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Promoting prevention and treatment of Diarrhoea:Increasing availability and USE of ORS and ZincDr. Gaurav AryaHealth Specialist, UNICEFOctober 30, 2010
Overview of the presentationNeed for talking about  diarrhoeaComponents of effective management of diarrhoea using ORS and ZincField challengesEvidence on availability and useInterventions for improving diarrhoea management in Uttar PradeshBrief introduction to the social marketing initiative in Lalitpur
Why are we talking about  diarrhoeaDiarrhoea 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 diarrhoeaComponents of effective management of diarrhoea using ORS and ZincReduced mortality of children due to diarrhoea
These are the field challengesDiarrhoea 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 diarrhoeaRural Practitioners & Chemists use antibiotics extensively and have inadequate knowledge about the use of  ORS & ZincLow compliance of Zinc for 14 daysThere is no data on availability of ORS and Zinc through the private channelsPublic health and distribution system has frequent outages and low reliabilityThere is continued and widespread use of anti-diarrheals Govt. & professional bodies unwilling to educate or include the RMP’s
Data shows…There are multiple drug modalities being practicedThere are multiple drug therapies being used
Data shows…The general prescription pattern of service providers is inappropriateMany of the retailers/ pharmacists have never retailed ORS and Zinc
Pictures Show…Here is where a large proportion of the population goes: RMPs
Pictures Show…And this is what they use for treatment:
What are we doing in Uttar PradeshCapacity 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

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Dr Arya

  • 1. Promoting prevention and treatment of Diarrhoea:Increasing availability and USE of ORS and ZincDr. Gaurav AryaHealth Specialist, UNICEFOctober 30, 2010
  • 2. Overview of the presentationNeed for talking about diarrhoeaComponents of effective management of diarrhoea using ORS and ZincField challengesEvidence on availability and useInterventions for improving diarrhoea management in Uttar PradeshBrief introduction to the social marketing initiative in Lalitpur
  • 3. Why are we talking about diarrhoeaDiarrhoea is the second largest killer and accounts for nearly 2 million child-deaths globally
  • 4. 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.
  • 5. More than one-quarter did not receive any kind of treatment
  • 6. 16% received antibiotics, which are not normally recommended for treating childhood diarrhoeaComponents of effective management of diarrhoea using ORS and ZincReduced mortality of children due to diarrhoea
  • 7. These are the field challengesDiarrhoea 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 diarrhoeaRural Practitioners & Chemists use antibiotics extensively and have inadequate knowledge about the use of ORS & ZincLow compliance of Zinc for 14 daysThere is no data on availability of ORS and Zinc through the private channelsPublic health and distribution system has frequent outages and low reliabilityThere is continued and widespread use of anti-diarrheals Govt. & professional bodies unwilling to educate or include the RMP’s
  • 8. Data shows…There are multiple drug modalities being practicedThere are multiple drug therapies being used
  • 9. Data shows…The general prescription pattern of service providers is inappropriateMany of the retailers/ pharmacists have never retailed ORS and Zinc
  • 10. Pictures Show…Here is where a large proportion of the population goes: RMPs
  • 11. Pictures Show…And this is what they use for treatment:
  • 12. What are we doing in Uttar PradeshCapacity Development
  • 13. Training of public healthcare providers in CCSP/IMNCI districts
  • 14. Training of private and public sector pediatricians through IAP
  • 15. Training of private physicians and pediatricians in Lalitpur through HLFPPT
  • 17. Demonstrate a model of alternative supply chain through Social marketing initiative in Lalitpur
  • 18. Provide buffer stock of ORS and Zinc to the public health system in CCSP/IMNCI districtsWhat are we doing in Uttar PradeshGenerating evidence and knowledge management
  • 19. Market assessment for availability of ORS and Zinc
  • 20. Promoting community use of ORS and Zinc through “depot holders” established by HLFPPT
  • 21. GIS mapping and supply chain monitoring of depot holders in Lalitpur
  • 22. Knowledge exchanges through academic associations and medical colleges
  • 27. AED/ USAID funded PouZN projectSocial Marketing: A Social innovationCOMMUNITY EMPOWERMENTSUSTAINABLE EFFORT HEALTH EDUCATIONACCESS & QUALITYORS and ZincDOCTORS &PHARMACIESCOMMUNITYConnecting with the rural pharmacy and practitioners Sensitizing the DoctorsMeetings with depot holdersCommunity Meetings ORS and Zinc promotion – through depot holders
  • 28. Depot holder’s meetingsAwareness & EducationPhysician Education Social Marketing: A Social innovation4 As of social marketingAwarenessCommunity Awareness : Preventive Health tips, Disease and therapy awareness by local HLFPPT district and block teamsPhysician and healthcare provider education: Knowledge sharing with doctors, ANMs, LHVs and AYUSH practitioners by Senior HLFPPT expertsAcceptability (Local)Customized Portfolio: WHO recommended ORS(in sachet) and 7 tablet pack of Zinc (20mg Tablets) Local adaptation of IEC material, branding & communicationAvailabilityEnhanced Distribution: Connecting rural pharmacies with city distributors across 700 villages in Lalitpur.AffordabilityCustom small packs (strips of 7 tabs costing Rs.8.25)Affordable ORS packets (Rs.6.50 per packet)
  • 29. Social Marketing: A Social innovationIEC Material