Abstract
Background
CHAI started the zinc/ORS program in India in 2012 because approximately 212,000 children under-5 were dying annually as a result of dehydration caused by diarrhoea. Diarrhoea was still the second-largest infectious cause of death among children and was responsible for 13% of all under-5 deaths in India. The focal states of MP, Gujarat and UP, accounted for 43% of the total under-5 diarrhoea burden in India (>90,000 deaths) annually.1 These deaths typically happened in hard-to-reach, resource-compromised areas with limited access to health care. However, deaths from diarrhoea are easily preventable through the nationally-recommended combined treatment of zinc and ORS. Therefore, CHAI and partners developed a program that focused specifically on increasing the coverage of both zinc and ORS for children suffering from diarrhoea. The baseline for this program uses the state-wide estimates from DLHS-3 conducted in 2008 (see Figure 1 for detailed breakdown of state-level diarrhoeal deaths and coverage targets).
Approach
The root cause of low zinc/ORS use was not complex: providers and consumers were often unaware that zinc/ORS is the recommended treatment for diarrhoea in children; due to the anemic demand, suppliers had limited incentive to invest in distribution and promotion of these products. In the private sector, this resulted in poor product access and high consumer prices, especially in rural areas. In the public sector, lack of resources and suboptimal products had also contributed to lower uptake. The political and partner environment further impeded the uptake of zinc/ORS through limited attention, modest funding, and unfavorable regulatory conditions where zinc was still a prescription-only product.
To overcome this market trap, CHAI worked with multiple stakeholders to catalyze significant scale up of zinc and ORS usage. Specifically, the work was focused on the following three objectives (also see Figure 2):
- Building demand: CHAI applied a business-orientated approach to generate demand using techniques from the pharmaceutical and consumer goods industries to change the practices of consumers and providers.
- Expanding supply of high quality products: CHAI helped to expand the availability of affordable, high quality, and optimal zinc/ORS products in the public and private sectors by partnering with suppliers to expand their distribution and promotion efforts and by ensuring products were taste-masked, dispersible, and packaged with the consumer in mind.
- Creating an enabling environment and leveraging additional resources: CHAI worked with governments and non-governmental organization (NGO) partners to align and to optimize diarrhoea treatment scale-up efforts and to drive integration within existing child health services. At the national level, CHAI also worked to achieve over-the-counter status for zinc.
