Lessons in Scale-up of a Public Sector Zinc ORS Intervention for Childhood Diarrhoea Management in the Indian State of Bihar

Abstract

Objectives: The Government of India introduced guidelines on therapeutic supplementation of zinc in the management of childhood diarrhoea in the year 2007, but programmatic constraints delayed its introduction into public health programs. Micronutrient Initiative, with support from a donor, initiated a program in 2010 to demonstrate and scale-up the use of zinc through public sector channels, in the state of Bihar. Methods: The project was implemented in 15 demonstration districts with a population of 36 million. Over 40,000 community level health workers were oriented on use of zinc. Support was provided to strengthen procurement and supply chain mechanisms. A robust system of monitoring and evaluation was introduced to track performance. Meaningful engagement with the government ensued throughout the demonstration phase. Results: Use of Community-level volunteers (CLVs) is a pre-requisite to scaling-up access to care. More than one-million children were reported to be provided care. The CLVs need to be engaged through a relevant supportive supervision model. Supply chain mechanisms need to be strengthened to prevent stock-outs at service delivery points. Simple reporting tools need to be introduced for improved case- reporting. Conclusions: It is feasible and viable to introduce and scale-up therapeutic zinc supplementation as an adjuvant to ORS in the management of childhood diarrhea through public sector channels. The community-based approach of service delivery and proactive engagement with the government are key essentials in achieving the above objectives.