1. Promoting prevention and treatment of Diarrhoea:Increasing the availability and USE of ORS and Zinc Dr. Gaurav Arya Health Specialist, UNICEF October 30, 2010

2. Overview of the presentation 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

3. Why are we talking about diarrhoea 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

4. Components of effective management of diarrhoea using ORS and Zinc Reduced mortality of children due to diarrhoea

5. These are the field challenges 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

6. Data shows… There are multiple drug modalities being practiced There are multiple drug therapies being used

7. Data shows… The general prescription pattern of service providers is inappropriate Many of the retailers/ pharmacists have never retailed ORS and Zinc

8. Pictures Show… Here is where a large proportion of the population goes: RMPs

9. Pictures Show… And this is what they use for treatment:

10. What are we doing in Uttar Pradesh 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

11. What are we doing in Uttar Pradesh 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

12. Social Marketing: A Social innovation COMMUNITY EMPOWERMENT SUSTAINABLE EFFORT HEALTH EDUCATION ACCESS & QUALITY ORS and Zinc DOCTORS & PHARMACIES COMMUNITY Connecting with the rural pharmacy and practitioners Sensitizing the Doctors Meetings with depot holders Community Meetings ORS and Zinc promotion – through depot holders

13. Depot holder’s meetings Awareness & Education Physician Education Social Marketing: A Social innovation 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)

14. Social Marketing: A Social innovation IEC Material

15. THANKS