The Micronutrient Initiative supported the governments of Afghanistan, Bangladesh and Indonesia to demonstrate effective strategies to strengthen the use of zinc supplements and ORS in the treatment of diarrhea (Zn-ORS) to reduce morbidity and mortality in children under five through the public health system during 2011-2014. The objective of this paper is to describe results of these projects and its implications on scale-up.
Program package focused on advocacy with governments for adequate planning and budgeting, strengthening supply chain management including initial provision of zinc, capacity building of health staff, strengthening Behavior Change Interventions, modifying the Health Management Information System to track stocks and coverage; and improving supportive supervision. Pre-post intervention-comparison design was adopted in Bangladesh, and post-intervention assessments in Afghanistan and Indonesia were compared to large-scale surveys near baseline.
We found apparent improvements in coverage and adherence to Zn-ORS in program areas. In Bangladesh, the coverage and adherence for Zn-ORS increased by 49 and 38 percentage points, respectively compared to only 22 percentage points increase for both coverage and adherence in the comparison districts, respectively. In rural areas of Afghanistan, coverage and adherence was 55% and 82%, respectively, vis-a-vis 5.3% coverage by Multiple Indicator Cluster Survey, 2010-11. Similarly, in Indonesia’s intervention sites, Zn-ORS coverage was 35% compared to 2012 DHS coverage (1%) and adherence was 27%. The positive findings for this program package across three country settings demonstrate its replicability.
Given these results, national and provincial governments have commenced scaling-up in all three countries.