Scaling up Diarrhea Treatment with Zinc and ORT through

Public-Private Partnership in different Asian Countries

Camille Saadé, AED/ POUZN Director

csaade@aed.org

Reconvening Bangkok: 2007 to 2010 – Progress Made and Lessons Learned in Scaling-Up FP-MNCH

Best Practices in the AME Region

7 – 11 March 2010

Diarrhea, still # 2 killer of children < 5

• Estimated 1.8 million deaths annually, down from 4 million in 1990

• Improvement in preventative measures (water, hygiene and sanitation)

• ORT / ORS rates declining

• Introduction of zinc treatment with ORT

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Zinc in the Treatment of Diarrhea

• WHO & UNICEF include Zinc for rational treatment of diarrhea (2004) with ORT

• Zinc treatment in diarrhea: – decreases duration of diarrhea by 20-24%– reduces the severity of diarrhea by 25%– provides protection for next 2 -3 months and

reduces diarrhea incidence by 34%

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POUZN Partnership Model

PrivateSectorPrivateSector

Public Sector Public Sector

NGOsNGOsCommunityCommunity

Development partners/ Catalyst

Health Providers

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Policy and the Public Sector

• Included Zinc in national diarrhea treatment guidelines along with ORT

• Zinc and ORS in procurement list

• Training of health workers on-going

• FDA approved Zinc as over-the-counter (OTC) for diarrhea treatment

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Engaging the Pharmaceutical Industry

• Well developed capabilities and infrastructure – Manufacturing, GMP compliance and Quality

Assurance– Intensive marketing to doctors and

pharmacists but limited direct-to-consumer marketing experience

– Nationwide distribution• Initial enthusiasm and expectation of quick

return

Production/ Supply is not the Issue

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L-O ORS

Sustained Demand is the Issue

• At multiple levels:

– Health providers

– Drug sellers

– Caregivers

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Harmonized Message: Rational Management of Diarrhea = ORT + Zinc +

Feeding

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Pharmaceutical marketing

Health Professionals

Drug Sellers

Time

Over-the-counter (OTC) marketing

Interpersonal communication, Mass advertising

The Phased Marketing Approach

General Public

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Working with Multiple Partners

• Competition and multiple products keep prices down

• Additional products increase “noise” and reach

• Competition helps push product to lower socio-economic groups

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Phase 1 Strategy: Establish Zinc Among Health Professionals

• Engage Zinc manufacturers in promoting rational management of diarrhea

• Enhance partners’ marketing capabilities• Intensify continuous promotional efforts and

extended distribution• Target key opinion leaders and top prescribers

1. Pouch bag

2. Brochures

3. Ballpoint

4. Notes

5. FAQ Booklet

6. Clear Folder

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Phase 2: Saturation of Health Care Providers

and Drug Sellers• Intensify regular Rx of Zinc among top

prescribers of diarrhea treatments

• Focus on drug sellers and 1st line care providers in rural areas: informal RMPs in India, midwives in Indonesia

• Target RMPs, midwives and outreach HW through NGO’s health promoters.

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Pharmaceutical marketing

Health Professionals

Drug Sellers

Time

Over-the-counter (OTC) marketing

Interpersonal communication, Mass advertising

The Phased Marketing Approach

General Public

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Phase 3: Reach the Caregivers

• Interpersonal communication:– Direct private sector promotion through NGOs– Outreach health workers

• Mass Media – most effective when health workers are on board, nationwide distribution in public health system is in place, and there is sufficient penetration in rural market

• Supported by Public sector and Development partners

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Model Adaptability

Engaging strategically the private sector:

• Applies to FP/ MNCH/ other Public Health

• Reaches national scale rapidly

• “Primes the market” for public sector

• Increases efficacy of USAID investment

• Is sustainable after project life