Programmatic Experiences

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Global Lessons Learned

Introducing Improved Treatment of Childhood Diarrhea with Zinc and ORT in India, Indonesia, and Tanzania
Overview: This publication focuses on the AED (now FHI 360) experience implementing the USAID-funded Point-of-Use Water Disinfection and Zinc Treatment Project (POUZN). Three different models of Public-Private Partnerships aiming at introducing zinc treatment, along with lo-ORS, as a standard of care for children with diarrhea. The project was active in India, Indonesia and Tanzania between 2005 and 2010.

Social Marketing Plus for Diarrheal Disease Control: Point-of-Use Water Disinfection and Zinc Treatment (POUZN) Project 2005-2010
Overview: This publication focuses on the Abt Associates experience implementing the USAID-funded Point-of-Use Water Disinfection and Zinc Treatment Project (POUZN) in three countries introducing zinc treatment, along with lo-osmolarity ORS, as a standard of care for children with diarrhea. This report encompasses the introduction of zinc with ORS in Nepal, Benin, Madagascar and Pakistan, as well as highlights and lessons learned in the implementation of water treatment programs in Kenya, Rwanda, Malawi, Benin, and the Democratic of the Congo between 2005 and 2010.

Country-specific lessons learned
Africa

Benin
A Public-Private Partnership for the Introduction of Zinc for Diarrhea Treatment in Benin: Results and Lessons Learned
Overview: Program country brief and lessons learned during implementation of the USAID-funded POUZN project in Benin, focusing on a social marketing model and partnerships with local NGOs to expand interpersonal communications to reach rural caregivers.  

Ethiopia
Strategy to Increase Access to Treatment of Childhood Diarrhea, Malaria and Pneumonia in Ethiopia
Overview: This MSH document is an analysis of bottlenecks to the treatment of diarrhea, malaria and pneumonia in Ethiopia and discusses impact and cost of targeted interventions.

Madagascar
Assuring Access to Pediatric Zinc for Diarrhea Treatment Through the Private Sector in Madagascar: Results and Lessons Learned
Overview: Program country brief and lessons learned during implementation of the USAID-funded POUZN project in Madagascar, focusing on a social marketing model with a two pronged approach to reaching urban caregivers with full price product while implementing interpersonal channels to reach poor, rural caregivers with appropriate messages and a subsidized product.

Assessment for the Introduction of Zinc and the Revitalization of Diarrhea Case Management in Madagascar
Overview: An assessment of the diarrhea case management situation and the feasibility of introducing zinc therapy for a USAID-funded BASICS project in Madagascar that focuses on the registration of zinc, modifications to the health information system, availability through public and private sectors, and behaviour change communication.

Tanzania
ADE.POUZN- Introducing Improved Treatment of Childhood Diarrhea with Zinc and ORT in Tanzania
Overview: Lessons learned from AED (now FHI 360)’s introduction of zinc treatment, both in the public and private sectors. Context and goals are discussed, as well as strategies implemented and adjustments made. The section on results includes data on changes in diarrhea treatment practices among both providers and caregivers of children under five.

POUZN Tanzania: Using a Multi-Sector Approach to Promote Zinc and Oral Rehydration Therapy
Overview:  The USAID-funded AED (now FHI 360) Project’s lessons learned in Tanzania, including details on collaborating with the MOH to help in updating the national guidelines for the treatment of diarrhea, enlisting the pharmaceutical companies for local production of zinc, and extending the distribution points to the rural areas by building on the Accredited Drug Dispensing Outlet (ADDO) program. 

Asia

Bangladesh
Assessment of Commercial Private Sector for Health Care Products in Bangladesh
Overview: A Pilot activity funded by USAID that explores how a market development approach could be used to promote the sustainable delivery of selected health care products to underserved populations in Bangladesh.  General opportunities for development programs to support commercial private sector initiatives in the healthcare sector of Bangladesh and (possibly) elsewhere are also identified.

Cambodia
Assessment of Pilot Zinc Introduction in Cambodia
Overview: Assessment of a pilot to introduce Zinc through the USAID-funded POUZN project in Cambodia that focuses on current policies for diarrheal disease case management as well as the feasibility of the public sector to distribute zinc and low-osmolarity ORS through public health facilities and the private sector to distribute OraselKIT® diarrhea treatment kit.

India
Control of Childhood Diarrhoea Through Scaling-up Zinc and ORS
Overview: Government of India Guidelines developed to assist State health programme managers for successful planning for scaling up of ORS and Zinc use for reduction in childhood deaths resulting from diarrhoea including procurement, monitoring and evaluation strategies and community awareness.

Essential Medicines Initiative India- Scale-up strategy for Diarrhea, Pneumonia and Malaria Treatment
Overview:  This document provides details of how scale up will be achieved and discusses the collaboration required among key stakeholders.  Barriers specific to accessing the recommended treatments to these three conditions and for child health services overall are addressed through proposed cross-cutting child health interventions.

The Private Sector Market for Diarrhea Treatment in India
Overview:
This assessment was performed by CHIA (2012) to examine supply and demand-side barriers of the diarrhea treatment market in order to provide in a way that offers strategic direction for the development of India’s essential medicines national strategy.

ADE.POUZN- Treating Childhood Diarrhea in India with ORT and Zinc- Engaging the Pharmaceutical Industry and Private Providers
Overview: Lessons learned from AED (now FHI 360)’s implementation of the nationwide scale-up of zinc treatment in India, including the introduction of zinc treatment in the private sector, the successful engagement of pharmaceutical companies to produce and market zinc treatment and of rural medical practitioners to provide coverage in areas not covered by pharmaceutical firms’ marketing efforts.

Promoting Appropriate Management of Diarrhea- A Systematic Review of Literature for Advocacy and Action- UNICEF-PHFI Series on Newborn and Child Health, India
Overview:
This systematic review summarizes current evidence on childhood diarrhea and provides evidence to inform child health programs in India.

Management Practices for Childhood Diarrhoea in India- Survey of 10 Districts
Overview:
This study was conducted to understand the current practices by caregivers and service providers related to the management of childhood diarrhoea to assist in strategic planning, design, implementation, and monitoring of programmes aimed at controlling childhood diarrhoea and to accelerate expanded utilisation of low-osmolarity ORS and zinc.

AED/POUZN: Creating a Partnership Model to Take Zinc to Scale in India
Overview:  A detailed version of AED (now FHI 360)’s lessons learned for creating a sustainable supply and demand for zinc treatment in India.  The document describes the evolution of the private sector partnership from a nationwide strictly urban strategy to a more focused rural business model involving small local pharmaceutical companies and NGOs to  to create demand among Rural Medical Practitioners (RMP) who are the first line health care providers for the majority of the rural population in India. 

Indonesia
Assessment for the Introduction of Zinc in Improved Management of Diarrhea in Indonesia
Overview: An assessment of the diarrhea case management situation and the feasibility of introducing zinc therapy for a USAID-funded BASICS project in Indonesia that focuses on outlook for the production and distribution of zinc products, government drug supply management, prescribing habits of practitioners and public awareness and education needs.

Nepal
Introducing Zinc Through the Private Sector in Nepal for the Treatment of Childhood Diarrhea: Results and Lessons Learned
Overview: Program country brief and lessons learned during implementation of the USAID-funded POUZN project in Nepal, focusing on partnerships with manufacturers and impact of demand creation efforts to motivate zinc use.

Pakistan
Partnering with the Pharmaceutical Industry to Ensure Access to Pediatric Zinc for Diarrhea Treatment in Pakistan: Results and Lessons Learned
Overview: Program country brief and lessons learned during implementation of the USAID-funded POUZN project in Pakistan, focusing on partnerships with four local zinc manufacturers and professional association to assure supply and sensitize providers in the Sindh and Punjab provinces. 

Country Scale up Plans / Strategies

Kenya
Scale Up of Zinc Sulfate Use through the Private Sector in Kenya- Assessment and Feasibility Study

Overview: A whole market assessment of diarrhea management practices for a USAID-funded SHOPs project in Kenya that focuses on identifying opportunities to increase access to and use of diarrhea treatment products (zinc and oral rehydration salts (ORS)) by caregivers of children under five through private sector channels.

Tanzania
Scale-up Strategy for Essential Medicines for Child Health- Diarrhea, Malaria and Pneumonia (2012-2015)
Overview: Government scale-up strategy published by the Ministry of Health and Social Welfare

Indonesia
POUZN Indonesia: Private and Public Sector Collaboration to Improve Diarrhea Treatment
Overview:  Lessons learned from AED (now FHI 360)’s implementation of the nationwide scale-up of zinc treatment in Indonesia, including the rapid registration and introduction of zinc treatment with the help of the public sector, the successful engagement of multiple pharmaceutical companies to produce and market zinc treatment to providers (doctors and midwives) and the project approach with the public sector to reach directly the caregivers through mass media.

Demand Creation and Behavior Change

Ghana: The USAID-funded SHOPS project has an example of a recent TV advertisement for Ghana’s mass media campaign to increase the awareness of caregivers about new national guidelines recommending the treatment of pediatric diarrheas with zinc and oral rehydration salts and to promote correct use of those treatments (see Video).

Indonesia:  AED’s USAID-funded mass media campaign in Indonesia to promote zinc treatment to consumers, including Ministry of Health endorsement of zinc treatment (see Video).

Instructional Materials

Research

Nigeria
The Private Sector Market for Diarrhea Treatment in Nigeria

Overview: This assessment was performed by CHIA (2011) to inform a scale-up plan for ORS and Zinc by identifying the main barriers to increasing accessibility and uptake of appropriate diarrhea treatments through Nigeria’s private healthcare delivery sector.  In particular, barriers to access and uptake were assessed at the levels of supply, distribution, and sale of treatments.

Tanzania
Creating a Sustainable Private-sector Drug Seller Program in Tanzania
Overview: This document provides an outline of the East African Drug Seller Initiative (EADSI) funded by the Bill & Melinda Gates Foundation.  EADSI aimed to increase access to quality medicines and pharmaceutical services in underserved areas through involvement of the private sector.

Promoting Zinc and ORS for the Management of Childhood Diarrhea in Tanzania: A Research Brief
Overview: A complete monitoring and evaluation report from AED’s USAID-funded work in Tanzania, including mystery client surveys of pharmacies and accredited drug dispensing outlets (ADDOs) and caregiver surveys. 

Uganda
Marketing Zinc for Childhood Diarrhea Treatment: Results from household and provider surveys in Benin and Uganda
Overview
Uganda: (ppt) summary of household research conducted with over 800 caregivers of children with diarrhea and 71 providers in Uganda.

India
Formative Research for Developing Communication Strategy to Private Sector
Overview: This Report presents the findings of the formative research conducted in two states in India to understand the underlying needs of the community as well as their health seeking behaviour and practices for childhood diarrhea treatment.  In addition, the influences and triggers to adopt ORS and Zinc supplements as the solution are discussed and a two phase communication approach is recommended.

Promoting Zinc and ORS for the Management of Childhood Diarrhea in India: A Research Brief
Overview: A report of monitoring and evaluation results from AED’s implementation of at-scale zinc supply and demand creation in India.  The report covers two surveys: a consumer survey and a provider survey of chemists and rural medical practitioners.

Indonesia
Promoting Zinc and ORS for the Management of Childhood Diarrhea in Indonesia: A Research Brief
Overview: A report on AED’s pre/post caregiver and a cross-sectional midwives surveys.  The project used mass media to create demand among caregivers and promoted zinc treatment directly to midwives, who are a trusted source of information among Indonesian caregivers.  

Nepal
Introducing Zinc through the Private Sector for the Treatment of Childhood Diarrhea: Results from a population-based household survey in Nepal
Overview: Report on results from household survey of 3000 households in Nepal to evaluate impact of Abt/PSI’s USAID-funded efforts to introduce zinc into private sector markets.

 

Recent Innovations

Experience with co-packaging

Technical/regulatory sample insert

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