematic and sustainable introduction and scaling of any evidence-based nutrition intervention targeting women and children. Finally, VA is committed to comprehensive monitoring and evaluation of its programs and the programs of its partners that includes measurement not just of program outputs, but program outcomes and estimates of program impact consistent with VA’s theory of change.    

 


¹Keats, E; etal. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet: March 8, 2021.

UP