Oral Rehydration Therapy

1. A Case Study on
Assigned by -
Prof. Dr. Mahesh Gadekar
Oral Rehydration Therapy

2. ORAL REHYDRATION THERAPY
Oral rehydration therapy (ORT) is a treatment for dehydration. It
involves drinking a special mixture of water, glucose and salts
(ORS) to restore the amount of fluids, sugars and electrolytes
in the body to normal levels.

3. Introduction
This case lays emphasis on high child mortality
rate in developing regions like Africa and
south Asia due to diarrhoea, regardless in the
presence of easy, low cost treatment which is
oral rehydration therapy.
ORT treated extreme dehydration caused by
diarrhoea which was the leading cause of
death among young children.

4. Mission
To reduce child mortality rate due diarrhoea with the help of
Oral Rehydration Therapy (ORT).

5. Case Outline
 Defining Diarrhoea and child mortality
 Treatments before ORT
 Promotion and adoption of ORT
 Stagnation of ORT Utilization
 Modifications in ORT
 Overcoming the challenges to increase ORT Utilization

6. Treatments Before ORT
 Before ORT Diarrhoeal Dehydration were typically treated with
Intravenous Fluids.
 It was able to decrease the mortality rate from cholera from over 30% to
less than 1%
 Intravenous Hydration was relatively complex.
 It required specialized equipments and trained professionals.
 It was very expensive.
 It was deemed to be an unfit solution for people from remote & resource-
poor environments.

7. Promotion & Adoption of ORT
 ORT came into the market as a low-cost, simple to administer substitution of
Intravenous Hydration.
 Multiple clinical studies proved that ORT have similar efficacy to Intravenous
Hydration.
 During 1971 Cholera Epidemic Dr. Mahalanabis demonstrated that ORT could be
administered by patients’ family members.
 In 1978 WHO advised that ORT can be used beyond Cholera.
 During early 1980s WHO & UNICEF officially recommended use of ORT to treat
Diarrhoeal Dehydration.
 Due to increase in the use of ORT, Diarrhoea related mortality decreased from 4.6
Million in 1980 to 3.3 Million in 1990.
 BARC promoted ORT to estimated 13 Million households in Bangladesh by the year
1990 and also provided the citizens training to make home-made solutions.
 During early 1990s UNICEF estimated that over 35% of diarrhoea episodes were
treated with ORT.

8. Stagnation of ORT Utilization
 After so much promotion and success of ORT, after 10 years Diarrhoea
still remained the second largest cause of child mortality.
 In the late 1990s and early 2000s focus of the global health community
shifted towards health emergencies like AIDS and Malaria.
 ORT also faced issues to get their funding for promotion at that time.
 Some Developing countries showed inefficiency in procurement and
distribution of ORS and Zinc Tablets due to poor coordination among
involved organizations.

9. Issues in the Case
 Even though ORT is an effective low cost treatment for diarrhoea it’s
progress has stalled in the 2000s with 1.5 M deaths per year.
 Misalignment in demand and supply for ORS
 Poor logistical execution at country level, ORS was unable to reach
the targeted rural population
 Shifting priorities of organization to different diseases.

10. SWOT Analysis
Strengths Weakness
Threats
Opportunities
 Low cost and easily available.
 Easy to administer.
 Highly efficacious.
 Easy to manufacture.
 Pharmacists do not consider it as
a real medicine.
 Possible failure of 7 point plan.
 Due to low cost, there is not
much monetary gain for
producers and suppliers.
 ORS subsided the symptoms and
not cure the the diarrhoea.
 Lack of financing for in-country
zinc production.
 Insufficient clean water supply in
developing countries.
 Employment opportunities by in-
country production.
 Low penetration of ORT.

11. 5 C’ s for Targeting Market
Competitors
1. NGOS
2. Govt. Agencies
3. Patients, Families
1. WHO
2. UNICEF
3. BARC
4. USAID
5. John Hopkin Medical
College
1.Technological – To make the
product more palatable using
same components
2. Economical– Though the
product is inexpensive it is
able to sustain at low cost in
the market
1. Public & Private
Organizations
2. Donors
3. Field Partners
1. IV fluid administrators
2. Global Health Emergencies
like HIV and Malaria.
Customer Collaborators Context
Companies

12. Answer: there are several factors that influence ORT utilization -
1. According to USA IDs project, better product design, packaging
and marketing can improve the uptake of ORT.
Use of bundled kits instead of separate zinc, ORS tablets.
1. Commercializing the product can improve the distribution
systems and encourage pharmacists to prescribe ORS.
2. Charging for the poorest patients can reduce the ORT
utilization in rural areas.
What influences ORT utilization? In driving utilization.
What are the roles of patients, providers and the system?
Question 1

13. Question 2
Answer: There are several loop holes in designing an implementing ORT as
treatment for diarrhea -
1. Problems due to improper training : Anecdotal Evidence revealed improper use
ORT by the health workers.
2.Problems due to logistics: Poor coordination among involved organizations led to
insufficiencies in procurement and distribution of ORS.
The most Surprising thing in the case was the misalignment of demand and supply
of ORS. ORS packets were collecting dust in health ministry controlled
warehouses; while many pharmacy and clinics reported shortage of ORS
Are the problems with ORT unexpected? What if anything is
surprising about the case?

14. Question 3
Answer: Dr. Nancy Binkin and colleagues were given 7 point plan for diarrhea
control by WHO and UNICEF, which included treatment package and
prevention package -
1. Dr Nancy Binkin and colleagues should consider opportunities to
strengthen partnerships with national govt. to improve supply chain
management
2. They should also use distribution networks of private sector companies to
distribute ORS.
3. Innovation in packaging and product design should be improved. The
product can be available in various flavors to increase demand/uptake in
young children.
What should Binkin and her UNICEF/ WHO colleagues do next?

15. Question 4
Answer: Generalities regarding healthcare system that we can infer
from this case -
1. There is lack of awareness among people, regarding this disease and
the alarming rate of child mortality.
2. Public health systems are designed poorly as there is not much
monitory benefits to either Govt., producers or even suppliers.
3. Demand and supply Gap in healthcare system.
4. Low penetration in most of the areas.
Using the ORT situation as an example, what generalities can we
draw about large scale global health problems?

16. THANK YOU