Dr Gaurav Arya


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Dr Gaurav Arya

  1. 1. Promoting prevention and treatment of Diarrhoea:Increasing the availability and USE of ORS and Zinc<br />Dr. Gaurav Arya<br />Health Specialist, UNICEF<br />October 30, 2010<br />
  2. 2. Overview of the presentation<br />Need for talking about diarrhoea<br />Components of effective management of diarrhoea using ORS and Zinc<br />Field challenges<br />Interventions for improving diarrhoea management in Uttar Pradesh<br />Brief introduction to the social marketing initiative in Lalitpur<br />
  3. 3. Why are we talking about diarrhoea<br />Diarrhoea is the second largest killer and accounts for nearly 2 million child-deaths globally<br />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.<br />More than one-quarter did not receive any kind of treatment<br />16% received antibiotics, which are not normally recommended for treating childhood diarrhoea<br />
  4. 4. Components of effective management of diarrhoea using ORS and Zinc<br />Reduced mortality of children due to diarrhoea<br />
  5. 5. These are the field challenges<br />Diarrhoea is still a widely prevalent disease in UP (NFHS-3)<br />Most Childhood diarrhea cases first treated by rural practitioners and chemists (World Bank survey 1997)<br />Very low use of ORS and Zinc for management of diarrhoea<br />Rural Practitioners & Chemists use antibiotics extensively and have inadequate knowledge about the use of ORS & Zinc<br />Low compliance of Zinc for 14 days<br />There is no data on availability of ORS and Zinc through the private channels<br />Public health and distribution system has frequent outages and low reliability<br />There is continued and widespread use of anti-diarrheals<br />Govt. & professional bodies unwilling to educate or include the RMP’s<br />
  6. 6. Data shows…<br />There are multiple drug modalities being practiced<br />There are multiple drug therapies being used<br />
  7. 7. Data shows…<br />The general prescription pattern of service providers is inappropriate<br />Many of the retailers/ pharmacists have never retailed ORS and Zinc<br />
  8. 8. Pictures Show…<br />Here is where a large proportion of the population goes: RMPs<br />
  9. 9. Pictures Show…<br />And this is what they use for treatment:<br />
  10. 10. What are we doing in Uttar Pradesh<br />Capacity Development<br />Training of public healthcare providers in CCSP/IMNCI districts<br />Training of private and public sector pediatricians through IAP<br />Training of private physicians and pediatricians in Lalitpur through HLFPPT<br />Supply chain<br />Demonstrate a model of alternative supply chain through Social marketing initiative in Lalitpur<br />Provide buffer stock of ORS and Zinc to the public health system in CCSP/IMNCI districts<br />
  11. 11. What are we doing in Uttar Pradesh<br />Generating evidence and knowledge management<br />Market assessment for availability of ORS and Zinc<br />Promoting community use of ORS and Zinc through “depot holders” established by HLFPPT<br />GIS mapping and supply chain monitoring of depot holders in Lalitpur<br />Knowledge exchanges through academic associations and medical colleges<br />Establishing partnerships<br />Professional bodies like IAP, IAPSM<br />HLFPPT<br />Polio Social Mobilization Network<br />AED/ USAID funded PouZN project<br />
  12. 12. Social Marketing: A Social innovation<br />COMMUNITY EMPOWERMENT<br />SUSTAINABLE EFFORT<br /> HEALTH EDUCATION<br />ACCESS & QUALITY<br />ORS and Zinc<br />DOCTORS &<br />PHARMACIES<br />COMMUNITY<br />Connecting with the rural pharmacy and practitioners<br />Sensitizing the Doctors<br />Meetings with depot holders<br />Community<br /> Meetings<br />ORS and Zinc promotion – through depot holders<br />
  13. 13. Depot holder’s meetings<br />Awareness & Education<br />Physician Education <br />Social Marketing: A Social innovation<br />4 As of social marketing<br />Awareness<br />Community Awareness : Preventive Health tips, Disease and therapy awareness by local HLFPPT district and block teams<br />Physician and healthcare provider education: Knowledge sharing with doctors, ANMs, LHVs and AYUSH practitioners by Senior HLFPPT experts<br />Acceptability (Local)<br />Customized Portfolio: WHO recommended ORS(in sachet) and 7 tablet pack of Zinc (20mg Tablets) <br />Local adaptation of IEC material, branding & communication<br />Availability<br />Enhanced Distribution: Connecting rural pharmacies with city distributors across 700 villages in Lalitpur.<br />Affordability<br />Custom small packs (strips of 7 tabs costing Rs.8.25)<br />Affordable ORS packets (Rs.6.50 per packet)<br />
  14. 14. Social Marketing: A Social innovation<br />IEC Material<br />
  15. 15. THANKS<br />