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POUZN Project Releases New Zinc Treatment "Lessons Learned" Report for Tanzania

The USAID-funded POUZN Project just released a new study entitled "Introducing Improved Treatment of Childhood Diarrhea with Zinc and ORT in Tanzania." The report is the latest in an installment of Lessons Learned documents on POU and zinc treatment in India, Tanzania, and Indonesia.

Click here to download the full report.

The report provides a thorough explanation of the project objectives, POU water treatment, and strategies adopted to promote POU uptake. POUZN gathered lessons from the experience introducing zinc in Tanzania that will be useful moving forward and may be helpful to other programs:

Key Lessons Learned

African manufacturers can produce quality zinc treatment products for distribution both domestically and internationally. Technical assistance is needed to help manufacturers meet international standards. If they see the potential market, they are willing to make the changes needed and to invest resources.

The public and private sectors have different objectives and time scales, and a project must be flexible enough to mobilize and synergize their comparative advantages. Both sectors have a role to play in introducing and sustaining a new health behavior such as zinc treatment, with their roles contingent on the country context. In Tanzania, the project worked simultaneously with both the public and private commercial sectors.

Inclusion of zinc therapy in national diarrhea treatment guidelines is critical; it may be supported “in theory” by Ministries of Health who nevertheless face competing pressures for attention and resources. In Tanzania, garnering support for zinc treatment was difficult because of multiple demands for limited child survival resources. Donor pressures can also exacerbate this problem. Building support, starting with the parts of the ministry most involved with diarrhea and pediatric concerns, ultimately helped secure policy changes and higher-level acceptance.

Slow public sector procurement can affect uptake in countries with a large public health sector. The government was reluctant to purchase zinc for the first time because of the expense, and also because it was impossible to project (and ensure) demand for the new product. UNICEF’s offer to procure the first one million treatment courses of zinc resolved this conundrum. Once zinc was available, facilities began dispensing and restocking the drug. By late 2009, after three years of implementation, the government was ready to procure zinc from its own budget.

Demand creation is needed at all levels to ensure both the “push” and “pull” of the product from the manufacturer through wholesalers, retailers, health facilities, and ultimately to caregivers. Introducing a new product like zinc requires “priming” several levels of the supply chain, as well as concerted behavior change strategies and materials. Activations and other marketing strategies need to focus on zinc (and ORS) rather than “bundling” it with other ongoing efforts.

The most vulnerable caregivers often rely on advice from rural drug sellers; which must be part of an effective intervention. Given the informal health sector’s role in Tanzania and many other countries, it is imperative to consider the best ways of reaching these providers. Approval of zinc as an over-the-counter (OTC) medicine was an important step for making zinc available in the large number of unregistered rural outlets. (OTC approval was also necessary in Tanzania before the project could undertake widespread promotion via mass media.)

Zinc treatment for diarrhea is a new concept facing strong competition. In Tanzania, mothers have a preference for anti-pyretics and antibiotics. ORS faces this same competition and neither product “cure” a case of diarrhea, which is what caregivers desire. Furthermore, research in Tanzania showed that mothers believe ten days of zinc is “too much.” Sustained education and promotional efforts are required to ensure appropriate practices among prescribers, drug sellers, and caregivers.

Additional Lessons Learned Reports

Posted July 2010

Contact

Camille Saade
POUZN Director
+1 (202) 884-8959
csaade@aed.org