Dr. Gaurav Arya

Health Specialist, UNICEF

October 30, 2010

Need for talking about diarrhoea

Components of effective management of diarrhoea using ORS and Zinc

Field challenges

Interventions for improving diarrhoea management in Uttar Pradesh

Brief introduction to the social marketing initiative in Lalitpur

Diarrhoea is the second largest killer and accounts for nearly 2 million child-deaths globally

In India, only 26% children suffering from Diarrhoea are treated with oral rehydration therapy (ORT) and the proportion is only 13% in Uttar Pradesh (NFHS-3) – This is despite the fact that ORT was introduced as the treatment of choice for diarrhoea more than 3500 years ago.

More than one-quarter did not receive any kind of treatment

16% received antibiotics, which are not normally recommended for treating childhood diarrhoea

AwarenessAcceptabilityAvailabilityAccessibilityAffordability

Increased Use

Sensitized healthcare providers

Knowledge in community

about seeking care for

diarrhoea in children

Reduced mortality of children due to diarrhoea

Diarrhoea is still a widely prevalent disease in UP (NFHS-3)

Most Childhood diarrhea cases first treated by rural practitioners and chemists (World Bank survey 1997)

Very low use of ORS and Zinc for management of diarrhoea

Rural Practitioners & Chemists use antibiotics extensively and have inadequate knowledge about the use of ORS & Zinc

Low compliance of Zinc for 14 days

There is no data on availability of ORS and Zinc through the private channels

Public health and distribution system has frequent outages and low reliability

There is continued and widespread use of anti-diarrheals

Govt. & professional bodies unwilling to educate or include the RMP’s

There are multiple drug modalities being practiced

There are multiple drug therapies being used

87

42.9

16.9

7.81.3

95.1

38.6

3.67.2 2.2

0.0

20.0

40.0

60.0

80.0

100.0

Allopathic Ayurvedic Homeopathic Unani Others

Service provider (N=77) Retailer (N=223)

77.9

36.4 33.8

10.4 9.1 3.915.6

83.9

23.8

47.1

10.3 1.3 3.113.9

0.0

20.0

40.0

60.0

80.0

100.0

ORS Homemade fluids

Antibiotic Antimotility/ Antidiarrhoeal

Plain Zinc AYUSH Pills & Syrups

Injections

Service provider (N=77) Retailer (N=223)

The general prescription pattern of service providers is inappropriate

Many of the retailers/ pharmacists have never retailed ORS and Zinc

66.7

11.5

52.2

12.62.6 1.9

18.1

0.0

20.0

40.0

60.0

80.0

100.0

ORS Homemade fluids Antibiotic Antimotility/ Antidiarrhoeal

Plain Zinc AYUSH Pills & Syrups

Injections

68.9

31.1

Ever Stocked ORS Never Stocked ORS

14.1

85.9

Ever Stocked Zinc Products

Here is where a large proportion of the population goes: RMPs

And this is what they use for treatment:

Capacity Development Training of public healthcare providers in CCSP/IMNCI

districts

Training of private and public sector pediatricians through IAP

Training of private physicians and pediatricians in Lalitpur through HLFPPT

Supply chain Demonstrate a model of alternative supply chain through

Social marketing initiative in Lalitpur

Provide buffer stock of ORS and Zinc to the public health system in CCSP/IMNCI districts

Generating evidence and knowledge management Market assessment for availability of ORS and Zinc

Promoting community use of ORS and Zinc through “depot holders” established by HLFPPT

GIS mapping and supply chain monitoring of depot holders in Lalitpur

Knowledge exchanges through academic associations and medical colleges

Establishing partnerships Professional bodies like IAP, IAPSM

HLFPPT

Polio Social Mobilization Network

AED/ USAID funded PouZN project

COMMUNITYDOCTORS &PHARMACIES

Meetings with depot holders

Community

Meetings

Sensitizing the

Doctors

ORS and Zinc

ORS and Zinc promotion – through depot holders

Connecting with the rural pharmacy and practitioners

HEALTH EDUCATION ACCESS & QUALITY

COMMUNITY EMPOWERMENT SUSTAINABLE EFFORT

4 As of social marketing

Awareness

Community Awareness : Preventive Health tips, Disease and therapy awareness by local HLFPPT district and block teams

Physician and healthcare provider education: Knowledge sharing with doctors, ANMs, LHVs and AYUSH practitioners by Senior HLFPPT experts

Acceptability (Local)

Customized Portfolio: WHO recommended ORS(in sachet) and 7 tablet pack of Zinc (20mg Tablets)

Local adaptation of IEC material, branding & communication

Availability

Enhanced Distribution: Connecting rural pharmacies with city distributors across 700 villages in Lalitpur.

Affordability

Custom small packs (strips of 7 tabs costing Rs.8.25)

Affordable ORS packets (Rs.6.50 per packet)

Physician Education

Depot holder’s meetings

Awareness & Education

IEC Material

THANKS