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[e-drug] Scaling up oral rehydration salts and zinc for the treatment of diarrhea (2)

E-DRUG: Scaling up oral rehydration salts and zinc for the treatment of 
diarrhea (2)

Dear E-druggers,

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,
New Delhi,
e-mail - kindiatown@hotmail.com

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