The Cost and Cost-Effectiveness of Vitamin A Supplementation: An Assessment of a Vitamin A Days-Plus Event in Burkina Faso.

Background: Campaign-based vitamin A supplementation (VAS) programs are under pressure to reduce costs and increase coverage. Objectives: This study examined coverage, costs, cost-effectiveness, and cost burdens of a campaign-based VAS event (JVA+) in the Yako and Kombissiri health districts of central Burkina Faso. Methods: Data were collected from groups of JVA+ event implementers and caregivers. Post-event coverage surveys measured coverage; spatially scaled primary data provided estimates of costs. Costs of caregiver participation were measured. Data were provided by all actors involved in the design and implementation of the JVA+ event. Results: Overall, 88% of the target age group was covered. Overall coverage did not differ across health districts but was lower in urban areas. Children 6 to 11 months of age had lower coverage, especially in urban areas. The VAS event cost ∼137k USD. Average cost per child reached was 1.34 USD, ranging from 1.19 USD (Yako) to 1.62 USD (Kombissiri). National costs, with international support, covered VA capsules and community health worker salaries. Community stakeholders incurred administrative and transportation/communication costs; regional and district-level stakeholders made small contributions. Caregivers in rural areas contributed significant amounts of time (∼20% of total program costs in some areas). Conclusions: The vast majority of Burkinabe children suffer from vitamin A inadequacy. JVA+ events can be generally effective in distributing twice-annual VAS, but are expensive and heavily reliant on international assistance, and are unsustainable. Young children were consistently under-reached, especially in urban areas. Costs to caregivers were high in rural areas. Evidence-based, area-specific changes in program design could increase coverage and efficiency.