Role of Public Health Institutions and Academia in Increasing the Prescription of ORS and Zinc for Diarrhoea

Management

Dr. V.K. Srivastava,

Professor of Social & Preventive Medicine &

Head, Department of Hospital Administration,

CSM Medical University, Lucknow 

Govt. of India Policy on use of Zinc in National Programme for Management of Diarrhoea:

Zinc (20mg/day for 14 days) is to be used in national programme as an adjunct to ORS in the management of diarrhoea in children older than 3 month to reduce duration and severity of acute diarrhoea (Govt. of India, 2006).

Why involve Public Health Institutions/ faculty members?

Because:

Their opinion matters

Their involvment gives value to the products

Their endorsement is convincing to people.

Public Health Institutions

VISIONHealthy people in healthy community

MISIONDevelopment of appropriate health man power for comprehensive health care

Academia/Faculty Members are associated with:

Development of Health Manpower (country’s need specific), and

Offer solutions to tackle health problems by carrying out research - both basic and applied

Why faculty members should involve themselves?

1. Is it of National significance?

2. Is it of Academic/Clinical interest?

3. Whether any value attached to it?

4. Is it within the purview of MCI ?

5. It is convincing?

6. Not much work done in this field?

7. Scope for further research?

Whether issue is of National Interest?

National Diarrhoea Disease control Programme

Goal

Reduce diarrhoeal associated mortality in children under the age of 5 years by 30% by 1995 and by 70% by 2000 AD.

Reducing case fatality rate to less than 1%.

It is convincing?

Enough evidence available

Recommended by UNICEF/WHO.

Govt. of India Policy

WHO: 7-Point Plan for Comprehensive Diarrhoea Control

Treatment package1. Fluid replacement to prevent dehydration2. Zinc treatment

Prevention package1. Rotavirus and measles vaccinations2. Promotion of early and exclusive breastfeeding

and vitamin A supplementation3. Promotion of hand washing with soap4. Improved water supply quantity and quality,

including treatment and safe storage of household water

5. Community-wide sanitation promotion.

Is it within the Purview of MCI ?

THE POSTGRADUATE MEDICAL EDUCATION – MCI-REGULATIONS, 2000 - SALIENT FEATURES

The goal of postgraduate medical education shall be to produce competent specialists and/or Medical teachers who :

I. Shall recognize the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy

II. Shall have mastered most of the competencies, pertaining to the speciality, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system;

THE MCI REGULATIONS ON GRADUATE MEDICAL EDUCATION, 1997 - SALIENT FEATURES

At the end of undergraduate program, the medical students should be able to : 

(a) Recognize “health for all” as a national goal and health right of all citizens and by undergoing training for medical profession fulfil his/her social obligations towards realization of this goal. 

(b) Learn every aspect of National policies on health and devote himself/herself to its practical implementation. 

(c) Appreciate rationale for different therapeutic modalities, be familiar with the administration of the "essential drugs" and their common side effects. 

Work done by Medical Colleges in UP-UK in use of promoting use of Zinc in Diarrhoea

A PILOT PROJECT ON DEVELOPING A MODEL FOR BUILDING A COMMUNITY LEVEL CAMPAIGN

A Pilot project was taken up in six cities across three states

(Lucknow, Varanasi, Ranchi, Dehradun, Kanpur & Agra) with the objective to:

Increase awareness of Zinc and focus on demand generation

through:1. Use available localized media & messengers2. Use existing community-based voluntary

networks

SELECTED CITIES FOR the COMMUNITY MODEL

City Institution

Lucknow KGMU, Prof. V.K. Srivastava

Varanasi IMS,BHU, Prof. S.C. Mohapatra

Ranchi Rajendra Medical College Prof. Shamim Haider

Dehradun GRRMCProf. S.D. Kandpal

Approach: Step wise

Step 1- Training and detailing of local HCPs about Zinc and diarrhea management

Step 2- Spreading awareness about Zinc and diarrhea management amongst consumers

Correct knowledge about Zinc Therapy

Change or adaptation among providers

Reduction in prescription of other medicines

IMPACT ASSESSMENT

How to accomplish the task by Academia/Faculty?

Through 1. Teaching

2. Training

3. Research

4. Others

1. Teaching/Training:

I. UndergraduatesII. PostgraduatesIII. InternsIV. Others- ICDS, NGOs etc.

2. Research

I. Basic

II. Applied National Heath programs Operational Research

III.Guiding MD Ph.D. Others

Promoting Research on ORS/Zinc use:

1. Operation Research eg. Feasibility studies

2. Short Regimen

3. Promoting use rate

Advocacy for Promoting ORS/Zinc use:

1. Within professional groups Meeting/Conferences Seminar/symposia

2. Others groups Schools NGOs Communities

Challenges

Low ORS use rates

Irrational use of antimicrobials &

other drugs

Very-very low use rate of Zinc in

Diarrhoea

Inappropriate management of

dehydration

Inadequate emphasis on feeding

Ultimate Goal

The revised recommendations must become routine practice both in the home and health facility

Thank you