In November 2012 the rural health centres in Kalomo District in Zambia had not received ORS for several months due to a lack of stock at national level. In January, I visited one of these health centres and asked the Clinical Officer in charge if she’d received any ORS yet. She said they had received 200 sachets on 23 December. But, she said, they weren’t using it, they were giving out Kit Yamoyos instead. What? In the ColaLife trial Kit Yamoyos should only be available to buy (or exchange for a promotional voucher) at retail outlets.
“How is it that you have Kit Yamoyos to give to mothers?” I asked. She explained that she had taken all the vouchers we’d left at the health centre, to be given to mothers as part of our promotion of the kit, straight to the local retailer and exchanged them for Kit Yamoyos. These Kit Yamoyos had then been put in the health centre store and were being given straight to mothers just like any other medicine supplied by the government.
Now this goes completely against what we are trying to do including:
- Move simple diarrhoea treatment to the home and away from the health centres so that they can deal with more difficult conditions that are more difficult to treat and need more sophisticated medicines
- Establish remote retailers as the source of Kit Yamoyos
- Establish Kit Yamoyo as something you buy, not something available free from a health centre
When we pointed this out the Clinical Officer did offer to reverse the transaction but we just asked her not to do it again and explained why.
However, what is interesting about this case study is that it played out, in real life, the concept of rural retailers acting as couriers and supplying remote rural health posts with essential medicines. This concept was written at the request of Zambia’s Minister of Health, Dr Joseph Kasonde, and is published here.
We don’t think that rural retailers would have the capacity to supply rural health centres but we think they may be able to supply the smaller, even more remote Health Posts.
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