Acceptance and challenges of the introduction of the routine community-based vitamin A supplementation strategy: the case of Burkina Faso

Objectives: With the phase-out of the polio campaigns, Burkina Faso has developed a new strategy for routine community-based vitamin A supplementation (VAS) by institutionalising community-based health workers (CBHW) to sustain the gain of two decades of successful programming. Formative research was conducted soon after the strategy was introduced to solicit feedback on the acceptability of the new approach by the implementing actors while identifying the main implementation challenges for improving its effectiveness and sustainability. Design: This qualitative study was conducted in 2018 through (i) document review, (ii) individual interviews with key informants at the central, regional and district levels, and (iii) focus groups with CBHW and caregivers. Setting: Data collection was carried out at six levels of sites covering the entire country and selected based on VAS coverage rates with the community routine. A total of six health districts were selected. Participants: We conducted 46 individual interviews with health workers and 20 focus groups with 59 CBHW and 108 caregivers. Results: The study showed good acceptability of the strategy by all stakeholders. In the first 2 years of implementation, the national coverage of VAS was maintained at a high level (above 90 %) and there was a reduction in operational costs. The main challenges included delayed CBHW remuneration and weak communication and supervision Conclusions: The acceptability of the community-based routine VAS was good and was perceived to have a high potential for sustainability. Addressing identified challenges will allow us to better manage the expectations of community stakeholders and maintain the initial results