Nepal’s National Vitamin A Programme: Policies, Guidelines and Regulatory Frameworks

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Policy Brief:

Nepal’s National Vitamin A Programme (NVAP) is embedded in a robust framework of national policies, multi-sector plans, guidelines, and laws that have evolved over decades. These documents collectively aim to ensure “nutritional well being of all people in Nepal” through coordinated efforts (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). Early evidence in the 1980s of widespread Vitamin A deficiency and its link to child mortality spurred high-level commitment. Over time, Nepal developed a comprehensive nutrition policy (2004) and launched multi-sector plans to tackle underlying causes of malnutrition. Operational guidelines for NVAP were created in the 1990s and updated as the program scaled nationwide. The Constitution of Nepal (2015) and subsequent health legislation enshrine citizens’ rights to nutrition and health, mandating government responsibility for programs like NVAP. Key development partners – notably UNICEF, the Nepali Technical Assistance Group (NTAG), and WHO – have provided critical support in funding, supplies, and technical guidance. Continuous monitoring through surveys (NDHS) and annual reports helps evaluate impact, showing sustained high coverage and significant reductions in vitamin A deficiency disorders. Together, these policies and tools have guided NVAP’s evolution from a pilot in 8 districts (1993) to a nationally acclaimed child survival intervention credited with saving tens of thousands of young lives ( Vitamin A Programme in Nepal – PMC ).

***Timeline of Programme Implementation***

The program’s success is underpinned by strong policies, community-based delivery by Female Community Health Volunteers, and partner support. ( Vitamin A Programme in Nepal – PMC ) (Microsoft Word – 11.1 Nutrition Policy and strategy.doc)

National Nutrition Policy and Strategy (2004)

Nepal’s National Nutrition Policy and Strategy 2004 was the first comprehensive policy blueprint for nutrition. Its overall goal was to achieve “nutritional well being of all people in Nepal” and to integrate nutrition into national development (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). The policy outlined priority areas and targets for various nutrition issues – including Protein Energy Malnutrition, micronutrient deficiencies (vitamin A, iron, iodine), low birth weight, and diet-related diseases. Crucially, it set a clear mandate for combating Vitamin A Deficiency (VAD) as a public health problem. Under this strategy, NVAP was institutionalized as a high-priority program:

Scope: The 2004 policy emphasized both preventive and therapeutic nutrition interventions. For VAD control, it endorsed a combination of mass high-dose vitamin A supplementation, nutrition education, and clinical management. Specifically, it called for biannual supplementation of vitamin A capsules to all children 6–59 months nationwide, coupled with promotion of vitamin A-rich diets (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). It also introduced postpartum vitamin A supplementation for new mothers and treatment of pregnant women with low-dose vitamin A in areas with night-blindness (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). Integration was a theme – for example, the policy linked deworming with NVAP by recommending biannual deworming of children 1–5 years alongside the vitamin A campaigns in all districts (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). These measures were to be sustained long-term to “virtually eliminate vitamin A deficiency” by 2017 (a target set in the policy).

Relevance to NVAP: The Nutrition Policy and Strategy 2004 provided the strategic foundation for NVAP’s expansion. It formally recognized NVAP as a core child survival intervention and secured government commitment (and budgetary support) for the biannual capsule distribution. By integrating NVAP into the essential health services package, the policy ensured that vitamin A supplementation became a routine, institutionalized activity delivered through the public health system. The policy also underscored complementary efforts – nutrition education (to improve diets) and clinical use of vitamin A for illnesses – which enhanced the overall impact of NVAP. This comprehensive approach helped Nepal reach full national NVAP coverage by 2002 and maintain high coverage thereafter ( Vitamin A Programme in Nepal – PMC ).

Evolution: The 2004 policy built on earlier nutrition initiatives and was later revised in 2008 to incorporate new data (e.g. NDHS 2006) and emerging issues. The update in 2008 reaffirmed NVAP’s importance and adjusted targets, showing the policy’s adaptability. Together, the 2004 policy and its 2008 revision guided Nepal’s nutrition actions until newer strategies (e.g. 2020 Nutrition Strategy) emerged. They also paved the way for the multi-sector plans that followed.

Responsible Authority: The policy was issued by the Ministry of Health and Population (MoHP), with technical input from its Child Health Division/Nutrition Section. It was endorsed at the cabinet level, reflecting high-level political commitment. Implementation involved multiple sectors (health, agriculture, education, local development), foreshadowing the multi-sector collaboration later formalized in MSNP.

Multi-Sector Nutrition Plan (MSNP)

Recognizing that malnutrition has complex causes, Nepal adopted a Multi-Sector Nutrition Plan (MSNP) approach to bring together various ministries and stakeholders. The first MSNP (2013–2017) was launched under the National Planning Commission’s leadership, followed by MSNP II (2018–2022). These plans align Nepal’s nutrition efforts with the global Scaling Up Nutrition (SUN) Movement and Sustainable Development Goals.

Scope: The MSNP is a high-level strategy that coordinates actions across sectors – health, agriculture, education, water/sanitation, and governance – to reduce stunting, wasting, micronutrient deficiencies, and other forms of malnutrition. The MSNP I (2013–2017) set out objectives to improve maternal and child nutrition by addressing immediate causes (inadequate diet, disease) and underlying factors (food security, caregiving, sanitation). MSNP II (2018–2022) built on this, with the goal of “improved maternal, adolescent and child nutrition by scaling up essential nutrition-specific and sensitive interventions and creating an enabling environment for nutrition” (Nutrition Report English Final – for 10 Copies Print.indd). Key targets included reducing child stunting and anemia by 2025 and 2030 in line with global targets (Nutrition Report English Final – for 10 Copies Print.indd) (Nutrition Report English Final – for 10 Copies Print.indd).
NVAP Relevance:
- Within the MSNP framework, NVAP is regarded as one of the essential nutrition-specific interventions that needs to be sustained to address immediate nutrient gaps. The health sector component of MSNP explicitly includes maintaining high coverage of vitamin A supplementation and deworming for children under five – a proven short-term nutrition intervention that protects child survival ((PDF) Nutrition and food security in Nepal: a narrative review of policies) ((PDF) Nutrition and food security in Nepal: a narrative review of policies). At the same time, MSNP emphasizes longer-term solutions (diversifying diets, food fortification, etc.) to eventually reduce dependence on supplementation. For example, MSNP II advocates fortification of foods (like wheat flour and rice with vitamin A, iron, folic acid) and improved complementary feeding ((PDF) Nutrition and food security in Nepal: a narrative review of policies) ((PDF) Nutrition and food security in Nepal: a narrative review of policies). In essence, MSNP provides a broader context for NVAP: it ensures that while NVAP continues to prevent Vitamin A deficiency in the short run, parallel efforts are made to improve diets and address root causes. NVAP’s success – often cited as a “quick win” in nutrition – helped build momentum for the MSNP, and the MSNP in turn commits to sustaining NVAP as part of the national minimum package of nutrition services.
Evolution: MSNP I (2013–17) was Nepal’s first attempt at a coordinated nutrition plan, and it established new structures like high-level Nutrition and Food Security Steering Committees at national and local levels. MSNP II (2018–22) was approved by the Cabinet in 2017 to continue and expand the multi-sector efforts, incorporating lessons learned and the newly federalized governance structure. By MSNP II, all seven provinces and local governments were engaged in nutrition programming, and there was greater emphasis on equity (e.g., improving vitamin A coverage in provinces lagging behind). As MSNP II concluded in 2022, plans for the next phase (MSNP III) are underway to further embed nutrition into Nepal’s development agenda, with NVAP remaining a cornerstone of child health efforts.
Responsible Authority: The National Planning Commission (NPC) spearheads the MSNP, reflecting its multi-sector nature. Implementation is jointly owned by relevant ministries: Ministry of Health and Population, Ministry of Education, Ministry of Agriculture and Livestock Development, Ministry of Water Supply, etc., each responsible for specific nutrition-sensitive actions. The NPC’s high-level coordination ensures these sectors align their policies (for instance, agriculture programs promoting vitamin A-rich crops complement NVAP’s supplementation). Development partners (UNICEF, the World Bank, EU, USAID, etc.) have supported MSNP with resources and technical assistance, under government leadership.

NVAP Implementation Guidelines (Past and Present)

The National Vitamin A Programme’s remarkable success in Nepal owes much to detailed implementation guidelines that translate policy into action at the community level. Historical NVAP Guidelines were developed in the early 1990s to launch and scale the program, and they have been updated as needed to respond to new challenges (e.g. integration of deworming, federal restructuring).

Historical Guidelines: The first Guidelines for Implementation of the National Vitamin A Deficiency Control Program were produced in 1992 by the Nutrition Section of the Child Health Division ( Vitamin A programme in Nepal – PMC ). These guidelines, revised in 1996, laid out the blueprint for how to run NVAP countrywide. They detailed the program’s objectives, target groups, dosage schedule, delivery mechanisms, monitoring, and roles of various actors (vitamin A programme in Nepal – PMC ). Key features of the guidelines included: biannual distribution rounds (pre-monsoon and post-harvest seasons) of high-dose vitamin A capsules to children 6–59 months; logistics for capsule supply and storage; training curricula for Female Community Health Volunteers (FCHVs) who would deliver the capsules; and an M&E plan to track coverage and impact ( Vitamin A Programme in Nepal – PMC ) ( Vitamin A Programme in Nepal – PMC ). The guidelines also identified 32 priority districts (mostly in the Terai and mid-/far-western hills) to start with, based on high risk of xerophthalmia, with a plan for phased expansion to all 75 districts ( Vitamin A Programme in Nepal – PMC ). This phased rollout strategy (adding a few districts every six months) was explicitly guided by the 1990s guidelines and allowed careful scaling with opportunity to learn and adapt as new districts were added ( Vitamin A Programme in Nepal – PMC ).
Content: The NVAP implementation guidelines provided very practical direction. For prevention, they set the standard dosing: 100,000 IU capsule for infants 6–11 months, 200,000 IU for children 12–59 months, every six months ( Vitamin A Programme in Nepal – PMC ). They included protocols for nutrition education – FCHVs and health workers were to educate families on locally available vitamin A-rich foods (like orange-flesh vegetables, green leafy veggies, liver, eggs) to improve dietary intake. The guidelines also covered the therapeutic use of vitamin A: treating measles cases, severe malnutrition, and persistent diarrhea in under-fives with age-appropriate vitamin A doses, and managing xerophthalmia cases by dosing and referral (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). By encompassing both preventive supplementation and clinical treatment, the guidelines ensured a comprehensive approach to VAD control at community and facility levels. Furthermore, once evidence emerged that deworming could synergize with vitamin A (by improving nutritional status), the program added distribution of albendazole for children 1–5 years during the vitamin A campaigns around 2010. The NVAP guidelines were accordingly updated to incorporate deworming in all districts (Collaborative Campaign Planning of Vitamin A Supplementation and Elimination of Lymphatic Filariasis in Nepal: Prospects and Challenges of Integration – Health Campaign Effectiveness Coalition) (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). They also guided FCHVs on recording and reporting: each FCHV maintained registers of children supplemented, which fed into aggregated ward and district reports.
Current Status:

With Nepal’s transition to a federal system (since 2017), the health governance structure changed, and there is recognition of the need to update NVAP guidelines to clarify the roles of provincial and local governments. As of the current period, the Federal Ministry of Health continues to provide central guidance (including procuring vitamin A capsules centrally) while local levels implement the biannual campaigns. Provinces coordinate to ensure no district misses the campaign. In practice, the core elements of the original NVAP guidelines remain in effect – the dosage regimen, use of FCHVs, and integration with deworming and nutrition education are unchanged. Minor adjustments (such as messaging strategies, reach to mobile populations, and COVID-19 precautions for campaign safety) have been incorporated through circulars and trainings. The spirit of the original guidelines – community-based service delivery with strong monitoring – continues to define NVAP implementation today, which is why Nepal has managed to maintain vitamin A coverage above 85% consistently (Nepal 2016 Demographic and Health Survey – Key Findings [SR243]).

Responsible Authority: The NVAP guidelines were issued by the Ministry of Health and Population’s Child Health Division (now part of the Family Welfare Division under the Department of Health Services). Back in the 1990s, the Child Health Division worked closely with donors and NGOs (notably USAID, UNICEF, and the newly formed NTAG) in drafting and revising the guidelines ( Vitamin A Programme in Nepal – PMC ). Today, any major revision of NVAP implementation modality would be led by the Family Welfare Division in coordination with provincial Health Directorates and partner agencies. On the ground, adherence to the guidelines is ensured by district/public health offices and health facility staff who supervise the FCHVs.

Legal and Constitutional Frameworks

Nepal’s commitment to nutrition and public health is also reinforced by its legal and constitutional provisions. Several laws and constitutional clauses provide an enabling environment for NVAP by recognizing citizens’ rights and setting obligations for the state:

Constitution of Nepal (2015):
- The Constitution explicitly guarantees the right to health and food as fundamental rights. Article 35(1) ensures that “Every citizen shall have the right to free basic health services from the State…” (Constitution of Nepal 2015 ), which covers essential child health services like vitamin A supplementation.
- Article 36 declares that “food” (and by extension nutrition) is a fundamental right of every citizen (Nutrition and food security in Nepal: a narrative review of policies). Moreover, Article 39(2) on child rights provides that every child has the right to proper care, nutrition, and health from the State and their family (Constitution of Nepal 2015 ). These constitutional rights compel the government to run programs such as NVAP to fulfill the citizens’ entitlement to basic nutrition and health. The Constitution also embeds the concept of food sovereignty – obligating the State to ensure access to adequate nutritious food for all. Thus, NVAP can be seen as a direct implementation of these rights for young children, preventing a life-threatening nutrient deficiency.
- The 2015 Constitution’s devolution of health responsibilities to local governments also means municipalities have a mandate (and funding through fiscal transfer) to carry out public health programs like the vitamin A campaigns within their jurisdictions. Overall, the Constitution provides the highest level of legal backing for NVAP, making it not just a program but part of the State’s duty to its people.
Public Health Service Act (2075/2018):
- Enacted in 2018, this Act operationalizes the health rights guaranteed by the Constitution. Its preamble notes the aim to make legal provisions for implementing the right to free basic health services and to ensure citizens’ access to quality health care (WHO MiNDbank – The Public Health Service Act, 2075 (2018)).
- The Public Health Service Act (PHSA) lays down the structure for delivering essential health services at all three levels of government. It defines what constitutes “basic health services” – which includes preventive programs for mothers and children. Although the Act doesn’t list each program by name, NVAP falls under basic child health services that must be provided free of cost. The law also emphasizes regularity and quality in service provision (WHO MiNDbank – The Public Health Service Act, 2075 (2018)), which in NVAP’s context translates to reliably conducting the biannual distribution with proper training and safe logistics.
- Under PHSA, provincial and local governments are entrusted to plan and implement public health programs, with the federal level ensuring support and setting standards. This has facilitated integration of NVAP into local annual work plans and budgets. The Act further calls for community participation and health promotion, aligning with NVAP’s model of using community volunteers.
- In summary, PHSA 2018 serves as a legislative anchor that secures NVAP as part of Nepal’s free basic health care package, and it clarifies roles in the decentralized system so that the program continues uninterrupted during governance transitions.
Mother’s Milk Substitutes Act (1992): Formally titled “Mother’s Milk Substitutes (Control of Sale and Distribution) Act, 2049 (1992)”, this law plays a supportive role in nutrition by protecting and promoting breastfeeding. The Act was enacted to implement the WHO International Code of Marketing of Breast-milk Substitutes. It regulates the marketing, promotion, and distribution of infant formula and other breastmilk substitutes, prohibiting unethical advertising and requiring proper labeling. As stated in its introduction, “This Act aims at promoting breast feeding and controlling the sale and distribution of mother’s milk substitutes.” (Mother’s Milk Substitutes (Control of Sale and Distribution) Act, 1992 …). By curbing aggressive formula marketing, the law helps ensure that mothers continue to breastfeed, which is critical since breastmilk is a natural source of vitamin A for infants. In Nepal, breastfeeding rates are high (with 99% of babies ever breastfed and two-thirds exclusively breastfed for 6 months (Nepal 2016 Demographic and Health Survey – Key Findings [SR243]) (Nepal 2016 Demographic and Health Survey – Key Findings [SR243])), partly thanks to such legal safeguards and public health messaging. The relevance to NVAP is indirect but important: sustained breastfeeding means infants receive vitamin A and other nutrients in early months, reducing the risk of deficiency before they enter the target age for NVAP (6 months). The Act is enforced by the Department of Food Technology and Quality Control and Ministry of Health, with oversight committees to monitor code violations. Alongside NVAP, this law contributes to an overall enabling environment for better child nutrition in Nepal.

Other legal measures: In addition to the above, it’s worth noting that Nepal has an Iodized Salt Act (1998) making iodization compulsory (eliminating VAD’s co-traveler, iodine deficiency) and more recently a Right to Food and Food Sovereignty Act (2018) that further elaborates citizens’ rights to food security and nutrition. These legal frameworks, together with the Constitution and Public Health Act, demonstrate Nepal’s comprehensive approach – addressing immediate needs via programs like NVAP while enshrining long-term commitments to end hunger and malnutrition in law.

Partner Support from Agencies (UNICEF, NTAG, WHO, etc.)

From its inception, Nepal’s Vitamin A program has been a stellar example of partnership between the government and development agencies. UNICEF, NTAG, WHO, and others have each played distinct and crucial roles in NVAP’s success:

UNICEF: The United Nations Children’s Fund has been a cornerstone partner for NVAP. UNICEF provided early financial and technical assistance when the program was starting in the 1990s ( Vitamin A Programme in Nepal – PMC ). Notably, UNICEF has supplied vitamin A capsules to Nepal (often procured globally through UNICEF’s supply division using donor funds, including significant support from the Government of Canada’s Micronutrient Initiative). As the program expanded, UNICEF supported training of health workers and FCHVs, development of behavior change communication materials (to educate communities on vitamin A and nutrition), and monitoring and evaluation. Even after Nepal took full ownership of NVAP, UNICEF continues to assist – for example, helping the government buffer vitamin A capsule stock in case of procurement delays and offering logistical support in hard-to-reach areas. UNICEF’s estimates of target population and its monitoring tools have helped Nepal maintain >90% coverage by identifying gaps ( Vitamin A Programme in Nepal – PMC ). In recent years, UNICEF has also advocated for NVAP’s integration into broader child health campaigns and during emergencies (such as ensuring vitamin A distribution during COVID-19 with precautions). Essentially, UNICEF’s role has been both operational (supply and training) and strategic (policy advocacy) to keep NVAP high on the public health agenda.
Nepali Technical Assistance Group (NTAG): NTAG is a unique home-grown institution born out of NVAP’s needs. In the mid-1990s, as NVAP scaled up, USAID funded John Snow, Inc. (JSI) to set up a Technical Assistance Group that eventually became an independent Nepali NGO in 1995 ( Vitamin A Programme in Nepal – PMC ). NTAG’s founding members included Nepali nutrition experts who had been involved in the initial vitamin A research and pilot programs. With support from UNICEF and USAID, NTAG was tasked to “specifically guide, adapt, and monitor implementation of the vitamin A programme on behalf of the MoH” ( Vitamin A Programme in Nepal – PMC ). Over the years, NTAG developed a formidable network of trainers and monitors at the community level. It conducted training-of-trainers for health staff and FCHVs before each distribution round, supervised the fieldwork during campaigns, and carried out coverage surveys and impact studies. NTAG’s close collaboration with government ensured that lessons from the field (such as reasons why a small percentage of children might be missed in a district) were quickly fed back into program improvements. Beyond vitamin A, NTAG later expanded to support other nutrition interventions, but NVAP remains its flagship. The presence of a dedicated local technical body like NTAG has been cited internationally as an innovation that contributed to NVAP’s sustained high performance ( Vitamin A Programme in Nepal – PMC ) ( Vitamin A Programme in Nepal – PMC ). To this day, NTAG, in partnership with the Family Welfare Division, helps with refresher trainings and independent monitoring to validate government reports.
WHO: The World Health Organization has contributed primarily through normative guidance and technical reviews. WHO’s global recommendations in the 1990s – endorsing high-dose vitamin A supplementation every 4–6 months for young children in areas of deficiency – provided the initial impetus and justification for Nepal’s program. WHO supported the vitamin A trials in Nepal indirectly via the International Vitamin A Consultative Group and disseminated the findings worldwide, which galvanized funding support for NVAP. In implementation, WHO has frequently provided technical experts to assist in designing surveys (for example, the 1998 Nepal Micronutrient Status Survey and the nutrition components of NDHS were done with CDC/WHO input). They also helped the government develop protocols for vitamin A dosing in measles and diarrhea case management (as part of WHO’s IMCI strategy). In recent years, WHO has facilitated policy dialogues on transitioning from a purely supplementation-focused approach to one balanced with food-based strategies, ensuring Nepal’s policies remain aligned with global evidence. Notably, WHO has recognized Nepal’s NVAP as a public health success story in South Asia and often showcases it in regional forums. While WHO is not directly involved in commodity procurement for NVAP, it contributed by publishing training materials and supporting the development of the nutrition information system that tracks vitamin A coverage. In summary, WHO’s role has been one of a technical advisor and global advocate for NVAP, ensuring the program is grounded in scientific evidence and integrated into broader child health policies.
Other Partners: Alongside UNICEF and WHO, USAID was instrumental, especially in the early days – funding the initial pilot studies in Sarlahi and Jumla, supporting NTAG, and helping procure capsules in the 1990s. The Micronutrient Initiative (MI) (now Nutrition International) has for decades provided vitamin A capsules to Nepal free of cost or at subsidized rates, through UNICEF. The World Bank and WFP have supported complementary nutrition activities (like homestead gardening or food distribution) that augment NVAP’s impact. Local organizations, community groups, and the media have also supported NVAP by spreading awareness so that parents know to bring their children on “Vitamin A Day.” These collective efforts mean NVAP has been consistently well-resourced and innovatively managed. The Government of Nepal gradually increased its own financing for NVAP – by 2008, it began funding more of the program’s operational costs ( Vitamin A Programme in Nepal – PMC ) – a transition facilitated by partner support in building a strong system.

In essence, the partnership model of NVAP is often summarized as: Government leadership, community volunteer delivery, and external partner support. Each partner agency filled gaps in capacity, and the result is a program that has been sustained for over 25 years with exemplary outcomes.

Monitoring, Evaluation, and Reporting Tools

Rigorous monitoring and evaluation have been integral to NVAP’s governance, allowing policymakers to track progress, demonstrate impact, and make data-driven adjustments. Two primary tools have been:

Nepal Demographic and Health Survey (NDHS): This is a nationally representative household survey conducted every 5 years (since the mid-1990s) that provides invaluable data on the population’s health and nutritional status. NDHS questionnaires ask mothers whether their young children received a vitamin A capsule in the past six months, and the results have been a key barometer of NVAP performance. For instance, the NDHS 2016 found that 86% of children aged 6–59 months had received a vitamin A supplement in the six months preceding the survey (Nepal 2016 Demographic and Health Survey – Key Findings [SR243]) – a remarkable coverage level, and an improvement from ~63% in 2001 and ~90% in 2006. NDHS also measures clinical outcomes related to vitamin A: it tracks night blindness in mothers and children and includes biochemical assessment of vitamin A status in some rounds (e.g., the 2016 NDHS included a micronutrient sub-survey which showed low serum retinol deficiency rates among children, corroborating NVAP’s success ( Vitamin A Programme in Nepal – PMC )). Trends from NDHS have documented the virtual elimination of vitamin A deficiency as a public health problem in Nepal. For example, child night-blindness dropped to under 1%, and maternal night-blindness significantly declined in vitamin A program districts. Such evidence has been crucial for advocacy – showing leaders and donors that NVAP is saving lives (researchers estimate over 45,000 child deaths averted from 1993–2015) ( Vitamin A Programme in Nepal – PMC ). NDHS data disaggregated by province also help identify any coverage disparities; for instance, if one province has slightly lower coverage (as State 2 did in 2016), targeted efforts can be made there. Overall, NDHS serves as an external validation of administrative coverage reports and provides outcome/impact indicators that justify the continued investment in NVAP.
Department of Health Services (DoHS) Annual Reports: Internally, the Ministry of Health’s DoHS publishes an Annual Report every year, compiling program statistics from all districts. NVAP coverage is a staple indicator in these reports. Each biannual distribution round, health facilities and FCHVs report the number of children reached, which is aggregated at district and national level. These administrative data typically show vitamin A coverage consistently in the 90–95% range of targeted children across the country (often even higher in some areas) – indicating that Nepal’s own system is capturing the majority of eligible children. The Annual Reports not only present coverage percentages but also record absolute numbers of children supplemented, capsules distributed, and any stock-outs or adverse events (if any). This helps in logistics planning (e.g., forecasting capsule needs for next year’s rounds) and in maintaining accountability at sub-national levels. Because the NVAP is conducted in a campaign style, the DoHS reports include it under the Child Health section, often highlighting it as a top-performing program. These reports are used by policymakers in Nepal to monitor year-to-year progress. For example, if a particular district’s coverage dipped due to political unrest or an earthquake in a given year, the Annual Report would flag it, prompting remedial actions in the next cycle. Additionally, the DoHS Annual Report is an official public record that goes to Parliament – meaning NVAP coverage is effectively reported to the nation’s legislature annually, underscoring its importance. Over the years, these reports have documented NVAP’s expansion (from 8 districts in 1993 to all 75 districts by 2002) and its integration of deworming in 2010. They have also showcased how NVAP was maintained even during conflict periods (mid-2000s) and crisis (COVID-19, when schedules were adjusted but capsules still delivered).
Other Tools: Besides NDHS and Annual Reports, NVAP has benefited from periodic evaluations and surveys. The Nepal Nutrition Assessment and Gap Analysis (NAGA) 2010 reviewed all nutrition programs including NVAP, providing strategic recommendations (many of which fed into MSNP). The Micronutrient Status Surveys (e.g., 1998 and a planned new survey) give biochemical evidence of vitamin A status. Post-campaign coverage validation surveys have occasionally been done by NTAG or others to ensure reported coverage is accurate. Moreover, the routine Health Management Information System (HMIS) captures vitamin A distribution data from health posts, which has been integrated into the electronic reporting system (District Health Information Software 2, DHIS2). These multiple data sources collectively form a robust M&E framework. The feedback loop is strong – data are discussed in annual NVAP review meetings at national level, and strategies are tweaked (for example, increasing social mobilization in communities where NDHS showed lower coverage of vitamin A or addressing misconceptions if any are found through surveys).

In summary, continuous monitoring through NDHS and DoHS reports has allowed Nepal to not only celebrate NVAP’s achievements but also to sustain political and public support. The transparency and regularity of reporting ensure that any emerging issue is caught early. This culture of data-driven management is a model for other public health programs. NVAP’s experience shows that when a program is backed by good data, it can maintain its quality and coverage over decades.

Comparative Framework Table

To summarize, the following table aligns each major policy/plan, guideline, or legal document with its scope, relevance to NVAP, responsible authority, and year of introduction:

Document / Plan / Law	Year Introduced	Scope and Focus	Relevance to NVAP	Responsible Authority
National Nutrition Policy and Strategy	2004 (rev. 2008)	Comprehensive national nutrition policy covering maternal, child nutrition and micronutrients (PEM, VAD, IDA, IDD, etc.). Set goals, guiding principles, and strategic approaches for improving nutrition nationwide (inner pages.pmd).	Established NVAP as a priority intervention to eliminate vitamin A deficiency. Mandated biannual vitamin A supplementation for under-fives, postpartum supplementation, nutrition education, and integration with other child health services (Microsoft Word – 11.1 Nutrition Policy and strategy.doc) (Microsoft Word – 11.1 Nutrition Policy and strategy.doc). Provided policy legitimacy and government commitment for NVAP scale-up.	Ministry of Health and Population (Child Health Division)
Multi-Sector Nutrition Plan (MSNP I)	2013 (FY2013–2017)	First cross-sectoral nutrition strategy involving health, agriculture, education, WASH, and local governance. Aimed to reduce stunting, maternal and child undernutrition through both nutrition-specific and nutrition-sensitive interventions.	Included vitamin A supplementation as one of the essential nutrition-specific interventions to be maintained. NVAP’s high coverage is leveraged to achieve MSNP’s short-term nutrition targets while other sectors address underlying causes ((PDF) Nutrition and food security in Nepal: a narrative review of policies) ((PDF) Nutrition and food security in Nepal: a narrative review of policies). MSNP’s multi-sector approach supports NVAP with complementary activities (e.g. homestead gardening to improve vitamin A intake).	National Planning Commission (with MoHP and line ministries)
Multi-Sector Nutrition Plan (MSNP II)	2018 (2018–2022)	Second phase of MSNP, updated to align with SDGs. Emphasized scaling up proven interventions and creating enabling environment (policies, resources) for nutrition. Targets for 2025 and 2030 (stunting, wasting, anemia reduction).	Reaffirmed the continuation of NVAP under government leadership as part of the nutrition-specific package. Also introduced fortification initiatives (vitamin A fortification in foods) to eventually complement and sustain gains from NVAP ((PDF) Nutrition and food security in Nepal: a narrative review of policies) ((PDF) Nutrition and food security in Nepal: a narrative review of policies). Provided a budgeted framework ensuring NVAP is funded through multi-sector nutrition budget lines.	National Planning Commission (approved by Cabinet), implemented by seven sector ministries and local governments
NVAP Implementation Guidelines	1992 (rev. 1996)	Operational guidelines detailing how to implement the National Vitamin A Program. Covered target groups, dosing schedule, logistics, training, monitoring, and phased rollout plan. Revised as program evolved.	Served as the “instruction manual” for NVAP rollout. Defined roles for FCHVs, health workers, and partners in biannual capsule distribution

Sources: The information in this table is drawn from government policy documents and laws, including the 2004 Nutrition Policy (Microsoft Word – 11.1 Nutrition Policy and strategy.doc) (Microsoft Word – 11.1 Nutrition Policy and strategy.doc), MSNP documents ((PDF) Nutrition and food security in Nepal: a narrative review of policies) ((PDF) Nutrition and food security in Nepal: a narrative review of policies), NVAP program guidelines ( Vitamin A Programme in Nepal – PMC ) ( Vitamin A Programme in Nepal – PMC ), the Constitution of Nepal 2015 (Constitution of Nepal 2015 ), Public Health Service Act 2018 (WHO MiNDbank – The Public Health Service Act, 2075 (2018)), and the Mother’s Milk Substitutes Act 1992 (Mother’s Milk Substitutes (Control of Sale and Distribution) Act, 1992 …). Data on partner contributions and program outcomes are from NVAP evaluations and publications ( Vitamin A Programme in Nepal – PMC ) (Nepal 2016 Demographic and Health Survey – Key Findings [SR243]).

Conclusion

The National Vitamin A Programme in Nepal is a model of how sound policy and strong implementation can achieve public health breakthroughs. From the high-level vision of the Nutrition Policy 2004 to the on-the-ground dedication of FCHVs guided by program manuals, every layer of the policy framework has contributed to NVAP’s success. The multi-sector plans have ensured that NVAP does not exist in isolation but as part of a broader push to improve child nutrition and survival. Legal frameworks like the Constitution and health laws ensure that these nutrition gains are sustained as entitlements, not just programmatic achievements. The enduring support of partners and a culture of data-driven management have further reinforced NVAP’s resilience, even in the face of conflict, disasters, and pandemics.

For public health professionals, Nepal’s experience underscores the importance of aligning programs with national policies and laws – creating both top-down accountability and bottom-up ownership. For policymakers, NVAP demonstrates that investing in preventive nutrition interventions yields immense returns in lives saved and disabilities averted. And for academic researchers, Nepal offers a living case study of scaling up an evidence-based intervention through effective governance and community engagement. As Nepal moves forward, the lessons learned from NVAP’s policy and regulatory framework will be invaluable in tackling remaining nutrition challenges and in informing other health initiatives. The continued evolution of strategies (like a forthcoming MSNP III and a new Nutrition Strategy 2020) will build on this legacy, aiming for a future where vitamin A capsules might no longer be needed because every Nepali child can obtain adequate nutrition through their diet – truly realizing the policy vision of nutritional well-being for all.