Creating an Enabling Environment for Scaling up Diarrhea Treatment with Zinc and ORS

Abstract

Objectives: Analyses of childhood diarrhea practices from 46 countries indicate a significant portion of caregivers from all wealth quintiles seek private sector care. We describe advantages of and strategies for working through the private sector and coordinating with the public sector to successfully scale up diarrhea management efforts. Methods: In Nepal, Pakistan, Benin, and Ghana, we created private-public partnerships to increase correct treatment of pediatric diarrhea with zinc and ORS. Key strategies include collaboration with Ministries of Health to develop appropriate policy and treatment protocols, identification of public and private sector champions to promote scale-up, and working with regulatory agencies and local manufacturers/ international non-governmental organizations to expedite product registration, regulate quality, and assure supply and distribution of affordable products. We partnered with professional associations to train providers and used private sector media channels to disseminate caregiver behavior change campaigns. Household surveys examined zinc and ORS coverage and use before and after program interventions. Results: Caregiver use of zinc and ORS increased from near zero at program initiation in all countries to a range of 7% (Pakistan) to 15% (Nepal) to 31% (Benin) in a single year.  Private sector supply increased from zero (all countries) to as high as 65% (Ghana) coverage. Thousands of providers were trained with corresponding increases in provider knowledge that zinc is the first line treatment (66% in Ghana; 87% in Benin). Conclusions: Engaging and leveraging the resources of the private sector can significantly enhance the potential for a successful scale-up of diarrhea management in developing countries.