Micronutrient Initiative, implemented a program during 2010-14 to scale-up use of zinc as adjuvant to ORS for childhood diarrhea management through public sector in Gujarat, India. The program aimed at increasing childhood diarrhoea treatment with zinc/ORS by involving community health workers (CHWs) in service provisioning, which was previously limited to facility level.
The project covered six districts havingtotal population of ~13 million;>20,000 CHWs were trained. Supplies of zinc/ ORS were ensured andsupportive supervision was provided to reinforce CHWs’ capacities. Monitoring data were collected and external pre-post evaluation was completed.
Nearly 90% CHWs are able to identify diarrhea cases and know correct doses of zinc/ORS. Among non-facility treated cases ~2/3 are treated by CHWs. Between May-2011 and December-2013 care-seeking for childhood diarrhea increased from 19.6% to 37.6% in public sector and dropped 80% to 74% in private care, indicating a shift from private to public sector care-seeking. Within public sector, care-seeking through CHWs increased from 5%-22%with just 15%-19% increase through facilities, implying a three-fold increase from CHWs as compared to facilities. Coverage of zinc increased from 2.5% to 22.4% and ORS from 15.3% to 39.6%. From facilities, zinc coverage declined and ORS marginally increased, whereas from CHWs ithas increased more than double.
With CHW training and supply provision, care-seeking for diarrhoea shifted from private sector to public sector, most of this shift through CHWs. This implies increased accessibilities played a role and it is feasible to involve CHWs as credible providers for diarrhoea management.