Helen Keller

Organisation

Helen Keller International (HKI) is a nonprofit headquartered in New York (founded 1915). A key focus is vitamin A supplementation (VAS) for children aged 6–59 months in countries with high malnutrition and child mortality. HKI partners with ministries of health and organizations such as UNICEF and Nutrition International.

The Problem: Vitamin A Deficiency

Vitamin A deficiency is a leading cause of preventable childhood blindness and a major contributor to child mortality. An estimated ~190 million children under five are affected each year. WHO classifies vitamin A deficiency as a public‑health problem when defined prevalence thresholds are exceeded.

Without adequate vitamin A, the risks of severe infections, vision loss, and death rise markedly. Vitamin A is critical for immune function, epithelial health, and vision (rhodopsin formation). Deficiency increases the severity and case‑fatality of measles, diarrheal disease, and respiratory infections. Typical ocular signs include night blindness and xerophthalmia, up to keratomalacia.

The burden is highest in sub‑Saharan Africa and South Asia. Drivers include diets low in animal‑source and fortified foods, food insecurity, recurrent infections, and limited access to basic health services. Burden is seasonal (e.g., “lean seasons”) and heterogeneous within countries; rural and hard‑to‑reach areas are disproportionately affected.

Measurement and surveillance are challenging. Surveys use biochemical markers (e.g., retinol‑binding protein) and clinical signs (e.g., night blindness), but are not routinely available everywhere. This complicates cross‑country comparisons and necessitates prioritization by risk indicators and context.

Evidence shows that regular vitamin A supplementation can reduce child mortality. Older meta‑analyses report reductions of up to 24% in high‑prevalence settings; more recent assessments indicate smaller, context‑dependent effects. Impact is greatest where deficiency is widespread, infectious disease burden is high, and alternatives (food fortification, dietary diversification) are limited.

Approach

HKI primarily supports countries by funding and providing technical assistance for government‑run VAS programs. Operationally, short, large‑scale campaigns are central; where ministries aim for routine delivery, VAS is increasingly integrated into primary care. Depending on context, delivery is door‑to‑door or via fixed sites with outreach; hybrid and catch‑up approaches complement routine services. VAS is often co‑delivered with basic services such as deworming, polio mop‑ups, and screening for acute malnutrition. HKI collaborates with health authorities on micro‑planning, train‑the‑trainer cascades, social mobilization, and joint supervision. Implementation typically involves two rounds per year for children aged 6 to 59 months; dosing is 100,000 IU for ages 6–11 months and 200,000 IU for ages 12–59 months, administered by cutting capsules and squeezing contents directly into the child’s mouth. Community distributors are part of the public health system or receive stipends. HKI coordinates with ministries of health, UNICEF, and Nutrition International; capsules are typically supplied by Nutrition International. Coordination through the Global Alliance for Vitamin A (GAVA) helps avoid gaps. As polio campaigns decline, stand‑alone VAS structures are increasingly necessary; at the same time, lower‑cost delivery models are being piloted to preserve high coverage and support gradual integration into routine systems.

Impact

Vitamin A supplementation (VAS) has a demonstrated effect on reducing child mortality. Randomized trials and meta‑analyses show large effects in high‑deficiency settings; older reviews report reductions of up to 24%. In more recent, context‑adjusted modeling, GiveWell applies conservative country‑specific effect sizes of roughly 4–12%. The biological pathways are well established: vitamin A supports immune and epithelial function; deficiency increases the severity and case‑fatality of infections (e.g., measles, diarrhea, respiratory disease). VAS also reduces vitamin A–related ocular morbidity (e.g., night blindness, xerophthalmia).

Program reach is a key driver of impact. In HKI‑supported campaign rounds, post‑event coverage surveys indicate median coverage around 85% of the target population, with variation by country, access, and delivery model (door‑to‑door, fixed‑site, routine integration). Co‑delivery (e.g., deworming) and targeted social mobilization further support uptake.

Because delivery costs are low and expected mortality effects are meaningful, VAS is highly cost‑effective. Average program costs per capsule delivered are about US$1 (context dependent). GiveWell estimates roughly US$1,000 to US$8,500 per death averted, varying by country and year. Impact is greatest where vitamin A deficiency and infectious disease burden are high and alternatives (food fortification, dietary diversification) are limited. HKI’s global reporting (e.g., 87 million capsules in 2024) illustrates operational scale; methodological uncertainties are reflected in the models (see Uncertainties/Monitoring).

Transparency

Helen Keller Intl publishes detailed data on reach, costs, and implementation of its vitamin A programs and is recommended by GiveWell as a Top Charity. Monitoring relies on post‑event coverage surveys (two‑stage cluster sampling, electronic data capture, standardized questionnaires), independent campaign monitors, and supervisor audits with household revisits (around 10% for quality checks).

Since 2024, HKI has strengthened monitoring: broader sampling across all HKI‑supported regions within a country, independent audits with teams blinded to audit locations, adoption of DHIS2 and standardized reporting, and added validation steps (e.g., caregiver recognition of capsules, verification against child health cards where available).

Key caveats: surveys aren’t available for all rounds/regions and may overestimate coverage; household surveys are subject to recall bias; partner spending (e.g., government) may be incompletely captured. GiveWell accounts for these via quality discounts, cross‑country cost averages, and assumptions about potential replacement by other actors.

Current Projects

Democratic Republic of the Congo, Nigeria, Burkina Faso, Cameroon, Côte d'Ivoire, Guinea (2024–2026): In August 2024, GiveWell recommended a $5.8 million grant to Helen Keller Intl to support vitamin A supplementation programs in six countries through June 2026. This grant supports both the continuation of current programs and potential exit funding in specific regions.

Madagascar (2023–2027): A $6 million grant recommended in April 2023 funds four years of vitamin A supplementation programs across six regions of Madagascar. These programs aim to reduce child mortality and improve the long-term health of children.​