Strengthening Zinc Supplementation and ORS Distribution in the Treatment of Childhood Diarrhoea in Select Rural and Urban Areas of Afghanistan through Capacity Building of Public and Private Sector Health Personnel and Strengthening Supply Chain Management
Ibrahim Shinwari *
Micronutrient Initiative, Kabul, Afghanistan.
Manoj Kumar Raut
Micronutrient Initiative, India.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Though the Government of Afghanistan has officially included zinc supplements in the diarrhoea treatment plan for young children, coverage remains abysmally low. The aim of this project is to strengthen the capacity of the government systems and involve private doctors and chemists to increase coverage and utilization of zinc along with ORS for the treatment of childhood diarrhea.
Methods: The project was implemented in diverse geographic settings through the public sector in two provinces (population of ~650,000) and through the private sector in five cities (4,000,000 population). In this project, capacity was strengthened through (i) training health providers in the public and private sector on use of zinc supplements (ii) provision of zinc and ORS supplies (iii) Increased focus on individual and group counseling skills (iv) Strengthened program monitoring.
A January 2014 endline survey will measure whether program goals of coverage and utilization of zinc and ORS were met.
Results: In the public sector, 453 community health workers (CHWs) from health posts and 1400 private doctors and pharmacists were trained. Data from government monitoring systems reported use of zinc supplements in 40% of childhood diarrheal cases treated in the two rural provinces. A rapid assessment of newly trained private sector providers in Kabul city revealed that 80% of doctors and 40% of chemists were including zinc in all diarrheal prescriptions for children.
Conclusions: It is possible to introduce zinc supplements for childhood diarrhea treatment through existing government and private health providers and improve coverage and utilization.