Role of Public Health Institutions and Academia in Increasing the Prescription of ORS and Zinc for Diarrhoea Management Dr. V.K. Srivastava, Professor of Social & Preventive Medicine & Head, Department of Hospital Administration, CSM Medical University, Lucknow
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Role of Public Health Institutions and Academia in Increasing the Prescription of ORS and Zinc for Diarrhoea
Management
Dr. V.K. Srivastava,
Professor of Social & Preventive Medicine &
Head, Department of Hospital Administration,
CSM Medical University, Lucknow
Govt. of India Policy on use of Zinc in National Programme for Management of Diarrhoea:
Zinc (20mg/day for 14 days) is to be used in national programme as an adjunct to ORS in the management of diarrhoea in children older than 3 month to reduce duration and severity of acute diarrhoea (Govt. of India, 2006).
Why involve Public Health Institutions/ faculty members?
Because:
Their opinion matters
Their involvment gives value to the products
Their endorsement is convincing to people.
Public Health Institutions
VISIONHealthy people in healthy community
MISIONDevelopment of appropriate health man power for comprehensive health care
Academia/Faculty Members are associated with:
Development of Health Manpower (country’s need specific), and
Offer solutions to tackle health problems by carrying out research - both basic and applied
Why faculty members should involve themselves?
1. Is it of National significance?
2. Is it of Academic/Clinical interest?
3. Whether any value attached to it?
4. Is it within the purview of MCI ?
5. It is convincing?
6. Not much work done in this field?
7. Scope for further research?
Whether issue is of National Interest?
National Diarrhoea Disease control Programme
Goal
Reduce diarrhoeal associated mortality in children under the age of 5 years by 30% by 1995 and by 70% by 2000 AD.
Reducing case fatality rate to less than 1%.
It is convincing?
Enough evidence available
Recommended by UNICEF/WHO.
Govt. of India Policy
WHO: 7-Point Plan for Comprehensive Diarrhoea Control
Treatment package1. Fluid replacement to prevent dehydration2. Zinc treatment
Prevention package1. Rotavirus and measles vaccinations2. Promotion of early and exclusive breastfeeding
and vitamin A supplementation3. Promotion of hand washing with soap4. Improved water supply quantity and quality,
including treatment and safe storage of household water
5. Community-wide sanitation promotion.
Is it within the Purview of MCI ?
THE POSTGRADUATE MEDICAL EDUCATION – MCI-REGULATIONS, 2000 - SALIENT FEATURES
The goal of postgraduate medical education shall be to produce competent specialists and/or Medical teachers who :
I. Shall recognize the health needs of the community, and carry out professional obligations ethically and in keeping with the objectives of the national health policy
II. Shall have mastered most of the competencies, pertaining to the speciality, that are required to be practiced at the secondary and the tertiary levels of the health care delivery system;
THE MCI REGULATIONS ON GRADUATE MEDICAL EDUCATION, 1997 - SALIENT FEATURES
At the end of undergraduate program, the medical students should be able to :
(a) Recognize “health for all” as a national goal and health right of all citizens and by undergoing training for medical profession fulfil his/her social obligations towards realization of this goal.
(b) Learn every aspect of National policies on health and devote himself/herself to its practical implementation.
(c) Appreciate rationale for different therapeutic modalities, be familiar with the administration of the "essential drugs" and their common side effects.
Work done by Medical Colleges in UP-UK in use of promoting use of Zinc in Diarrhoea
A PILOT PROJECT ON DEVELOPING A MODEL FOR BUILDING A COMMUNITY LEVEL CAMPAIGN
A Pilot project was taken up in six cities across three states
(Lucknow, Varanasi, Ranchi, Dehradun, Kanpur & Agra) with the objective to:
Increase awareness of Zinc and focus on demand generation
through:1. Use available localized media & messengers2. Use existing community-based voluntary
networks
SELECTED CITIES FOR the COMMUNITY MODEL
City Institution
Lucknow KGMU, Prof. V.K. Srivastava
Varanasi IMS,BHU, Prof. S.C. Mohapatra
Ranchi Rajendra Medical College Prof. Shamim Haider
Dehradun GRRMCProf. S.D. Kandpal
Approach: Step wise
Step 1- Training and detailing of local HCPs about Zinc and diarrhea management
Step 2- Spreading awareness about Zinc and diarrhea management amongst consumers
Correct knowledge about Zinc Therapy
Change or adaptation among providers
Reduction in prescription of other medicines
IMPACT ASSESSMENT
How to accomplish the task by Academia/Faculty?
Through 1. Teaching
2. Training
3. Research
4. Others
1. Teaching/Training:
I. UndergraduatesII. PostgraduatesIII. InternsIV. Others- ICDS, NGOs etc.
2. Research
I. Basic
II. Applied National Heath programs Operational Research
III.Guiding MD Ph.D. Others
Promoting Research on ORS/Zinc use:
1. Operation Research eg. Feasibility studies
2. Short Regimen
3. Promoting use rate
Advocacy for Promoting ORS/Zinc use:
1. Within professional groups Meeting/Conferences Seminar/symposia
2. Others groups Schools NGOs Communities
Challenges
Low ORS use rates
Irrational use of antimicrobials &
other drugs
Very-very low use rate of Zinc in
Diarrhoea
Inappropriate management of
dehydration
Inadequate emphasis on feeding
Ultimate Goal
The revised recommendations must become routine practice both in the home and health facility