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Assessment for the Introduction of Zinc in the Treatment of Diarrhea in Madagascar

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ASSESSMENT FOR THE INTRODUCTION OF ZINC IN THE TREATMENT OF DIARRHEA IN MADAGASCAR May 2006 This publication was produced for review by the United States Agency for International Development. It was prepared by Grace Adeya of RPM Plus, Phil Harvey of A2Z, Micheline Ntiru of Helen Keller International, and Eric Swedberg and Emmanuel Wansi of BASICS. ASSESSMENT FOR THE INTRODUCTION OF ZINC IN THE TREATMENT OF DIARRHEA IN MADAGASCAR The author's views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Recommended Citation Grace Adeya, Phil Harvey, Micheline Ntiru, Eric Swedberg, and Emmanuel Wansi. 2006. Assessment for the Introduction of Zinc for the Treatment of Diarrhea in Madagascar. Rational Pharmaceutical Management Plus (RPM Plus), A2Z Micronutrient and Child Blindness Project (A2Z), Helen Keller International, and Basic Support for Institutionalizing Child Survival (BASICS) for the United States Agency for International Development (USAID). This report would not have been possible without the technical and editorial involvement of Jane Briggs of RPM Plus, and Diana Silimperi, Tom Schaetzel, Paul Crystal and Perri Sutton of BASICS. Support for this publication was provided by USAID/Madagascar and the U.S. Agency for International Development/Bureau for Global Health/Office of Health, Infectious Diseases and Nutrition/Maternal and Child Health Unit. BASICS was responsible for the coordination, editing, and dissemination of this publication. U.S. Agency for International Development Ministère de la Santé et du Planning Familial Bureau for Global Health (Ministry of Health and Family Planning) Office of Health, Infectious B.P. 88, Antananarivo 101 Diseases and Nutrition MADAGASCAR Ronald Reagan Building Tel: 261 22 63121 1300 Pennsylvania Ave., NW Fax: 261 22 29779 Washington, D.C. 20523 USA [email protected] Tel: (202) 712-0000 www.sante.gov.mg Email: [email protected] www.usaid.gov/our_work/global_health A2Z Micronutrient and Child Blindness Project BASICS Academy for Educational Development 4245 N. Fairfax Dr., Suite 850 1825 Connecticut Ave., NW Arlington, VA 22203 USA Washington, D.C. 20009-5721 Tel: (703) 312-6800 Tel: (202) 884-8000 Fax: (703) 312-6900 Fax: (202) 884-8400 Email: [email protected] E-mail: [email protected]. www.basics.org www.aed.org Helen Keller International Rational Pharmaceutical Management Plus 352 Park Avenue South, 12th Floor Center for Pharmaceutical Management New York, NY 10010 Management Sciences for Health Tel: (212) 532-0544 4301 North Fairfax Drive, Suite 400 Fax: (212) 532-6014 Arlington, VA 22203 USA E-mail: [email protected] Tel: (703) 524-6575 www.hki.org Fax: (703) 524-7898 E-mail: [email protected] www.msh.org/projects/rpmplus/ Assessment for the Introduction of Zinc in the Treatment of Diarrhea in Madagascar _____________________________________________________________________________ Table of Contents Acronyms ..................................................................................................................................... ii Acknowledgements .................................................................................................................. iii Executive Summary.................................................................................................................. iv 1.0 Introduction........................................................................................................................... 1 2.0 Methodology ......................................................................................................................... 3 2.1 Participants ......................................................................................................................... 3 2.2 Activities............................................................................................................................... 4 2.3 Observations on the Methodology and Recommendations for Next Application..... 7 3.0 Findings.................................................................................................................................. 9 3.1 Diarrhea Prevalence and Treatment............................................................................... 9 3.2 Pharmaceutical Sector Requirements for the Introduction of Zinc........................... 16 3.3 Behavior Change Communication (BCC)..................................................................... 24 3.4 Summary of Key Findings............................................................................................... 27 4.0 Action Plan for the Introduction of Zinc for IMCI in Madagascar.......................... 29 4.1 Logistics............................................................................................................................. 30 4.2 Case Management........................................................................................................... 31 4.3 IEC/BCC/Community Mobilization................................................................................. 33 Annex 1: Stakeholders Met During Assessment Team Visit .................................................. 35 Annex 2: Mission Activity Schedule ......................................................................................... 38 Annex 3: Child Survival Technical Meeting Participants Sept. 27, 2005.............................. 39 Annex 4: Child Survival Technical Meeting Participants Oct. 6, 2005 ................................. 40 Annex 5: Scope of Work ............................................................................................................ 41 Annex 6: Estimated Requirements for Zinc by District ......................................................... 45 Annex 7: Country Assessment Tool for the Introduction of Zinc in the Clinical Management of Diarrhea............................................................................................................ 55 -i- Assessment for the Introduction of Zinc in the Treatment of Diarrhea in Madagascar _____________________________________________________________________________ Acronyms ADRA Adventist Development And Relief Agency ASOS Action Santé Organisation Secours (Action Health and Relief Organization) CCMS Comite de Coordination de Mobilisation Sociale (Committee for Coordination and Social Mobilization) CHD Centre Hospitalier de District (District Hospital) CSB Centre de Santé de Base (Health Center) AMM : Agence du Medicaments de Madagascar (Drug Regulatory Authority) DPLMT Direction de la Pharmacie, des Laboratoires et de la Medecine Traditionnelle (Directorate of Pharmacies, Laboratories, and Traditional Medicine) DULMT Direction des Urgences et de la Lutte Contre les Maladies Transmissibles (Directorate of Emergency Medicine and the Fight Against Infectious Diseases) DSF Direction de la Santé de la Famille (Directorate of Family Health) EML Essential Medicines List GAIN Groupe D’action Intersectoriel Pour la Nutrition (Intersectoral Group for Nutrition Action) MCDI Medical Care and Development International MINSANPF Ministère de Santé et du Planning Familial (Health and Family Planning Ministry) MOH Ministry of Health OTC Over the Counter PCIME Prise en Charge Intégrée de la Maladie de l’Enfant (IMCI) PSI Population Services International PHAGECOM Pharmacie à Gestion Communautaire (Community Pharmacy) PHAGDIS Pharmacie de Gros de District (District Depot) SALAMA Central d’achat des Médicaments (Central Pharmacy Agency) SIECMS Service de l’Information-Education-Communication et de la Mobilisation Sociale (IEC and Social Mobilization Service) SIG Système d’information et Gestion (Management Information Systems) SPC Service des Participations Communautaires (Community Participation System) SSSa Service des Statistiques Sanitaires (Service of Health Statistics) SSD Service de la Santé de District (District Health Service) SSEA Service de la Santé de l’Enfant et de l’Adolescent (Service of Child and Adolescent Health) U5 Under five years old UPSM: Unité de Production des Solutes Massifs (Unit for the Production of High Volume Solutions) -ii- Assessment for the Introduction of Zinc in the Treatment of Diarrhea in Madagascar _____________________________________________________________________________ Acknowledgements The Zinc Assessment Team would like to express its appreciation to Santénet and PSI. In particular, Serge Raharison, Deputy Director of Santénet, and Douglas Call, Madagascar PSI Country Director, were instrumental in arranging team meetings, providing transport for meetings and during field visits, and providing administrative and logistical support. We would also like to thank USAID/Madagascar and the USAID/GH/HIDN/MCH for their support. -iii- Assessment for the Introduction of Zinc in the Treatment of Diarrhea in Madagascar _____________________________________________________________________________ Executive Summary A five-person team visited Madagascar from September 27 to October 7, 2005 to assist the Ministry of Health (MOH) and its partners in moving forward with the introduction of zinc for the treatment of diarrhea. The team met with key stakeholders in the MOH, donor community, UNICEF, WHO, cooperating agencies and projects, and the private sector; conducted field visits to Tuléar II and Toamasina; and met twice with the Zinc Technical Committee to develop a draft action plan for zinc introduction in the next year. Diarrhea prevalence and treatment
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