Public-private partnership approaches for scaling up zinc with ORS

Transcription

1 Public-private partnership approaches for scaling up zinc with ORS Presenter: Vicki MacDonald, Abt Associates June 4, 2014 SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O Hanlon Health Consulting

2 Diarrhea mortality in children under five Second leading cause of death in children under 5 years (11%), excluding neonatal causes At least 801,000 child deaths per year Source: Liu et al. Lancet 2012;379:

3 WHO/UNICEF Joint Statement 2004 Revised recommendation for the treatment of childhood diarrheas: Oral rehydration therapy (ORT) or oral rehydration solution (ORS) Zinc supplementation for days Antibiotics only when specifically indicated

4 The private sector is a major source of care for childhood diarrhea & pneumonia South Asia 79% 21% SE Asia 66% 34% N. Africa & Europe 60% 40% Private Public Sub-Saharan Africa 51% 49% Latin America & Caribbean 34% 66% 0% 20% 40% 60% 80% 100% Source: Montagu D and Visconti A. Analysis of multicountry DHS data. 4

5 Conditions for success in public-private partnerships for diarrhea management Strong public sector leadership and engagement Access to quality affordable pediatric zinc Improved caregiver knowledge about the role of zinc with ORS and their correct use Enhanced provider knowledge about zinc as the recommended treatment Supervision through regulatory agencies

6 Public sector leadership National policy includes zinc with ORS in diarrhea management protocols Public sector supports private sector involvement Regulatory agencies ensure zinc can be purchased over the counter with ORS 6

7 Widely available, quality, affordable zinc and ORS Partner with pharmaceutical companies to market and distribute zinc/ors products Facilitate production of quality zinc products Partner with international NGOs in countries without a viable pharmaceutical industry to import quality products

8 Expanding caregiver knowledge Consumer demand for zinc/ors generated through: national mass media (TV/radio) campaigns, interpersonal communication and community mobilization co-funding marketing activities of zinc manufacturers 8

9 Expanding provider knowledge and supportive supervision Partnerships with: regulatory authorities to train drug sellers drug inspectorate to provide supportive supervision professional associations to train professional cadre pharmaceutical companies to reach clinicians and pharmacists through CME

10 Proportion of caregivers treating with zinc Results: Increased zinc use in all countries 60% 50% 54% *Baseline from DHS 40% 30% 31% 20% 10% 0% * 0% * 4.8% * 1% 1% 15% 7% 5% 0.9% Benin Madagascar Nepal Pakistan Uganda 3 years 1 year 1 year 3 months 2 years * 5% DHS data pre-intervention Pre-intervention Post-intervention 10

11 Results: Majority of retail outlets correctly recommend zinc/ors for management of uncomplicated diarrheas Mystery Client Survey in Ghana 2012Mystery Client Survey in Ghana 2012 Mystery Client Survey in Ghana 2012 Recommended ORS** 79.6% Recommended Zinc** 65.9% Recommended Antimicrobials 47.8% Recommended Antidiarrheals 11.3% **Correct behavior N =

12 Results: Providers Stock Zinc and ORS Ghana 66% of retail outlets carry zinc 90% carry ORS Nigeria: 45% of retail outlets carry zinc 80% carry ORS 12

13 Private sector: essential to scaling delivery Synergies are realized when public and private sectors work together Public sector has an important leadership, policy and regulatory role Private manufacturers can move quickly to ensure supply Mass media and interpersonal communications are critical to raising awareness among both caregivers and providers Working through regulatory agencies is an excellent channel to reach retail providers with training and supervision 13

14 Contact: SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O Hanlon Health Consulting