January 18, 2022

Championing Zinc and Low-Osmolarity Oral Rehydration Solution (LO-ORS) to Combat Diarrhoeal Disease in High-Burden Northern Nigeria.

January 18, 2022

Championing Zinc and Low-Osmolarity Oral Rehydration Solution (LO-ORS) to Combat Diarrhoeal Disease in High-Burden Northern Nigeria.

Wellbeing Foundation Africa and Nutrition International LO-ORS Zinc Case Studies Contribute Key Learning To Nigeria’s National Product Supply Chain Management Program. 

My vision for the Wellbeing Foundation Africa (WBFA) was to build an NGO which promotes an environment where the wellbeing of all can thrive. In which every man, woman, adolescent, child, and infant has reliable, obtainable health care, at all stages of life. Through our vast global partnerships and in alignment with the United Nations Sustainable Development Goals (SDGs) with measurable and meaningful outcomes, we have successfully established this vision and advocated heavily for the betterment of universal health care and practices within Nigeria. 

This has led the Wellbeing Foundation Africa to actively commit to promoting comprehensive access, availability and management of Nigeria’s Essential Medicines List. One medicine in particular which we have been championing is Zinc and Low-Osmolarity oral Rehydration Solution (LO-ORS) to combat childhood diarrhoea. 

Diarrhoea is the second commonest cause of childhood mortality among children under 5 years of age globally. Each episode contributes to a significant nutritional deprivation that negatively affects child growth, particularly in more serious and prolonged episodes. The mortality of diarrhoea remains high in Africa, despite being easily treated with Zinc LO-ORS. 

Within Nigeria, Diarrhoea is the second largest cause of death in children, responsible for an estimated 151,700 children dying in Nigeria every year. It remains an immense threat to child survival in Nigeria with 10% of deaths in children under five resulting from this disease. The national diarrhoea prevalence rate also varies considerably from region to region, with the highest in the North-East and North-West of Nigeria at 24.7%  and 14 % respectively, while lowest rate was recorded in the South-West region having a prevalence of 5.3%, largely influenced by socio-economic status of households.

Our advocacy efforts bore fruit 2012, when WBFA in collaboration with the WHO PMNCH, UN Every Woman Every Child Initiative, the Clinton Health Access Initiative (CHAI) and the Federal Ministry of Health succeeded in integrating Zinc LO-ORS into Nigeria’s Essential Medicines List, which led to saving over 1,000,000 lives.

Nigeria still suffers from a high death rate due to diarrhoea which undermines the accomplishment of the Sustainable Development Goals (SDGs) if left unmanaged, as the understanding and implementation of Zinc LO-ORS is not universally adopted in Nigeria. When WBFA identified these gaps, and that Diarrhoea prevalence and treatment in Nigeria is substantially higher in the Northern regions, we engaged Nutrition International (NI) as a partner to support the Scaling up Zinc and LO-ORS to improve Childhood Diarrhoea treatment in two states – Sokoto and Kano in Northern Nigeria – in order to further improve their performances towards ensuring equity in the distribution of wealth and healthcare services related to diarrhoea management across the country. Our partnership allows both technical and financial support to Kano and Sokoto to address key factors associated with high diarrhoea morbidity and mortality, including the bottlenecks associated with the supply chain in diarrhoea treatment.

Therefore, this week the Wellbeing Foundation Africa is extremely proud to be presenting and participating at the Stakeholders Meeting on the National Product Supply Chain Management Program (NPSCMP) New Approaches to DRF/DMA Set-Up. WBFA’s journey in the implementation of Zinc and LO-ORS to improve childhood diarrhoea treatment in Northern Nigeria (Kano and Sokoto State) with a focus on DRF/DMA strengthening is of valuable knowledge for NPSCMP.

The Wellbeing Foundation Africa’s ongoing program intervention with Nutrition International implementing – ‘Scaling up Zinc and LO-ORS to Improve Childhood Diarrhoea treatment in Northern Nigeria’, supported by the Government of Canada, with a specific focus on supporting states Drug Revolving Fund mechanisms commenced in August 2021 in the two high-burden north-west states of Kano and Sokoto to:

  • To provide Zinc LO-ORS to at least 80% of health facilities by 2024 using the DRF scheme.
  • To achieve additional Zinc LO-ORS coverage of 1,843,832 cases across the two states by 2023.
  • To increase the number of caregivers who seek care promptly for childhood diarrhoea cases diarrhoea by additional 2,238,439 caregivers.

The Project focuses on health system strengthening, comprising 2 key areas, as follows:

  1. Improving quality of care: Improving the capacity (knowledge and skills) and motivation of frontline health workers to provide quality care (treatment, counselling and support) to children with diarrhoea and their caregivers. This will be accomplished through targeted training, supportive supervision and increasing access to needed tools.
  2. Improving supply of Zinc LO-ORS to health facilities to improve availability of the commodities in a sustainable manner. NI will focus on improving state procurement systems for the commodities and support the states to implement or strengthen Drug Revolving Fund (DRF) schemes that incorporate Zinc LO-ORS to complement existing health commodity procurement systems in the states. The project is strengthening the capacity of the state SPHCDA and other line managers at different levels to be able to manage the DRF scheme.

WBFA is currently working in 173 healthcare facilities within 151 communities and has reached over 126,226 caregivers through our program. Since the launch of the program, a total of 1,055 healthcare workers from both States;  577 from Kano State (281 male and 296 female) and 478 from Sokoto State (248 male and 230 female) have been trained specifically on the best practices of Integrated Management of Childhood  Illnesses (IMCI). In addition, a total of 18,606 caregivers, nearly all of them women, have been educated on the use of Zinc LO-ORS for the management of diarrhoea disease in the two selected states.

We are proud that the program is conducted in close collaboration with the State Primary Health care development agency and the states’ Ministry of Health. Relevant units and departments include primary health care (SPHCDA) and pharmaceutical services (SPHCDA and/or SMOH), State medical store or the DRF coordinating unit in the target states. Activities are conducted at state, LGA and health facility levels, targeting facilities providing diarrhoea treatment services.

The WFBA NI partnership played a strong role in strengthening the DRF scheme in the state, and our successes, challenges, and learning during the program are full of insight. Through our programming, WBFA has been able to provide technical assistance to the state, ensuring its investment in its DRF scheme, which also highlights increased revenue for the facilities to be self-sustaining. This also led to the transparent introduction of PHR into all facilities in the state.

A few key lessons we learned throughout was that Kano State has been able to sustain the DRF scheme in the last 14 years piloted by a few local governments. This, paired with improved commitment from the state government and support from WBFA NI, led to the state being able to review its DRF tool which was last reviewed 8 years ago. Therefore, good political will and sustainable partnership between governmental and non-governmental agencies are key to the sustenance of DRF in the state. 

Pre-program, there was a lack of formal training on the DRF scheme by key stakeholders and healthcare workers, which was identified as a major challenge in confronting the successful implementation of the DRF scheme in the 2 states. Following the technical support from WBFA/NI on the training of healthcare workers, there was a large improvement in understanding and knowledge capacity. Thus, it is recommended that because the majority of participants lack formal training and understanding of the scheme, it is important that stakeholders are periodically engaged in reinforcement training on the DRF Scheme.

There is also a need for continuous collaboration between the Federal, State, and Local governments and healthcare facilities on the DRF scheme. The government should leverage the temporary technical and financial support provided by the private sector and donors, as this will go a long way in ensuring the sustainability of the scheme over time.

Supporting Sokoto and Kano states to increase and sustain availability and access to Zinc  LO-ORS commodities by strengthening their Drug Revolving Fund schemes is catalysing modern medicine. This is done through a better supply chain and financial procurement management in tangential action with health systems strengthening, deploying a dedicated midwifery and nursing workforce to reach community health care facilities and households, and creating statewide behavioural change that delivers measurable improvements where they are needed most. 

As WBFA commits to continued cooperation and collaboration with the Federal Ministry of Health, stakeholders and partners for harmonised policy strengthening and implementation, and as we share success stories, case studies and lessons learnt from DRF engagement, we recognise that improving treatment outcomes in childhood diarrhoea requires access and availability to medicines that mothers trust. 

Access to essential medicines and other health care products is a human right irrespective of socio-economic status and will allow us to realise our sustainable development goals. Most leading causes of death and disability can easily be alleviated, treated and prevented with cost-effective essential medicines. We must work towards the accessibility and availability of these life-saving medicines. The Wellbeing Foundation Africa reiterates our commitment to developing and supporting a strategic plan in which procurement, storage, inventory management, distribution and policy creation can be done efficiently and widely. We must build a resilient health system that ensures access to basic health care services in a sustainable manner for all.



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