ORS/Zinc status – India

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IndiaIndia (2nd)*

Population: 1.38b (2020)
Area: 3.287m sqkm

Diarrhoea deaths: 55,310 (2019)

ORS coverage: 51% (2015)

ORS + Zinc coverage: 24% (2021)

* India has the second highest number of diarrhoea deaths after Nigeria

India’s Essential Medicines List (2022) (PDF)

National policy
✅ ORS+Zinc in National Clinical Guidelines
✅ ORS included in the National Essential Medicines List
✅ Zinc included in the National Essential Medicines List
Co-packaged ORS & Zinc included in the National Essential Medicines List (as at Feb-2022)
Note:  India included co-packaged ORS and Zinc in the Intensified Diarrhoea Control Fortnight (IDCF) 2019 Guidelines but left it to the discretion of states if they want to use it in their state. During the IDCF treatments are issued prior to illness.

Zinc availability
✅ Zinc available “over the counter”
❌ Any retailer can sell Zinc

Outlets for Zinc tablets:
✅ Pharmacies
✅ Drug stores/shops
❌ Supermarkets
❌ General retail outlets
✅ Community Health Workers
❌ Door-to-door sales people
✅ Government hospitals/clinics
✅ Private hospitals/clinics
✅ Child Health Days/Special Campaigns
❓ Other

Co-pack availability
✅ Co-packaged ORS and Zinc available in the private sector
✅ Discussions underway about introducing co-packaged ORS and Zinc
Comment: There was a consultation and advocacy by some of the development partners on the Zinc and ORS co-packs. But the Ministry [of Health] is concerned about the cost implications and the non-availability of Zinc and ORS co-packs from the pharmaceutical companies.
Comment 29-Mar-2022:
The current guidelines and the Intensified Diarrhoea Control fortnight only speak of provision of separate ORS packs and zinc tablets. The EML also includes Zinc syrup and ORS separately.
Comment 31-Mar-2022:
With the availability of combo {combination packs/co-packs], compliance will improve and antibiotic misuse will decrease.

Outlets for co-packaged ORS and Zinc tablets:
Note that co-packaged ORS and Zinc is not yet available in the public sector.
✅ Pharmacies (needs verification
✅ Drug stores/shops
❌ Supermarkets
❌ General retail outlets
❌ Community Health Workers
❌ Door-to-door sales people
❌ Government hospitals/clinics
❌ Private hospitals/clinics
❓ Campaigns and outreach
❓ Other

Co-packaged ORS and Zinc brands (may not be exhaustive)

Healthy Diarrhoea Kit
Healthy Diarrhoea Kit (India)
Healthy Life Pharma Pvt Ltd

Electral-Z Kit (this may be for export only – needs verification)
This kit appears to contain five 200 mL sachets of ORS. The only other co-pack with 200 mL sachets that we are aware of is Pharmanova’s Kit Yamoyo (Zambia)

Electral-Z Kit (India)
FCD India

Co-packaged ORS and Zinc manufacturers (may not be exhaustive)

Healthy Life Pharma Private Limited, Mumbai, Maharashtra (Healthy Diarrhoea Kit)
FCD India (Electral-Z Kit)

Co-pack costs
Typical cost of a ORS/Zinc co-pack in the PUBLIC sector: not available
Typical cost of a ORS/Zinc co-pack in the PRIVATE sector: INR 60 to INR 100 (USD 0.80 to 1.22 – Feb-23)

Diarrhoea programmes currently on-going

Name Organisation Funder Diarrhoea specific Target area
Government of India’s Diarrhoea Control Program and Intensified Diarrhoea Control Fortnight (IDCF) Ministry of Health & Family Welfare/ National Health Mission Government (MoHF,W) Yes National,

Urban slum and remote areas
Home based young child program MoHF,W Government No Nutrition, Health, WASH
ORS Zinc Corners NHM (National Health Mission ) MOHFW Yes Health care facilities

Additional information

Feb-22
The government has intention to introduce co-packaged ORS/Zinc. but in absence of persistent technical and programmatic support, not able to implement at ground level. Needs cohesive sustained and comprehensive approach to technically and programmatically support Government in taking forward the sustainability and scalability of ORS Zinc co-package.
Feb-22
Central Drugs Standard Control Organization (CDSCO), India has approved the co-packaged ORS and Zinc. This means that manufactures can produce and market co-packs. However, co-packaged ORS and Zinc has not been included in the National List of Essential Medicines (NLEM). For the NLEM there is a separate body which finalises the list. The moment it gets included in NLEM, it would be mandatory for government to procure it and supply to health facilities for diarrhea treatment.
Co-packaged ORS and Zinc has been mentioned in the Intensified Diarrhea Control Fortnight Campaign (IDCF) Guidelines 2019.

 

Information based on 4 questionnaires and 3 comments

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Making co-packaged ORS and Zinc the "go to" treatment for childhood diarrhoea

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