A private-sector intervention addresses leading cause of child mortality

The United Nations Children’s Fund (UNICEF) and the World Health Organization recommend using oral rehydration salts (ORS) and zinc to treat diarrhea, a leading cause of death in children under 5 years of age worldwide. Under the Diarrhea Alleviation through Zinc and ORS Therapy (DAZT) project, FHI 360 is working with the private sector in the Indian states of Gujarat and Uttar Pradesh to increase the uptake of zinc and ORS treatment. In this Q&A, Saikat Mukhopadhyay discusses the DAZT project’s unique approach.

A private-sector intervention addresses leading cause of child mortality

Photo Credit: Jessica Scranton/FHI 360

How has DAZT’s partnership with the private sector led to better health outcomes in maternal and child health?

In India, it is important to reach patients through the private sector. At the onset of the project, we conducted a survey that showed that only approximately 67 percent of the people afflicted with diarrhea sought medical treatment, and of this population, more than 80 percent went to a private practitioner. Moreover, in rural and impoverished areas there is a lack of formal medical facilities for those seeking care and treatment for diseases such as diarrhea.

We are trying to ensure that rural populations receive the best treatment for diarrhea. In order to do that, we must reach the private, rural medical providers (RMPs) who are providing the majority of patient care, especially at the bottom of the economic pyramid. RMPs are not formal doctors, but follow doctors’ patterns for prescribing medicine. They frequently do not have up-to-date information on the most effective ways to treat diarrhea in children. They often prescribe only antibiotics and antidiarrheals, which can be harmful.

To change this, we started by encouraging formal doctors to prescribe zinc and ORS. We then worked with RMPs to change their prescribing behavior.

Has this project’s approach increased demand for zinc and ORS therapy?

In September 2011, sales of ORS and zinc in Gujarat and Uttar Pradesh were 3,000 and 4,000 units, respectively. By July 2014, demand reached 500,000 units for ORS and roughly 200,000 units for zinc.

What is unique about the project’s approach?

Three major features make this project unique. The first is its sustainability. We are trying to educate and mentor our partners, whether they are nongovernmental organizations (NGOs) or pharmaceutical partners, on the importance of promoting zinc and ORS treatment. Also, after the project ends in 2015, a pharmaceutical partner has agreed to continue the promotion of zinc and ORS therapy — a critical step to sustainability. Second, due to the adaptability of its collaborative model, this project could be scaled up across India and customized to develop the capacity of private-sector partners in other countries. Third, the approach used in this project can be used to fight other diseases. This project’s cascade model begins with reaching key opinion leaders, doctors and RMPs, which increases impact at the point of care through those who are treating patients.

This project features a toll-free helpline. How does it work?

We discovered that one of the major problems in villages is transporting patients to medical facilities. RMPs can treat mild cases. But, to reduce mortality in patients with severe diarrhea, it is important to consult a formal provider and, for patients in rural settings, getting to a formal provider is a challenge.

The helpline was created to help RMPs if they have a critically ill, dehydrated patient, especially after normal business hours. The provider can call the 24-hour helpline to get advice from a pediatrician on how to manage a critically ill patient. RMPs can talk to a helpline doctor about the patient’s condition and ask the questions needed to make a diagnosis.

The helpline also has recorded messages with information about ORS and zinc and provides “the do’s and don’ts” of treating diarrhea.

Why is this project important?

Every grant will end someday. But, the need will likely continue, even if the intervention has reduced it. The only way to continue good work in social sectors is by helping projects and people achieve self-sustainability.

Through our model of operation, the DAZT project has achieved a measure of self-sustainability. The marketing of ORS and zinc is expected to continue after the project ends. Both NGO and pharmaceutical partners are continuing to promote this therapy without our intervention. Pharmaceutical companies have an incentive to promote it because doctors will continue to prescribe it. It has become a major commercial product for them.

DAZT is implemented by FHI 360 in partnership with the Micronutrient Initiative (MI), the Johns Hopkins Bloomberg School of Public Health and UNICEF.

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