Stop Diarrhoea Initiative
Stop Diarrhoea Initiative is a signature programme of Save the Children, in partnership with Reckit Benckiser. The programme was envisaged to contribute to RB and Save the Children's global ambition of removing diarrhoea as a top five leading cause of death amongst children by 2020. In line with the Save the Children's Theory of Change, the programme will: test the effectiveness and efficacy of the WHO-UNICEF 7 point plan; collate evidence to demonstrate proof of concept and value for money, and advocate for the state and national government and its partners to replicate and scale up the approach nationally.
India consists of 1.22 billion people spread across a wide variety of socio economic variations. As a result, most model programmes developed for Indian states are designed to cater for these socio-economic variations and the Government of India always requires development partners to work across a range of states and contexts. In order to test the effectiveness the WHO-UNICEF 7 point plan, Save the Children wanted to demonstrate proof of concept from several states which represent the socio-economic diversity of the Indian context. The Government would not accept the effectiveness of the 7 point plan unless the results demonstrated were from a fair representation of the vast majority of the Indian states. Taking this into consideration, Save the Children designed an intervention for the WHO-UNICEF 7 point plan to be implemented and tested across four states: Delhi, Uttarakhand, Uttar Pradesh and Kolkata in West Bengal.
The programme was designed to achieve a 100% coverage at ward and block level which is more than the 80% coverage recommended by WHO for a targeted location.
Our operational model was based on working at ward level in urban areas and block level in rural areas. A ward consists of approximately 100,000-150,000 people whilst a block comprises of a cluster of 100-200 villages with a population size of 100,000 - 200,000. The block and the ward are some of the smallest administrative units at the district level.
These four states are a fair representation of the socio-economic status of India, as two (Uttarakhand and Uttar Pradesh) are part of the Empowered Action Group (EAG) States. EAG states are government priority states that have the highest infant mortality rates. There were many reasons for the choice of these states:
- High under-five mortality and diarrhoea incidence in the target areas. Our analysis and research indicate that except Delhi, West Bengal and Udam Singh Nagar in Uttarakhand, under-five mortality in our target areas is above the national average
- Delhi was specifically chosen due to its high urban slum population with a dire need for increased coverage of the 7 point plan. This will help us to demonstrate proof of concept in slum areas. Additionally, implementing the programme in Delhi will position us to advocate effectively with the central government, as well as with our strategic partners who are based in Delhi. Leveraging effective advocacy for the programme is crucial to the success and we have already engaged the Government of Delhi to secure their commitment to the programme.
- The targeted slum in Kolkata has the highest migration influx in the country and Cholera is highly endemic, presenting the programme with a complex entero - disease pattern. Kolkata also houses two renowned research institutes: The National Institute for Cholera and the All India Institute of Public Health. Partnering with these research institutes has assisted in testing the WHO/UNICEF 7 point plan and in gathering evidence from the programme's results.
- Uttar Pradesh is a priority state for the GoI in reducing children's deaths from diarrhoea and pneumonia. The State Government has committed to working with Savehe Children in delivering the complementary activities in order for us to achieve the objectives of the programme. This is critical for leveraging financial resources from the government for the complementary activities, including the roll out of rotavirus vaccine and demonstrating impact
- Poor coverage of the 7 point plan intervention across requiring an immediate intervention.
Coverage of these interventions in the target locations is below the WHO-UNICEF recommended standard of 80%. Through this Signature Programme, Save the Children aims to work with the State and National Governments, RB and other partners, such as the Clinton Global Health Access Initiative, Micronutrient Initiative, WHO, UNICEF, the Aga Khan Foundation (India), Family Health Initiative (FHI) 360, WaterAid and WASH United amongst other key partners to increase coverage from the baseline to 80%. Successful implementation offers the unique opportunity for this to be the generation that contributes to stopping children dying from diarrhoea, by demonstrating how it can be eliminated as a public health problem and influencing the GoI and other major stakeholders to take the approach to scale.
Following Save the Children's analysis in the target areas, we concluded that the effective testing of the 7 point plan should comprise:
- Increasing access to quality diarrhoea treatment services at community and facility level. This included:
- Working closely with the State Governments to identify and fill key gaps in services, such as increasing the number of trained frontline health workers.
- Enhancing the capacity of private, public and community level health workers to ensure they can provide appropriate education and support to children and their families.
- Working with the GoI to strengthen the existing supply chain for ORS and Zinc to ensure adequate and timely provision whilst creating demand at community level.
- Partnering with CHAI and FHI 360 to sensitise Rural Medical Practitioners / unqualified doctors practising in the rural and urban areas on the use of ORS and Zinc for treatment of diarrhoea.
- Monitoring the availability and use of ORS and Zinc using a mobile-based application. The application will provide real time data on the availability of these drugs to Primary Health Care Units and District Stores for replenishment.
- Increasing coverage of immunisation through strengthening routine immunisation and promoting sustainable outreach services, to ensure the most remote and marginalised communities are reached. As the vaccine against rotavirus is yet to be introduced, we are advocating to the government for an accelerated roll out of rotavirus vaccine in our target areas.
- Contributing substantially to the eradication of open defecation by facilitating the construction of household latrines through government schemes, such as the SBA. Our approach is market driven, enabling communities to create the demand and to hold the government accountable for management of the facilities. Additionally, Save the Children is rehabilitating and constructing household toilets for the most marginalised communities.
- Improving access to safe and sustainable water supply by working with the local government to increase piped water supply in the target locations. Save the Children is training local mechanics to ensure effective functioning of the handpumps in the communities as well as promoting efficient water treatment and safe water storage at the household level.
- Empowering communities by improving their awareness, knowledge, attitudes and beliefs, and practices to prevent diarrhoea especially to promote exclusive breastfeeding, Vitamin A supplementation, hand washing with soap and the importance of sanitation, safe water and personal hygiene. This involves a combination of communications and empowerment methods, such as mass media, participatory Women and Children User Group sessions, street plays and one-to-one counselling.
In addition, Save the Children, is:
- Facilitating close coordination between different government ministries, especially between the Ministries of Health and Family Welfare, Women and Child Development, Drinking Water and Sanitation, and Urban Development. This is done through the provision of a platform for continued dialogue among key government ministries and departments. The Technical Advisory Group, set up during the inception phase, is also encouraging better coordination of activities amongst key government departments.
- Conducting an evaluation of the programme activities. Alongside our regular and systematic monitoring, the programme is conducting a comprehensive evaluation to test the effectiveness of the model and assess its contribution to reducing morbidity and mortality rates. Demonstrating attribution, programmatic contributions and related value for money analysis is key to leveraging government and other partners commitment to scale-up and future replication.
- Advocating for improved child health services, especially diarrhoea prevention programmes and scale-up (at all levels). We are ensuring that there is sufficient government ownership, coordination, leadership, institutional framework and strong policies in place for sustainable and effective management and control of common childhood diseases, including diarrhoea. We are also advocating to ensure that the WHO-UNICEF 7 point plan is fully integrated and operational in all states and national plans. Through application of multiple approaches, we are ensuring that feedback obtained from the assessments is used to advocate for inclusion of relevant budget lines in the respective ministries strategies. These approaches include engaging experienced senior short term consultants to work directly with the ministries and also identifying and empowering influential individuals within the state as ÔÇÿAdvocates Against Childhood Diarrhoea.