Bridging the access gap for treatment of diarrhea

This week, the global public health community welcomed the World Health Organization’s decision to include co-packaged oral rehydration salts (ORS) and zinc on its Model List of Essential Medicines for Children (EMLc). This new global normative guidance is an important and enabling step toward improving access to first line treatments for children with diarrhea.

This decision is important because it reinforces the lifesaving benefits of both ORS and zinc in treating childhood diarrhea. ORS has long been hailed as a major contributor to the decline in diarrhea deaths among young children since it was first introduced in global diarrhea control programs over 40 years ago. While this decline has been impressive, there remain vulnerable populations with persistently low access to these inexpensive and effective commodities. It is sobering to be reminded that in 11 of the 15 highest-burden countries, 6 have combined ORS and zinc coverage levels of 2 percent or less.

We know that on a strong backbone of community interventions delivered through a well-trained cadre of health workers, the combined use of ORS and zinc could prevent an estimated 64% of child deaths due to diarrhea. Co-packaged presentation is a key lever for driving better usage, and where introduced, countries see a significant increase in uptake of both products.

This decision is also important because it formalizes the long-standing joint call by WHO and UNICEF to use both ORS and zinc to treat diarrhea in children. Countries can use this standard to shape national policy and treatment guidelines for diarrhea, prioritize what products they procure and supply, and adapt provider training practices to allow for improvement in the equity of access. We hope that this leads to more equal procurement of these products and translates to more availability in the hands of community health-workers.

In partnership with countries, we’ve already been helping to build evidence of what works and what doesn’t to scale up ORS and zinc.  The experience of countries like Bangladesh have clearly shown that even in the absence of improved national coverage levels, improved equity of coverage ensuring that vulnerable populations have access can translate to significant declines in mortality. Further reduction of deaths will likely not occur without a concerted effort targeting marginalized communities and those with low access to primary care services.

By calling attention to ORS and zinc as therapy that needs to be administered together, WHO took an important step in helping countries build on the existing evidence. Working together to improve access to ORS and zinc as one of the important elements of the integrated approach to child health, we can help accelerate the decline in child mortality, and, ultimately, advance progress toward the United Nations Sustainable Development Goals and universal health coverage.

Today, we have evidence of what works and what doesn’t. It is time for us, as a global community, to act on that evidence.

About the author:

 

Rasa Izadnegahdar is deputy director of the Bill & Melinda Gates Foundation’s Maternal, Newborn and Child Health Discovery & Tools team, which works to identify and address underlying biological risks to health for mothers and their children.

 

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no relevant conflicts of interests to declare.

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