Abt Associates Inc. 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 Lessons Learned: Implementing Zinc Treatment Programs through the NGO Sector Vicki MacDonald Abt Associates June 2, 2011

Introduction – Working with NGOs Where the commercial (pharmaceutical manufacturing) sector is weak, an experienced social marketing NGO is needed to take on a management role to: Import Products Package Appropriately price Distribute to sales outlets Promote correct use

Implementing a zinc program within the NGO Model Benin Imported zinc from France and ORS from India Co-packaged zinc with ORS into a diarrhea treatment kit Distributed through commercial and community-based channels Promoted product use through mass media and interpersonal channels Public sector purchased kit from PSI and sold to clients at cost recovered price (no profit) Madagascar Imported zinc from France and ORS from India Co-packaged into 2 diarrhea treatment kits Subsidized kit through community NGO channels (ViaSur) Cost recovered kit through commercial channels (HydraZinc) UNICEF provided zinc and ORS to public sector, sold at a subsidized price Products marketed through both community and mass media channels

NGO Model: Policy Considerations  High dependence on public sector services required close collaboration between public and the coordinating organization  Required Government support and role in policy development and willingness to register imported products (zinc from France and ORS from India) for private sector sale  Needed Government support to allow over-the-counter sales  Needed a policy allowing trained community health workers to promote and/or sell zinc/ORS to caregivers

NGO Model: Product Supply Co-packaging ORS and Zinc: Packaging is costly It has shown to increase ORS use where rates are very low Given the high cost of packaging (40-50% of cost) ORS and Zinc should be co-marketed but not necessarily co- packaged unless there is no ORS available on the market or very low use of ORS/ORT

NGO Model: Product Supply within the NGO Model Small number of pre-approved suppliers limited options for price competition and form of product Importation is a costly and time consuming process that can negatively impact product availability Moving product into rural areas through local NGOs is costly, time consuming and not sustainable

NGO Model: Promotion of Zinc Use Behavior change communication through mass media is critical for large-scale impact Improves consumer knowledge of treatment Critical to encouraging trial and use Improves correct use Improves brand awareness Encourages providers to stock and recommend zinc

NGO Model: Interpersonal Communications Working closely with our NGO partner linked the project to its network of local community partners who disseminated information about zinc and improved its accessibility in rural areas through community-based distribution and sales

NGO Model: Summary Lessons Learned Working with an NGO enabled:  Importation of zinc and ORS into countries without local manufacturing capacity  Products to be available through both commercial and community-based sales channels  Setting appropriate prices and subsidization when necessary  Appropriate mass media as well as greater reach of information and correct use messages into rural areas

Abt Associates Inc. 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