E-DRUG: Scaling up oral rehydration salts and zinc for the treatment of
I have had the priviledge and opportunity over the years of professionally
following how two evidence-supported essential medicines, i.e Folate, in
combination with Ferrous iron, and indeed Zinc Suplhate, make the rather
mountainous and tortuos journey from Programme evidence to supply solution, and
I can attempt to respond to Wilbert's fundamental question of "So why is it so
hard to introduce?" with the following suggestion:
In my experience, this has largely been due to significant disconnects between
the stakeholders involved in:
1. Programme research/evidence and Programme implementation.
2. Programme implementation and Programme supply.
3. Programme supply and Market reality/possibility.
4. Regulatory bureaucracy and other impediments.
5. Unresolved finished product myths and related issues.
If I may just briefly touch on point No. 5 i.e. unresolved product
myths/issues, for Zinc Sulphate, many of you will remember that it took
sometime for the first official monograph to be published (USP29)and, as far as
I am concerned, the issue of “unacceptable taste”, and indeed how one can
objectively and reliably assess this during evaluation of procurement bids,
remains a big challenge. I am interested to learn more about this issue from
any colleague who has successfully dealt with the problem. I however understand
from some colleagues on the frontline that the “taste” issue and eventually
compliance for Zinc is real.
Furthermore, from time to time, the media compounds the problem. For example, a
Monday 4 May 2009 BBC “One-minute World News” clip carried the caption “Zinc
pill for diarrhoea queried” It goes on to say “ The widespread practice of
using zinc and copper supplements to treat diarrhoea may not be effective,
research by an Indian team suggests….” Such issues, if not managed promptly and
carefully, can really become a problem even where progress is being made.
One can continue to ask the “why” question further, for each of the above
disconnects and sadly, I have to say, my conclusion seems to be that, often
more premium is put on stakeholder rather than programme interests.
Murtada Sesay, B Pharm.Hons(Ghana), MSc(UK), MMI(USA), MCIPS.
Pharmacist and Procurement Specialist,
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