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Cost-effectiveness estimates
Helen Keller International
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Summary DALY estimation
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Burkina Faso


CameroonCote d'IvoireDR Congo


Guinea
Kenya
MadagascarMali
Niger
NigeriaMozambiqueSierra LeoneTanzania
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Number of children reached in 2024 1,316,733 6,268,341 4,275,333 10,650,495 1,901,834 3,345,489 2,933,358 2,172,619 5,438,281 5,640,455 588,380 415,070 455,450
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Under five mortality in a year 55,356 63,046 65,790 306,481 45,350 59,036 63,429 83,597 119,782 768,479 75,675 23,993 89,057
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Total unbder five children 3,965,835 5,119,261 5,405,956 22,226,497 2,556,226 8,285,329 5,328,957 4,831,874 5,414,959 39,351,433 6,580,812 1,360,592 12,550,745
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Total expected death among the intervention children 18,379 77,197 52,030 146,860 33,740 23,838 34,915 37,589 120,298 110,150 6,766 7,319 3,232
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Total death prevented 1,102.76 4,631.85 3,121.83 8,811.58 2,024.43 1,430.27 2,094.89 2,255.33 7,217.87 6,609.02 405.96 439.17 193.91
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Life expectancy at age 2.5 years 61.663.2661.3665.4561.8861.3363.0361.4464.0668.262.9363.3564.85
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Discounted life expenctancy at age 2.5 years27.928.227.928.52827.928.227.928.328.928.128.228.4
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Total DALYs averted from deaths 30,767 130,618 87,099 251,130 56,684 39,905 59,076 62,924 204,266 191,001 11,407 12,384 5,507
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Total costs of the intervention 1,250,152 6,813,006 3,805,351 4,692,206 3,348,142 2,791,779 1,113,163 2,086,671 2,533,343 3,173,446 1,578,937 364,111 683,326
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Costs per DALY averted US$ 40.63 52.16 43.69 18.68 59.07 69.96 18.84 33.16 12.40 16.61 138.41 29.40 124.08
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Costs per DALY averted without discounting (US$) 18.4 23.3 19.9 8.1 26.7 31.8 8.4 15.1 5.5 7.0 61.8 13.1 54.3
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GDP per capita US$ PPP 2,896.2 7,653.5 5,591.5 1,709.7 4,579.1 6,619.4 1,883.5 3,308.7 2,015.0 6,439.8 1,699.7 3,515.6 4,220.8
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Please note the monitoring data figures were not subject to internal validation prior to being shared with The Life You Can Save and may change.
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Monitoring data
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Name of the country Burkina FasoCameroonCote d'IvoireDR CongoGuineaKenyaMadagascarMaliNigerNigeriaMozambiqueSenegalSierra LeoneTanzaniaComments
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YearS2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)
S2(2023) /S1(2024)S1: First semester 2024
S2: Second semester 2023
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Name of the programme Vitamin A supplementation
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Brief description of the programmeSince the 1980s, Helen Keller Intl has been at the forefront of demonstrating that twice-yearly vitamin A supplementation (VAS) can reduce child mortality by up to 24% when it reaches at least 80% of children under five in areas where vitamin A deficiency is a public health concern. Building on WHO’s 1997 recommendation for universal VAS in such contexts, coverage across sub-Saharan Africa exceeded 80% from the early 2000s through large-scale, door-to-door campaigns, many of them linked to polio immunization. However, with the phase-out of polio campaigns since 2016, coverage has declined as efforts shifted towards routine facility-based delivery, which has struggled to reach older children. Helen Keller now supports 14 countries in sub-Saharan Africa to sustain VAS, testing alternative delivery models—including outreach, facility-based integration, and continued door-to-door campaigns with added services such as deworming and malnutrition screening. Despite persistent challenges in cost, complexity, and health system capacity, Helen Keller remains committed to working with governments to build sustainable, high-impact delivery approaches that ensure this life-saving intervention continues to reach children in need.
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Objective of the programme1. All countries will have, at least, identified, tested and documented a country-specific sustainable and cost-effective delivery model for VAS that is fully integrated in health system
2. All countries will have developed and started implementing a transition plan for VAS towards a cost-effective and sustainable model
3. Global evidence will have increased on cost effective and sustainable delivery models for VAS
4.The proportion of VAS services costs covered by domestic funding will have increased
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Outcome description1. Coverage of VAS>80% of children under five
2. VAS service funded and supported by local goevrnments
3. Increased efficiency of health system functions and actors
4. Increased evidence of cost-effective delivery models for VAS
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Target group (age specific/description)
Children aged from 6 to 59 months
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Total Target Population by age group/target group in number for the second semester 2023 1,092,488 5,833,851 3,236,348 8,006,201 2,413,615 3,716,143
There is no support from Helen Keller.
2,011,133 6,361,641 5,893,770 708,534
Data were not available beacause of the strike of health worker
495,467 352,073
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Number of children reached with VAS capusles during the second semester 2023 1,119,578 5,747,946 2,937,074 7,955,556 2,203,496 3,357,446
There is no support from Helen Keller.
1,872,364 5,438,281 5,544,101 668,664
Data were not available beacause of the strike of health worker
413,488 482,340
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Total Target Population by age group/target group in number for the first semester 2024 1,240,653 6,363,659 5,180,887 10,531,672 2,237,452 3,871,439 3,259,112 2,129,241 6,924,961 6,064,880 723,763
Data were not available beacause of the strike of health worker
506,859 367,298
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Number of children reached with VAS capusles during the first semester 2024 1,316,733 6,268,341 4,275,333 10,650,495 1,901,834 3,345,489 2,933,358 2,172,619 5,438,281 5,640,455 588,380
Data were not available beacause of the strike of health worker
415,070 455,450
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TOTAL Number of Vitamin A capsules distributed for the fiscal year 2024 2,436,311 12,016,287 7,212,407 18,606,051 4,105,330 6,702,935 2,933,358 4,044,983 10,876,562 11,184,556 1,257,044
Data were not available beacause of the strike of health worker
828,558 937,790
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Gender distribution of the beneficiariesNot availableData are not disaggregated by gender in all countries.
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Programme start dateThe data providded program started 1 st July 2023 and end the 30rd june 2024
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Duration of the programmeThe information provided is linked to the duration of one year for the implementation of the program for the fiscal year 2024, which starts on July 1, 2023, and ends on June 30, 2024.
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List of outcome indicators (prevention of morbidity / mortality; improvements in living standards, learning outcomes)
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Indicator 1 VAS Coverage 1.1 % of eligible infants 6−11 months of age receiving an age-appropriate vitamin A supplement through event-based vitamin A distribution in the previous semester using administrative data.
1.2 % of eligible children 12−59 months of age receiving an age-appropriate vitamin A supplement through event-based vitamin A distribution in the previous semester using administrative data.
1.3 % of eligible infants 6−11 months of age receiving an age-appropriate vitamin A supplement through event-based vitamin A distribution in the previous semester using PECS data.
1.4 % of eligible children 12−59 months of age receiving an age-appropriate vitamin A supplement through event-based vitamin A distribution in the previous semester using PECS data.
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Indicator 2 : Cost per Supplement2.1 Cost per supplement using administrative coverage.
2.2 Cost per supplement using PECS coverage.
2.3 Difference between costs reported using administrative data and PECS data.
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Baseline status of the outcome indicators
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Indicator 1 fiscal year 2023 VAS coverage94%83%100%96%100%83%
No supoort from Helen Keller
92%94%88%80%80%80%80%
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Indicator 2 - no data available
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Endline status of the outcome indicators after evaluation or effect size of the programme after evaluation
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VAS coverage semester 2 2023 102%99%91%99%91%90%No suport from Helen Keller93%85%94%94%no data83%137%
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VAS coverage semester 1 2024106%99%83%101%85%86%90%102%79%93%81%no data82%124%
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Average104%99%87%100%88%88%90%98%82%94%88%#DIV/0!83%131%
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Cost of the programme/intervention in details
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Cost of capital items2443.51106249124511120780253391080526207557328100610160629319961305613150
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Costs of recurrent items 1,247,709 6,706,757 3,680,840 4,571,426 3,322,803 2,683,727 1,051,088 2,029,343 2,432,733 3,012,817 1,546,941 519,203 362,796 683,326
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Total costs of the programme 1,250,152 6,813,006 3,805,351 4,692,206 3,348,142 2,791,779 1,113,163 2,086,671 2,533,343 3,173,446 1,578,937 532,259 364,111 683,326
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Cost estimate timeframe ($)The above cost is for one year the fiscal year 2024
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Detailed estimations
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Burkina FasoCameroonCote d'IvoireDR CongoGuineaKenyaMadagascarMaliNigerNigeriaMozambiqueSenegalSierra LeoneTanzaniaComments
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Additional number of chidren reached12%16%-17%5%-15%3%10%-15%5%1%2%44%
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https://pmc.ncbi.nlm.nih.gov/articles/PMC8925277/
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Under five mortality per 1000 live births 77 67 67 73 95 40 65 91 115 105 62 39 94 39
This study showed 12% reduction in all causes of death due to vitamine A difficiency
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Live births in thousands in a year 729 957 997 4 370 488 1 500 1 001 951 1 096 7 510 1 261 532 259 2 346
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Total live births 728,612 957,392 997,001 4,369,683 487,595 1,499,998 1,001,244 951,445 1,095,892 7,509,758 1,260,855 531,890 258,903 2,346,391
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Under five mortality rate per children 0.11 0.07 0.07 0.02 0.19 0.03 0.06 0.10 0.10 0.01 0.05 0.07 0.36 0.02
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Expected total mortality in a year 139,153 438,670 287,309 177,927 370,542 89,213 190,431 207,798 570,679 78,864 28,792 151,181 7,551
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Reported deaths in UNICEF data 55,356 63,046 65,790 306,481 45,350 59,036 63,429 83,597 119,782 768,479 75,675 23,993 89,057
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Total under five children 3,965,835 5,119,261 5,405,956 22,226,497 2,556,226 8,285,329 5,328,957 4,831,874 5,414,959 39,351,433 6,580,812 2,875,459 1,360,592 12,550,745
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Death rate 0.0140 0.0123 0.0122 0.0138 0.0177 0.0071 0.0119 0.0173 0.0221 0.0195 0.0115 - 0.0176 0.0071
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Total death among the intervention population 18,379 77,197 52,030 146,860 33,740 23,838 34,915 37,589 120,298 110,150 6,766 7,319 3,232
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Total death prevented 1,102.76 4,631.85 3,121.83 8,811.58 2,024.43 1,430.27 2,094.89 2,255.33 7,217.87 6,609.02 405.96 - 439.17 193.91
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Life expectancy at birth61.09263.761.94461.89560.7463.64663.63260.43961.18354.46263.61161.78666.995
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LE at avergae age at death 2.5 61.663.2661.3665.4561.8861.3363.0361.4464.0668.262.9363.3564.85
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Discounted at 3%27.928.227.928.52827.928.227.928.328.928.128.228.4
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Total DALYs averted (six months protection) 30,767 130,618 87,099 251,130 56,684 39,905 59,076 62,924 204,266 191,001 11,407 - 12,384 5,507
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Costs per DALY averted US$ 40.63 52.16 43.69 18.68 59.07 69.96 18.84 33.16 12.40 16.61 138.41 29.40 124.08
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Prevalence of VAD 86.6% 39%30%61%25.90%62%45%36%25%29.50%72.10%48%17%69.50%
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Source
Status report on vitamin A deficiency and associated factors in the health area of Sanmatenga province (Burkina Faso) | Research Square
https://www.unicef.org/cameroon/what-we-do/nutrition-0
https://www.sante.gouv.ci/assets/fichiers/projet-de-supplementation-en-vitamine-a-et-de-deparasitage-des-enfants-de-6-a-59-mois-dans-24-districts-sanitaires.pdf
https://documents1.worldbank.org/curated/en/510801506583879408/pdf/120109-WP-ScalingUpNutritionDRCFINAL-PUBLIC.pdf
https://www.nutritionintl.org/wp-content/uploads/2023/02/Kenya-Country-Brief-Feb-2023-Digital.pdf
https://helenkellerintl.org/where-we-work/madagascar/
https://wellsbringhope.org/the-long-term-battle-of-vitamin-a-deficiency-in-niger/
https://www.nri.org/latest/news/2013/cassava-to-help-combat-vitamin-a-deficiency
https://www.researchgate.net/publication/8028201_Vitamin_A_deficiency_and_child_mortality_in_Mozambique
https://www.gava.org/content/user_files/2016/12/VAS-symposium-report.pdf
https://www.unicef.org/sierraleone/stories/community-health-workers-increase-vitamin-supplementation-vas-and-immunization-coverage
8. Ndau, E, Mosha, T, Horton, S, and Laswai, H. Influence of vitamin A status on the anthropometric attributes of children aged 6-36 months in Tanzania. Tanzania J Agric Sci. (2018) 16
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GDP per capita US$ PPP2896.1874167653.4503385591.4963981709.7320774579.1018736619.3585741883.5374313308.6694892015.0228216439.8129221699.7050343515.5627134220.796387
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