Renu Kumari is an ASHA, an Accredited Social Health Activist volunteer, and is part of a major movement to save lives throughout Bihar, India by making sure children who have diarrhoea are properly treated with zinc and oral rehydration salts (ORS).

In India, every year more than 200,000 children under the age of five die from diarrhoeal disease.

World-wide, 30% of global child deaths from diarrhoea disease are children in India, a horrific and crippling statistic that remains unacceptable, which is why there is renewed focus across India to address child health issues, including the treatment of diarrhoea.

Renu is part of this renewed focus, a village-level volunteer who is being trained through a partnership between the State Health Society of Bihar and MI to scale up zinc and ORS programs to treat diarrhoea in children and ensure they can live and thrive. Using zinc, in combination with ORS, to treat diarrhoea not only helps children get better faster, it can save their lives.

This partnership is building the capacity and capability of health care providers like Renu, as well as whole communities, to deliver and sustain better diarrhoea care in the home.

As part of the government’s scaling up program, the zinc and ORS are packaged together in a “combi-pack”, a user-friendly box on how to quickly and easily administer the treatment. After MI launched the combi-pack, as “seed” supply, the government continued to supply the zinc/ORS (in syrup form) as part of its scale-up program.

Renu uses her own first-hand experience to explain the effectiveness of the zinc/ORS therapy. After the “shop purchased medicine” did not help her grandchild recover from diarrhoea, Renu used the combi-pack and her grandchild recovered within days, much to everyone’s relief and joy.

Sharing her story helps her communicate with greater conviction about this affordable and proven child survival treatment to the mothers in the communities she visits.

MI puts much of its programming effort into making sure everyone involved in the health care field are well trained, including Block Community Mobilizers, ASHAs, Medical Officers, Child Development Officers, staff nurses – the list is endless.

The ASHAs are key players in the “treatment shift” and success of the program by ensuring caregivers use zinc and ORS to treat childhood diarrhoea.

Until 2008, zinc had never been distributed for diarrhoea treatment in Bihar state. This changed during the government’s flood-relief efforts that year, which affected more than 4 million people.

During that time, MI distributed close to 60,000 diarrhoea treatment kits, including “how to” information.

This initial project demonstrated to decision makers how effective zinc and ORS could be in treating diarrhoea and how it could be administered through existing health systems.

After that success, the opportunity opened up to organize and mobilize, as well as boost the enthusiasm of health service providers, around the use of this effective and affordable life saver. With support from the Children’s Investment Fund Foundation (CIFF), MI and the Government of Bihar, the project was launched in 2010.

In the past two years, the zinc/ORS program has had impressive results:

• training of around 50,000 health care providers;
• distribution of hundreds of thousands of zinc/ORS combination kits (combi-packs);
• reported treatment of more than 500,000 children for diarrhoea;
• a 93% treatment rate (with both zinc and ORS) of reported cases of children under five years of age.

We are confident that, with the efforts of Renu and her fellow ASHAs and others involved in the health care system, this initiative in Bihar will remain the gold standard for our programming in the Asia region.

ASIDE: Diarrhoea is one of the leading causes of death for children under five years of age throughout the developing world. It lasts for several days and causes severe dehydration. In addition, diarrhoea is the leading cause of malnutrition in children, creating a deadly cycle of diarrhoea illness: diarrhoea is a major cause of malnutrition, and malnourished children are more likely to become ill from diarrhoea.

Using zinc, along with ORS, to treat diarrhoea boosts a child’s immune system, helping her recover from diarrhoea more quickly. It also protects the child against future episodes of diarrhoea, giving the body more recovery time between episodes.

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