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Zinc and ORS: Ready for take-off in Cambodia

Mothers class in Cambodian village

Last month I had the opportunity to go out into field with my colleagues in Cambodia where PATH is working with the Ministry of Health (MOH) and local provincial health and operating districts to increase the coverage of zinc and ORS. A major new development in this effort has been the approval by the MOH, through the establishment of a new national policy on the control of acute respiratory infection and diarrheal disease, to allow Village Health Groups (VHGs), essentially a team of two community health workers, to distribute zinc. In most countries zinc is regulated as a drug and therefore can only be distributed by licensed pharmacists, doctors and nurses. These regulations, despite the benign nature of zinc (no side effects, no risk of overdose, etc.), greatly hinder access. However, thanks to the new national policy, mothers in our pilot area in Cambodia are being supplied with zinc and ORS by their nearby VHG, greatly improving access and availability to rural areas. 

Each quarter the VHGs from each village receive training and information at their nearest health center from staff trained by the provincial health office. In our pilot areas, two quarterly VHG meetings were dedicated to training VHGs to treat diarrhea using ORS and zinc, and to recognizing signs of pneumonia. In turn the VHGs use their regular monthly “mother classes” to build awareness among mothers in their villages about diarrhea and pneumonia, and to encourage the mothers to visit the VHG for zinc and ORS when their child has diarrhea.

At the quarterly meeting, the VHG gets resupplied with zinc and ORS as needed. Never before have the VHGs had the means to provide treatment. Previously, mothers would usually wait until the case was serious enough and then set off for the health center, which is often 20 to 30 bumpy kilometers on the back of a motor bike. Upon arrival at the health center, the child would often need expensive intravenous rehydration and an overnight stay.

As a result of the national policy, which in turn catalyzed this new approach to diarrhea management and the training and supplying of VHGs and the mothers classes, coverage of zinc and ORS is going up, and the number of cases of moderate to severe dehydration showing up at health centers has been falling in our pilot areas, quite significantly. 

On my visit to the field I was joined by Dr. Veasna, the head of Cambodia’s Division of Acute Respiratory Infection/Control Diarrheal Disease) and a primary author of the new policy. He was extremely pleased to see the progress and, in partnership with PATH and UNICEF, the MOH is now making plans to take this program nationwide. With help from UNICEF, which will facilitate training down to the health centers, and PATH, which will facilitate reaching from the health centers to the villages via the VHGs and the mother classes, we are poised for achieving dramatic increases in zinc/ORS coverage throughout the country, and subsequently, reduced morbidity and mortality from diarrhea.

For more information:
-- Learn how PATH and the Government of Cambodia are combining strategies to tackle pneumonia and diarrhea through an integrated national policy.
-- Vietnam is bringing all resources to bear on overcoming diarrhea and setting a model for the Mekong region.
 

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