The plenary sessions from the first three days show- cased the broad reach and programmatic successes with vitamin A and iodine, as well as efforts to increase coverage with IFA supplementation, zinc treatment, MNPs and fortification. Presenters under this plenary theme, moderated by Dr Ellen Piwoz from the Bill & Melinda Gates Foundation and Professor Guansheng Ma from the Chinese CDC, addressed the necessary next steps to ensure sustainability. Aspects of sustainable programs Dr Michael Zeilinger, Chief of the Nutrition Division in USAID’s Bureau for Global Health, began his discus- sion by reviewing what high coverage actually reveals about a program. He suggested that, while our current delivery strategies may achieve high coverage over time, this does not necessarily equate to reproducibility of sustainability. Coverage does not tell us how robust the system is, if resources are allocated regularly, or if adequate staff are available. With the growing success of some micronutrient programs, he warned that efforts to achieve high coverage quickly in order to meet the demands of government officials or donors may result in programs being built upon short-term strategies or one-off delivery opportunities. As a community, we need to remember and impress upon leaders that “high coverage” does not equate to “sustainable.” The two are not synonymous. The goal for micronutrient programs must be to achieve sustainable high coverage. High-coverage data may result in an intervention being relegated to “finished” or “yesterday’s news.” This is illustrated by historical data on oral rehydration therapy and immunization. Efforts to increase coverage in the 1980s peaked in 1990 with the momentum of the World Summit for Children. Gaps in sustainable programming were already apparent within a few years in both Asia and Africa. He pointed out that global initiatives such as the Global Alliance for Vaccines and Immunizations (GAVI) are still working to attain 80% DPT3 coverage in Africa and Asia. Global and regional data also hide within-country variation. This not only raises questions about sustainability, but likely affects an intervention’s impact. If we consider VAS programs over the past decade, there has been a steady increase in global coverage that may surpass 80% in the next few years. USI provides another example. But are these pro- grams sustainable? Can we realistically expect to see a public health impact? Or are we in danger of falling into the trap of other child survival interventions?
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