Mother with GRZ co-pack outside Chinsali Urban Clinic
Sep-15 was a turning point to our work in Zambia. In this month the first batch of government-branded Kit Yamoyo packs were delivered to Medical Stores Limited (MSL), the public sector medicines distributor in Zambia, for distribution to health facilities in 11 of the 14 districts facing the biggest nutritional challenges. The GRZ ORS/Zinc co-pack, to give it its proper name, was then given free of charge to caregivers with children suffering from diarrhoea. Under the KYTS-ACE programme (Feb 2015-Jan 2017), funded by SUN, districts receiving the co-pack via the Public Sector were: Chipata, Kalabo, Mansa, Lundazi, Shangombo, Chinsali, Mbala, Kaputa, Samfya, Mwinilungu and Zambezi. These are very hard to reach districts with low nutritional outcomes for children, a high prevalance of diarrhoea in children under 5 years old and very low coverage of zinc for diarrhoea (estimated at under 1%). For learning purposes, to compare the pubic sector and private sector in Zambia, we enabled Value Chain driven supply, through the private sector only, in 3 other such districts: Mongu, Mumbwa and Kasama. In Zambia, unlike other countries, the private sector is very poorly developed, with a small number of pharmacies nationwide, mainly in big towns. Although in theory people can buy both ORS and Zinc over the counter – off prescription – they are rarely stocked; most people rely on the public sector facitlities, which are free.
This 2015 batch of 30,300 co-packs was the first of many future deliveries, as the MOH observed interest at the frontline of public sector facilities in the new co-pack. By Dec-16 452,000 kits had been delivered to MSL. This order was funded by the Scaling Up Nutrition (SUN) Programme and has, as we will provide evidence for shortly (Mar-18), transformed the access to ORS and zinc for the treatment of diarrhoea. This is one of the pillars of the SUN Programme in Zambia.
Norr, through its partnership with ColaLife, donated an additional 14,635 kits in Oct-17.
Then a crisis hit when MSL ran out of ORS and zinc in the last quarter of 2017. We were asked if our kits could be distributed across the whole country. We politely declined as we wanted to stay focussed on the 14 districts that needed ORS and zinc the most. However, the pressure built and built and what remains of the GRZ co-pack is being distributed country-wide. Some of this pressure came for health staff who had had experience of the co-pack in the SUN districts.
On the one hand this is disappointing as the donation was made for the SUN districts but on the other hand it is indicative that the GRZ co-pack is becoming accepted and valued as the go-to treatment for childhood diarrhoea in Zambia. We will also use this experience as we continue to push for co-packaged ORS and zinc to be included in the Zambia Essential Medicines List.
Through late 2016 and 2017 we were able to compare how the co-pack changed dispensing practice, by looking at health centres in Mongu District that had only separate ORS and Zinc in 2016, and which by 2017 were benefiting from the new policy of distributing the co-pack everywhere.*
Regular readers will remember that we started ColaLife to look at the potential of the private sector – small shops that sell Coca-Cola and other Fast Moving Consumer Goods in very remote places. Yet our work over the past 7 years has shown that in Zambia, at least, despite our efforts to develop private sector value chains and despite a theoretically supportive policy framework, it is the public sector that has had the power to really make a difference to access to Kit Yamoyo and improve coverage of ORS together with Zinc*. You can explore more in this post, and the papers below.
*UPDATE Feb 2024 : We look at how government involvement in the learning process from 2011-2018 has led to a sustainable government supply of co-packaged ORS and Zinc in this paper:
**UPDATE Oct 2024: A paper is finally due for publication by the end of 2024: Impact of co-packaging oral rehydration salts and zinc on diarrhoea treatment dispensing behaviour in selected rural health facilities in Zambia, by Simon Berry, Dario Domingo, Akufuna Ngenda,cJane Berry and Rohit Ramchandani.
