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 2

3. 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. 4 POUZN Partnership Model Private Sector Private Sector Public Sector NGOs Community Development partners/ Catalyst Health Providers 6

5. 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. 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 7

8. L-O ORS

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

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

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

12. 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. 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. 1.Pouch bag 2.Brochures 3.Ballpoint 4.Notes 5.FAQ Booklet 6.Clear Folder

15. 15 Phase 2: Saturation of Health Care Providers and Drug Sellers Intensify regular R x 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.

17. 17 Pharmaceutical marketing Health Professionals Drug Sellers Time Over-the-counter (OTC) marketing Interpersonal communication, Mass advertising The Phased Marketing Approach General Public

18. 18 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

19. 19 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