Capacity building of community level health workers and equipping them with supplies to enhance care seeking and usage of zinc and ORS for management of childhood diarrhoea through public sector in Gujarat, India

Abstract Number Theme Presentation Type Cover Approved
0432 Monitoring and surveillance for tracking progress and program improvement Poster Approved


Abstract Content


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.

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