EVERY WOMEN EVERY CHILD UN COMMISSION ON LIFE-âSAVING

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inefficiencies and sustainability concerns, especially with the key partners indicating that some funding may cease at the end of 2012. Quality: Procurement and distribution at the public health facility level is not based on actual demand: a significant proportion of public health facilities in Uganda do not stock adequate supplies of zinc and ORS. This is largely due to Uganda’s supply system, whereby volumes of medicines are “pushed” to HC III and II based on assumed demand. This results in chronic under-‐stocking of Zinc and ORS. In the 45 districts covered by SURE, ORS was only available in 86% of HC2 and 89% of HC3 during the last quarter of 2012. For facilities that have been out of stock at least one day, the average stock out over the last 3 months lasted 15 days at HC2 and 18 days at HC31. No data is available re. Zinc Evidence/ regulatory issues: Lack of an overarching policy and conducive regulatory framework: the MOH prepared a draft Protect-‐Prevent-‐Treat (PPT) strategy, which has yet to be endorsed. Awareness/ demand Caregivers' knowledge about ORS is generally high . However, the level of knowledge about (1) the severity of risk posed by diarrhea, and (2) the use of zinc to complement ORS treatment, remain poor. For example, only 17% of caregivers had been exposed to any message about zinc/ORS – consistent with weak mass media efforts (source: SHOPS' KAP survey). This situation is reflected in caregiver behavior, in which there is lack of compliance with the recommended treatment regimens (in particular demand for zinc). In addition, a significant percentage of caregivers do not seek treatment at all (~ 14% of total), suggesting that the severity of diarrhea is not affecting their behavior. Implementation plan a) Immediate plan • Behavior Change Communication (BCC) 1. Awareness-‐raising. Strong and sustained efforts to improve caregivers’ knowledge of diarrhea treatment with zinc and ORS: Craft key communication messages, develop creative work with a specialized agency and produce material. Conduct Behavior Change Communication campaigns through mass media. Leverage the national VHT network to disseminate BCC messages and material, and further develop this opportunity through the development and utilization of a mobile phone platform to effectively communicate messages to VHTs and caregivers. • Incorporate ICCM commodities into the national supply chain through: (1) Support to MOH's on-‐going quantification effort of community-‐level demand for ORS and Zinc, including an assessment of the additional procurement cost for NMS; (2) quantification of ICCM consumption vs. facility consumption; (3) develop long term ICCM sustainability guidelines; (4) support facility-‐based VHT quality improvement collaborative meeting; (5)
support the MoH in the roll out ICCM sanctioned VHT to other district, with a view to progressively achieve national coverage; and (6) development of a Logistics Management Information System (LMIS) that can appropriately track the supply of commodities from central public sector supply to facilities vs ICCM. • Optimize national logistics management for ORS and zinc to support forecasting, procurement and distribution in public sector: Support the NMS to improve the national Logistics Management Information System so that the quantification of consumption, volumes issued and costs is appropriately tracked, especially around the transition from individually packed Zinc & ORS to co-‐packed ORS-‐zinc boxes. This will enable regular revise of the essential medicine kit to take into account volume increases correlating with demand generation efforts, and avoid stock outs. • Educate Public providers about Zinc benefits and treatment course, and about the ORS-‐Zinc co-‐pack through production of IMCI computer assisted training and adaptation Tool (ICATT) materials. Create & print & distribute job aids for public health workers (Chart booklets, wall charts, treatment algorithms…). Train and support/supervise public health workers at Health Centers level IV, III, II and VHT in management of childhood diarrhea (Zinc + ORS) b) Intermediate plan • Train private providers in the management of diarrhea and promote ORS and Zinc as the appropriate treatment in the management of uncomplicated diarrhea. Create & print & distribute training materials based on IMCI for private health workers (job aids, video, …). Leverage lessons learned, databases and best practices from complementary private sector-‐oriented trainings such as the Integrated Management of Malaria rolled out in 2012 through the AMFm. Train private providers in integrated case management of child diarrhea (IMCI). Increase detailing efforts by pharmaceutical distributor to private providers, again developing relationships established through the AMFm. • Optimize the private supply chain through mapping the private supply chain and engage with key distributors to by-‐pass unnecessary levels and reduce margin. Learn the lessons of AMFm to ensure that international cost savings are passed on to the consumer – in particular through the enforcement of a recommended retail price that can be communicated as part of the BCC campaign. • Accelerate the introduction of low-‐cost caregivers/providers-‐friendly product. Work with NDA to fast-‐track registration of new zinc and ORS products (smaller pack size, flavor, syrup…) • Behavior Change Communication (BCC) 2: Dissemination of messages to caregivers in rural poor populations through interpersonal and social channels to reinforce awareness-‐raising impact of media campaign and encourage completion of behavior change. Two key channels: (1) Community activation by specialist communications agency with expert rural reach; (2) Support to the ongoing roll-‐out of Ministry of Health community outreach programmes including Family Health Days, Child Health Days and vaccination days. •
Page 2 and 3: 1. BACKGROUND ...................
Page 4 and 5: 1. BACKGROUND 1.1 Introduction The
Page 6 and 7: RMNCH services and commodities
Page 8 and 9: 1.3 Process of development of
Page 10 and 11: integrated. There will be an i
Page 12 and 13: Product development/ market shap
Page 15: community level. However the po
Page 20 and 21: Specific issues identified Provid
Page 22 and 23: A parallel step will be to im
Page 26 and 27: 3.4.2 Amoxicillin tablets for tr
Page 28 and 29: progressively achieve national c
Page 30: REFERENCES 1. Annual Health Secto

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EVERY WOMEN EVERY CHILD UN COMMISSION ON LIFE-âSAVING