Building partnerships with the commercial private sector to introduce zinc for treatment of pediatric diarrhea in Nepal and Pakistan

Approximately 1.2 million children die annually from diarrhea. To address the need for appropriate treatment in Asian countries where the majority of caregivers seek care from the private sector, partnerships were developed with four commercial pharmaceutical firms in Pakistan and three in Nepal to assure availability of affordable, quality zinc products in both urban and rural areas. Population-based household surveys were conducted in Nepal (n=3550) and Pakistan (n=1725) with caregivers of children under five to determine diarrhea management practices. A multistage sampling design was used to obtain nationally-representative estimates for the household surveys and analyses were weighted correspondingly. Diarrhea treatment information was obtained via structured questionnaires and retail audits were conducted to determine sales. The partners brought to market high quality pediatric zinc products, employed their own sales/detailing forces and distribution systems to market the products, and contributed additional funds to marketing and provider training activities. Sales for all zinc products in both countries more than doubled in one year. Affordable products were available in private sector outlets throughout target areas. In Nepal 58% of zinc users obtained zinc from a private provider or pharmacy and 73% thought zinc was affordable. In Pakistan, 87% of zinc users obtained their zinc from a private pharmacy and 59% thought it was affordable. Collaborative pharmaceutical partnerships are critical to assure access to appropriate treatment products in Asia. Introduction of zinc through private sector commercial channels is crucial in those countries where treatment/care is sought primarily through private sector sources.