Public-private Partnership Approaches for Scaling up Zinc with ORS

Abstract

Objectives: Based on evidence from four previous private sector programs, USAID's SHOPS project, in partnership with the Ghana Health Service, developed a strategy to maximize availability of, demand for, and use of zinc plus oral rehydration solution (ORS) for the treatment of pediatric diarrheas. This abstract describes the private sector-focused strategy for addressing high diarrhea prevalence among children under five in Ghana.
 Methods: SHOPS established a conducive policy and regulatory environment, engaging stakeholders from both sectors; collaborated with regulatory bodies to train over 10,000 chemical sellers and pharmacy staff and 350 clinicians in diarrhea management; partnered with pharmaceutical manufacturers to increase availability of quality, affordable products; developed an innovative campaign to increase awareness and demand; and partnered with NGOs to promote use through community mobilization. We conducted in-depth interviews and mystery client surveys with providers to assess reported and actual prescribing behavior.
 Results: Private sector sales of zinc tablets increased ten-fold after training providers and 300% after the media campaign, treating over 2 million children with diarrhea to date. Most (75%) providers mentioned zinc as their preferred diarrhea treatment; 65% actually prescribed zinc with ORS as treatment. Retail audits confirm over 60% of chemist shops and pharmacies carry zinc and ORS. These results are notable in that zinc was completely unknown and unavailable in Ghana prior to the initiation of the program in 2012.
 Conclusions: In a single year, significant progress in scaling up diarrhea treatment was realized through strategic partnerships with the private sector in Ghana.

Sociodemographic and institutional determinants of zinc bundled with oral rehydration salt utilisation among under-five children with diarrhoeal diseases in East Wallaga zone, western Ethiopia: a community-based cross-sectional study

“…The zonal town, Nekemte, is located 333 km west of Addis Ababa, which is the capital city of Ethiopia. East Wallaga zone has an area of 21 980 million km 2 and is geographically bounded in the east by West Shewa and Jimma zones, in the west by West Wallaga zone, in the north by Horo Guduru Wallaga zone and Amhara regional state, and in the south west by Buno Bedele zone. Administratively, the zone has a total of 17 districts, and the total population Open access of the zone in 2021/2022, as projected from 2007, was 1 585 215 with a male to female ratio of 1.1:1.…”

“…1 Currently, nearly 1.7 billion cases of childhood diarrhoeal diseases account for one in nine child deaths, making diarrhoea the second leading cause of death and the leading cause of malnutrition in children under 5 years old across the globe. 2 It kills more than 5.2 million under-five children globally, and around 800 000 children die of diarrhoea and dehydration each year in Africa. 3 Of all child deaths from diarrhoea, 78% occur in the African and South-East Asian regions, which are also disproportionately burdened with infant and childhood HIV infections.…”

Predictors of Under-Five Caregivers’ Utilization of Co-Packaged Zinc and Oral Rehydration Salts for Childhood Diarrhea in East Wollega Zone, Western Ethiopia

“…5 Based on this, zinc and ORS supplementation and continued feeding were recommended for an acute diarrheal disease treatment as they prevent disease and reduce the duration of illness and its recurrences. 6 …”

“…Also, the bundling of zinc and ORS has various public health benefits, such as improved adherence to its combined therapy, adherence to or preparation of its individual components, health-care worker dispensing practices, increased uptake and coverage, a reduction in inappropriate antibiotic prescription and utilization, and increased utility for the service receiver. 6 , 9…”