Camille Saadé, AED/ POUZN Director csaade@aed

1. Scaling up Diarrhea Treatment with Zinc and ORT through Public-Private Partnership in different Asian Countries Camille Saadé, AED/ POUZN Director csaade@aed.org Reconvening Bangkok: 2007 to 2010 – Progress Made and Lessons Learned in Scaling-Up FP-MNCH Best Practices in the AME Region 7 – 11 March 2010

2. Diarrhea, still # 2 killer of children < 5 • Estimated 1.8 million deaths annually, down from 4 million in 1990 • Improvement in preventative measures (water, hygiene and sanitation) • ORT / ORS rates declining • Introduction of zinc treatment with ORT

3. Zinc in the Treatment of Diarrhea • WHO & UNICEF include Zinc for rational treatment of diarrhea (2004) with ORT • Zinc treatment in diarrhea: • decreases duration of diarrhea by 20-24% • reduces the severity of diarrhea by 25% • provides protection for next 2 -3 months and reduces diarrhea incidence by 34%

4. POUZN Partnership Model Public Sector Private Sector Development partners/ Catalyst HealthProviders NGOs Community 6

5. Policy and the Public Sector • Included Zinc in national diarrhea treatment guidelines along with ORT • Zinc and ORS in procurement list • Training of health workers on-going • FDA approved Zinc as over-the-counter (OTC) for diarrhea treatment

6. Engaging the Pharmaceutical Industry • Well developed capabilities and infrastructure • Manufacturing, GMP compliance and Quality Assurance • Intensive marketing to doctors and pharmacists but limited direct-to-consumer marketing experience • Nationwide distribution • Initial enthusiasm and expectation of quick return

7. Production/ Supply is not the Issue

8. L-O ORS

9. Sustained Demand is the Issue • At multiple levels: • Health providers • Drug sellers • Caregivers

10. Harmonized Message: Rational Management of Diarrhea = ORT + Zinc + Feeding

11. The Phased Marketing Approach Pharmaceutical marketing Health Professionals Over-the-counter (OTC) marketing Drug Sellers Interpersonal communication, Mass advertising General Public Time

12. Working with Multiple Partners • Competition and multiple products keep prices down • Additional products increase “noise” and reach • Competition helps push product to lower socio-economic groups

13. Phase 1 Strategy: Establish Zinc Among Health Professionals • Engage Zinc manufacturers in promoting rational management of diarrhea • Enhance partners’ marketing capabilities • Intensify continuous promotional efforts and extended distribution • Target key opinion leaders and top prescribers

14. Pouch bag • Brochures • Ballpoint • Notes • FAQ Booklet • Clear Folder

15. Phase 2: Saturation of Health Care Providers and Drug Sellers • Intensify regular Rx of Zinc among top prescribers of diarrhea treatments • Focus on drug sellers and 1st line care providers in rural areas: informal RMPs in India, midwives in Indonesia • Target RMPs, midwives and outreach HW through NGO’s health promoters.

16. The Phased Marketing Approach Pharmaceutical marketing Health Professionals Over-the-counter (OTC) marketing Drug Sellers Interpersonal communication, Mass advertising General Public Time

17. Phase 3: Reach the Caregivers • Interpersonal communication: • Direct private sector promotion through NGOs • Outreach health workers • Mass Media – most effective when health workers are on board, nationwide distribution in public health system is in place, and there is sufficient penetration in rural market • Supported by Public sector and Development partners

18. Model Adaptability Engaging strategically the private sector: • Applies to FP/ MNCH/ other Public Health • Reaches national scale rapidly • “Primes the market” for public sector • Increases efficacy of USAID investment • Is sustainable after project life