dr gaurav arya
TRANSCRIPT
Dr. Gaurav Arya
Health Specialist, UNICEF
October 30, 2010
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
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
AwarenessAcceptabilityAvailabilityAccessibilityAffordability
Increased Use
Sensitized healthcare providers
Knowledge in community
about seeking care for
diarrhoea in children
Reduced mortality of children due to diarrhoea
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
There are multiple drug modalities being practiced
There are multiple drug therapies being used
87
42.9
16.9
7.81.3
95.1
38.6
3.67.2 2.2
0.0
20.0
40.0
60.0
80.0
100.0
Allopathic Ayurvedic Homeopathic Unani Others
Service provider (N=77) Retailer (N=223)
77.9
36.4 33.8
10.4 9.1 3.915.6
83.9
23.8
47.1
10.3 1.3 3.113.9
0.0
20.0
40.0
60.0
80.0
100.0
ORS Homemade fluids
Antibiotic Antimotility/ Antidiarrhoeal
Plain Zinc AYUSH Pills & Syrups
Injections
Service provider (N=77) Retailer (N=223)
The general prescription pattern of service providers is inappropriate
Many of the retailers/ pharmacists have never retailed ORS and Zinc
66.7
11.5
52.2
12.62.6 1.9
18.1
0.0
20.0
40.0
60.0
80.0
100.0
ORS Homemade fluids Antibiotic Antimotility/ Antidiarrhoeal
Plain Zinc AYUSH Pills & Syrups
Injections
68.9
31.1
Ever Stocked ORS Never Stocked ORS
14.1
85.9
Ever Stocked Zinc Products
Here is where a large proportion of the population goes: RMPs
And this is what they use for treatment:
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
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
COMMUNITYDOCTORS &PHARMACIES
Meetings with depot holders
Community
Meetings
Sensitizing the
Doctors
ORS and Zinc
ORS and Zinc promotion – through depot holders
Connecting with the rural pharmacy and practitioners
HEALTH EDUCATION ACCESS & QUALITY
COMMUNITY EMPOWERMENT SUSTAINABLE EFFORT
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)
Physician Education
Depot holder’s meetings
Awareness & Education
IEC Material
THANKS