increasingaccesstodiarrheatreatmentinindia:*...recent scientific advances have informed these...

Increasing access to diarrhea treatment in India: Building demand for zinc and ORS among caregivers and providers Request for Proposal

September 2012

Agenda

2

•  RFP

•  Background

•  GeneraAng demand among consumers and providers

Agenda

The Request

•  Respond to the connecAons brief –  ConnecAons Idea –  Top level channel plan –  Budget split recommendaAons –  Develop rural household profile –  Develop rural mum profile –  Develop rural medical pracAAoner profile

•  Timings for launch for 2013 diarrhea season

•  Cost Proposal for partnering with CHAI to develop and implement the project

•  Staffing proposal for partnering with CHAI to develop and implement the project

•  Provide an overview of agency credenAals relevant to the current project

4

CHAI will evaluate agencies based on the following criteria: Primary •  Demonstrated knowledge of the target markets •  ConnecAon and communicaAon plan that clearly demonstrates how it will

create the desired behavior change in the target markets –  We are looking for a 3-‐year plan but your response should provide most detail for 2013

•  Demonstrated passion and commitment to go above and beyond to help CHAI deliver its aggressive goals to save lives, including: –  Compelling cost savings vs commercial clients –  Helping CHAI to galvanize and excite exisAng and potenAal partners, including local

government to commit significant addiAonal resources to the cause

Secondary •  Ability to implement similar communicaAon programs in other CHAI focal

countries (Kenya, Nigeria and Uganda) and create addiAonal leverage

5

Criteria for selecAon

Milestone Timing

CHAI briefing to agency September 10 (Mon)

Response from agency September 27-‐28 (Thurs-‐Fri)

EvaluaAon of responses October 1-‐4 (Mon-‐Thurs)

Agency selected October 5 (Fri)

6

Timing

•  It is expected that your agency will deliver a compelling presentaAon to the CHAI team in person in New Delhi on September 27th (Thursday) or 28th (Friday).

•  You will have a maximum of 2 hours to deliver the presentaAon as well as allow for quesAon Ame.

•  You should provide a printed and digital copy of the presentaAon on the same day including all the key informaAon.

•  Copies of presentaAons for parAcipaAng agencies who are not selected will be destroyed by October 5th (Friday)

•  ParAcipaAng agencies (selected and non-‐selected) will be informed by October 5th (Friday)

7

ConfidenAality and applicaAon process

Background

8

Almost one in three child deaths is due to pneumonia or diarrhea, claiming almost 3.3 million lives each year…

| 9

18%

15%

8 2%

36%

21%

Pneumonia

Diarrhea

Malaria

HIV/AIDS Neonatal causes

Other (measles, pertussis,

injuries, etc.)

ProporAonal distribuAon of cause-‐specific deaths among children under five years of age, 2011 1

…but a disproporHonate amount of global funding has been allocated to treat other diseases

~3.3million U5 deaths/year from diarrhea and pneumonia alone

Pneumonia and diarrhea remain the two largest killers of children…

Source: Black R, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and naAonal causes of child mortality in 2008: a systemaAc analysis. The Lancet. 2010;375:1969-‐87; World Malaria Report 2011, Global Fund Disbursements in Detail; PEPFAR OperaAonal Plans FY 2007-‐2010; USAID, Introducing Pediatric Zinc with ORT/ORS in the Private Sector , MeeAng report, August 2010

~6,500

~1,300

14.8

HIV/AIDS Malaria Diarrhea

US$ millions, between 2007-‐2011

Zinc scale-‐up in 8 countries

ACT treatment, CommunicaAon & advocacy, training (Global Fund & PMI)

HIV Treatment (Global Fund & PEPFAR)

With the leadership of the UN Commission on Life-‐Saving CommodiAes for Women and Children, there is an opportunity to catalyze change

| 10

•  The Goal: Save lives of children dying from pneumonia, diarrhea and malaria and accelerate progress towards MDG4 by improving access to available treatments

•  By 2015: 60-‐80% coverage of diarrhea, pneumonia and malaria treatment for children under five

•  By end 2012: Concrete progress towards this goal in all ten priority countries

Across 10 high-‐burden countries:

UN Commission Advocates at the highest levels to catalyze change

Chairs: Pres. G. Jonathan of Nigeria PM J. Stoltenberg of Norway

Technical Working Group (3 Themes) Supports the Commission to examine barriers to scale-‐up

Diarrhea & Pneumonia Working Group

Translate Commission recommenda@ons into ac@ons for countries

Iden@fy barriers to scale-‐up and translate country needs into concrete decisions for Commission

Leadership Structure and Roles

“Making sure that women and children have the medicines they need is cri@cal for our push to achieve MDGs” Secretary-‐General Ban Ki-‐Moon

Provides near-‐term support to countries in efforts to scale-‐up access to treatment

Vice-‐chairs: UNFPA UNICEF

Market shaping

Regulatory environment

Best pracHces & innovaHons

To date, the UN Commission has launched, and the 10 priority countries have developed naAonal plans to catalyze treatment scale-‐up

| 11

Q1 Q2 Q3 Q4

2011 2012

Progress to date • Global taskforce created •  Scale-‐up plans finalized for 10 priority countries (lead by govt./local partners with support from working group)

• UN Commission launched

Q2 2012 and Ongoing • Resource mobilizaAon •  ImplementaAon of naAonal plans in 10 priority countries

ü 

India Kenya Nigeria Uganda DRC Bangladesh Ethiopia Niger Pakistan Tanzania

Measels 4% Diarrhea

13%

Malaria 1%

Pneumonia 20%

Prematurity 14%

Birth Asphyxia 10%

Neonatal Sepsis 6%

CongeniAal anomalies

3%

Injuries 3%

HIV/AIDS 1%

Others 25%

246m episodes/year ~225,000 deaths/year

ProporAonal distribuAon of cause-‐specific deaths among children under five years of age, 2010

Source: World Health StaAsAcs 2011 www.who.int District Level Household and Facility Survey 2007-‐08

12

In India, ~225,000 children die every year due to diarrhea

3

JOINT STATEMENTMore than 1.5 million children under five continue todie each year as a result of acute diarrhoea. Thenumber can be dramatically reduced through criticaltherapies such as prevention and treatment ofdehydration with ORS and fluids available in thehome, breastfeeding, continued feeding, selective useof antibiotics and zinc supplementation for 10–14 days.

These new recommendations, formulated by UNICEFand WHO in collaboration with the United StatesAgency for International Development (USAID) andexperts worldwide, take into account new researchfindings while building on past recommendations.Success in reducing death and illness due todiarrhoea depends on acceptance of the scientificbasis and benefits of these therapies by governmentsand the medical community. It also depends onreinforcing family knowledge of prevention andtreatment of diarrhoea, and providing information andsupport to underserved families.

PROGRESS AND CHALLENGESNEW DEVELOPMENTSRecent scientific advances have informed theserevised recommendations. They are:

• Development of an improved formula for ORSsolution with reduced levels of glucose and salt,which shortens the duration of diarrhoea and theneed for unscheduled intravenous fluids1

• Demonstration that zinc supplements given duringan episode of acute diarrhoea reduce the durationand severity of the episode2, and

• Findings that zinc supplementation given for 10–14days lowers the incidence of diarrhoea in thefollowing 2–3 months3

Many more lives can be saved if these advances areused in conjunction with effective home treatmentand use of appropriate health services. To be mosteffective, these revised recommendations mustbecome routine practice both in the home and health

facility. (See the Technical Annex on page 6 foradditional details.)

BUILDING ON PAST SUCCESSESORS, ORT and other components of clinicalmanagement of diarrhoea have made a significantcontribution to reducing deaths from diarrhoea.However, if the global goals are to be met, there is stillmuch to do.

Family knowledge about diarrhoea must be reinforcedin areas such as prevention, nutrition, ORT/ORS use,zinc supplementation, and when and where to seekcare. Where feasible, families should be encouragedto have ORS ready-to-mix packages and zinc (syrup ortablet), readily available for use, as needed.Breastfeeding should continue simultaneously withthe administration of appropriate fluids or ORS.

ORS included in stakeholder guideline

Zinc included in stakeholder guideline

Indian Academy of Pediatrics (IAP) ✓ ✓ Indian Medical AssociaAon (IMA) ✓ ✓ Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

✓ ✓

NaAonal Rural Mission (NRHM)1 ✓ ×

NaAonal Program for Treatment of Diarrhea

✓ ✓

NaAonal EssenAal Medicines List ✓ ✓

13

ORS and zinc are simple, highly effecAve and affordable and is recommended by key global and local stakeholders to treat childhood diarrhea

Treatment of diarrhea in children under five, percentage, esAmates

The Challenge Diarrhea treatment seeking behavior Percentage, esAmates

However, most paAents do not access the recommended diarrhea treatment: zinc coverage remains dismal, yet offers an opportunity for impact

The Opportunity

~35

~35

~29

Home or No treatment

Treated with anA-‐ bioAcs / other

Treated with ORS

Treated with Zinc & ORS

~1

Number of cases of diarrhea

246 mln cases of diarrhea in India /

year The Opportunity

SOURCE: WHO; Private Healthcare in Developing Countries: www.ps4h.org/globalhealthdata.html; Fischer Walker, Cynthia et al. The Global Burden of Childhood Diarrhea. Maternal and Child Health: Global Challenges, Programs, and Policies. Ed. John Ehiri. New York: Springer. 2010; Fischer Walker et al; Scaling Up Diarrhea PrevenAon and Treatment IntervenAons: A Lives Saved Tool Analysis, 2011.

District Level Household and Facility Survey 2007-‐08 Larson, C, et al. Scaling up zinc treatment of childhood diarrhoea in Bangladesh, Health Policy and Planning, 2011

Private Sector 45%

Public Sector 21%

Home or No

Treatment 29%

Others 5%

14

The Indian Diarrhea Treatment Market: Products and Availability

•  Tablet and syrup (50 & 100ml) •  Dosage = 1/day for 14 days •  Syrup = 5ml/day for 14 days •  Reduces stool volume over a couple of days

•  24% reducAon in Ame to recovery •  Reduces likelihood of another episode for 3 months

• Higher price point • OTC expected by September 2012

•  Available in powder sachet: •  5g = 200ml and 20g = 1 litre •  Dosage = 50-‐200ml arer each stool depending on age of child

•  Various flavours available •  Decreases vomiAng •  Efficient rehydraAon; replenishes electrolytes

• Higher price point • Mixed availability

ORS

•  Injectable, oro-‐dispersible, crushable, syrup

•  Dosage = 1-‐2 tab per day •  Pharmacist can cut blister and supply 1-‐2 tabs

•  Does not stop diarrhea • Widely available •  Low price point (30-‐40 rupees/3 days)

•  Treat cholera and dysentry

AnHbioHcs

•  Tablet and syrup •  Dosage = 1 tab only once •  Pharmacist can cut blister and supply 1-‐2 tabs

•  Stops diarrhoea quickly • Widely available •  Very low price point (1-‐2 rupees/tablet)

AnH-‐diarrheals

Features

•  Child doesn’t suffer from dehydraAon •  Stops the child from geung worse – may not need to see and pay for HCP

•  Child recovers more quickly and has more energy

•  20% reducAon in stool output •  30% reducAon in vomiAng

•  Can always obtain •  Affordable

•  Immediate relief (for mum) •  Can always obtain •  Affordable

Benefits

Zinc

•  Stops the child geung worse • Quicker recovery •  Stronger child • Healthier child

•  Does not help dehydraAon •  Does not stop diarrhea •  Long term use = resistance to anAbioAc

•  Does not help dehydraAon •  Causes consApaAon – causes distension of the gut and possibly pain?

•  Does not reduce frequency of stool output

• Not as affordable •  Child needs to drink a lot of fluid regularly

• Not as affordable • Need to remember to dose for 14 days

16

Issues

Products currently used to treat child diarrhea: features and benefits

ORS powder and Zinc syrup are currently the most common formulaAons purchased in the Indian market

49.4

12.6

38

7.7 5

87.3

Currently stocking Currently not stocking Never stocked

ORS

Zinc

Availability of ORS/zinc at the retail level Study in 4 districts in Uxar Pradesh; n=300

Reasons for not stocking ORS: •  35%: Low demand •  15%: Low profit margin •  10%: Not aware of ORS

Harmfully low

availability of zinc

Reasons for not stocking zinc: •  83%: Not aware of zinc •  7%: Low demand

18

There is limited availability of the products at the retail level, due to a lack of awareness about the products

The Indian Diarrhea Treatment Market

19

•  ORS/zinc is recommended by global (WHO and UNICEF) and local stakeholders (IAP, IMA)

•  Good local manufacturing capability •  Partnerships with GoI and others working on diarrhea treatment (e.g., FHI360, MI, PSI)

Strengths to Leverage

•  Diarrhea not perceived as a serious illness •  Lack of perceived efficacy (symptom relief) of ORS •  No perceived differenAaAon between ORS and home remedies?

•  High perceived efficacy of anAbioAcs/anA-‐diarrheals •  Belief that ORS is difficult to prepare •  Belief that ORS needs to be given too frequently and too high a volume for the child

•  Mum will not give treatment without HCP advice •  Poor compliance to 14 day course of zinc •  Supply chain views ORS/Zinc as low volume

Weaknesses to Neutralize

•  Current low awareness of zinc among caregivers and HCPs

•  RMPs comprise 60% of total HCP visits and are hungry for informaAon

•  Low availability of ORS and zinc beyond Class 1 & 2 towns, represenAng opportunity for growth

•  OTC status for ORS and expected soon for zinc •  Growing poliAcal axenAon on diarrhea •  Several key bodies (including NRHM) are yet to include Zinc in their guidelines

•  ExisAng provider outreach models (FHI360, MI)

OpportuniHes to Capitalize on

•  ConAnuity of program post 2015

Threats to Combat

20

ORS and zinc: SWOT analysis

Building caregiver and provider demand for zinc and ORS

21

22

ObjecHve: To increase usage of ORS/zinc from <1% to 50% in three states by end of 2015

Geographic focus: Madhya Pradesh, Uxar Pradesh, Gujarat

DuraHon: July 2012 – Dec 2015

Ugar Pradesh

Gujarat

Madhya Pradesh

Key Program Components:

1)  Generate demand: Target consumers/providers(HCP’s) based on analysis of most effecAve messages and communicaAon channels; developing creaAve soluAons to reach beyond tradiAonal urban markets

2)  Catalyze poliHcal will: Mobilize and harmonize investments from governments and partners toward state-‐wide scale up goals

3)  Ensure supply of zinc/ORS: Ensure wide-‐spread availability of affordable, high-‐quality products in public and private sector

The 3 states represent nearly half of naAonal diarrhea burden – with over 164K deaths annually

Specifically, CHAI aims to increase usage of ORS/zinc from <1% to 50% in three states by end of 2015

The Key Problem:

•  Mums don’t believe that diarrhea is a serious illness. They do not believe that it can harm their child.

•  They watch and wait for several days unAl the condiAon worsens, before they will go and visit their front line healthcare provider (HCP).

•  Once they do visit their HCP, they have come to expect that they will be given medicaAon that will stop their child’s diarrhea within a day.

•  HCP’s believe that anAbioAcs and anA-‐diarrheals are the best treatment for diarrhea to saAsfy these paAent expectaAons

The key problems we need to solve:

23

Defining our Target Market Who do we need to reach to save the most lives?

24

25

Across the focal states, the vast majority of the diarrhea deaths among children (>80%) are in rural areas – with over half in rural UP alone

4%

23%

11% 54%

2% 6%

% and number of U/5 diarrhea deaths in focus area

Na@onal Family Health Survey (NFHS-‐3) 2005-‐06

Madhya Pradesh

Urban

Rural

Urban

Urban Rural

Rural

Gujarat

Ugar Pradesh Total Urban: 17%

Total Rural: 83%

Agency to advise on potenAal reach of communicaAons

27 CiHes

398 Towns

4,738 Peri-‐urban

600,000 Villages

AdministraAve Structure in India Source: NovarAs, Aroygya Parivar, November 2010

DistribuAon, detailing and communicaAon of ORS/Zinc has been limited beyond Class 1 and Class 2 towns

Key Focus to Date: 33% of the market

Opportunity: 67% of the market

27

Understanding the profile of rural households will be essenAal to success

Uxar Pradesh

Gujarat

Madhya Pradesh

Ugar Pradesh – 75% Rural: •  42% illiterate (higher for women) •  78% have no television •  84% no access to a toilet •  69% of children axend some school •  87% some sort of immunisaAon

Madhya Pradesh – 72% Rural: •  45% illiterate (higher for women) •  80% have no television •  90% no access to a toilet •  69% of children axend some school •  77% some sort of immunisaAon

Gujarat – 58% Rural: •  36% illiterate (higher for women) •  62% have no television •  70% no access to a toilet •  71% of children axend some school •  85% some sort of immunisaAon

Na@onal Family Health Survey (NFHS-‐3) 2005-‐06

Agency to expand on the rural household profile

Defining our Target Market Who are these people that we need to reach?

28

Demographics: • Age: 18-‐29 • Illiterate • Axended school for a couple of years • Live in 2 room house • Water obtained from pump in the village • Income? • Electricity?

Key Influencers: •  Healthcare professional •  Mother in law •  Husband •  Educated female member

of community

Daily/Weekly AcHviHes: • May visit Haat or town once a week, but more likely that the husband goes

• Community centre? • How oren visit pharmacy? • Visit with friends/neighbours? • RelaxaAon Ame?

Diarrhea History: Has the mum had much experience with diarrhea?

Key Insight: “Diarrhea is a bit annoying and inconvenient, but it

usually goes away by itself in a couple of days”

Barriers to Using Product: • Need to give child too much fluid, too oren

• Not perceived as necessary medicine – will not cure symptoms so can do without it

Enablers to Using Product: • VisiAng a HCP • HCP recommendaAon • Availability of product • Compelling price

AspiraHons/MoHvators: • For child? EducaAon? • For self?

InteracHon with HCP’s: • Child has been immunised by ANM at 6 months and 9 months

Media ConsumpHon: •  No exposure to TV •  Radio once per week •  No print •  Husband sees TV once

per week

29

Agency to expand on the rural mum profile

Introducing our rural mum

30

mums with child suffering diarrhea

take acAon straight away

give fluids at home

visit Doctor if diarrhoea

persists/worsens

ORS 1st line


persists/worsens

watch and wait


persists/worsens

“Diarrhea is a bit annoying and can make my child lethargic for a few days, but other than that it is not serious. I know that it will stop in 3-‐4 days”

“I am happy to treat at home for the first couple of days using sugar-‐salt-‐lemon or any other fluid, it will usually fix itself, and if not, I can easily see my RMP”

Current Treatment Seeking Behavior

PATH TO PURCHASE

Target Audience Rural mums with children under the age of 5 years.

Audience Insight “I don’t need to see my HCP. Diarrhea is a bit annoying and inconvenient, but it usually goes away by itself in a couple of days”

Growth Priority Convince mums that “watch & wait” or give home fluids, to visit their doctor straight away

TODAY

FUTURE Behaviour (What are they buying/doing?) Currently doing nothing for the first day or two, then going to their local RMP to request something to stop the diarrhea. Antude (Why are they buying/doing it?) “I know that diarrhea isn’t serious, I’ll wait for a day or so to see if the diarrhea goes away by itself. If it doesn’t improve I’ll go and see my local doctor to get something to stop the diarrhea”

Behaviour (What will they buy/do?) Go and see their doctor on the first day that diarrhea starts Antude (Why will they buy it?) “I understand that diarrhea is a serious condiAon that could harm my child. I need to see my doctor when the diarrhea starts”

PRIMARY BARRIER

“Diarrhea is not serious, I don’t need to treat it straight away”

31

Task map – immediate acAon

Insight: •  “I don’t need to see my HCP. Diarrhea is a bit annoying and inconvenient,

but it usually goes away by itself in a couple of days”

Single Minded Benefit: •  If I see my HCP soon arer the diarrhea starts, my child will not suffer and

will recover quickly

Reason to Believe: •  My HCP will give me ORS that will stop my child becoming dehydrated •  My HCP will give me zinc that will allow my child to recover faster

32

Consumer creaAve strategy


KEY KNOWLEDGE GAPS KEY MEASUREMENTS OF SUCCESS

At what point does a mum deem diarrhea to be serious enough to take the child to a HCP?

•  Frequency or wateriness of stools? •  VomiAng? •  Length of Ame? •  Energy level of child •  Childs thirst or appeAte? •  CombinaAon of the above •  Something else?

Gates baseline shows that; too many stools, vomiAng and fever are the main reasons to seek care.

•  Visited their HCP on last diarrhea episode arer x days (from x days) to get treatment

•  Used ORS + Zinc to treat child on last diarrhea episode from x% to x%

•  “I believe diarrhea is a serious medical condiAon” from x% to x%

•  “I will visit my HCP to get treatment for diarrhea” from x% to x%

•  “I believe that ORS + Zinc is the best treatment for my child’s diarrhea” from x% to x%

33

What do we know? What does success look like?

Defining our Target Market Who are the healthcare professionals that we need to reach?

34

AYUSH 25%

CharacterisAcs of treatment seeking behavior in India

Unqualified RMPs 65%

MBBS Allopathic 10%

53.69% 52.26% 53.67% 59.50%

48.94%

Poorest QuinAle

Next 20% Next 20% Next 20% Least poor quinAle

RMP Treatment Seeking

•  RMPs treat more than 50% cases of common illnesses in rural areas

Source: Centre for policy research:-‐“Mapping medical providers in rural India” A Parallel Health Care market: Rural Medical PracAAoners in West Bengal, India ]

35

Unqualified pracAAoners are the most preferred source of treatment for common illnesses, especially in our target market

Demographics: •  Male •  Age 40 •  School unAl 16 years old •  Can read basic Hindi (not English) •  Grew up in the village where they have their pracAce

Key Influencers: •  Their mentor or teacher •  GP prescribing pracAces in

nearby town •  News from bigger towns •  (unlikely to be influenced by

female HCP’s)

Sources of InformaHon: •  Mentor or teacher •  Pharmacy in town where they purchase

products (visit at least fortnightly) •  Pharma reps •  Health secAon of local Hindi newspaper

Diarrhea History: Treat 2-‐3 children/day in peak season (1-‐2/week in dry season)

Key Insights: e.g “By the @me they get to me, they need something to stop the diarrhea not just some

ORS”

Barriers to RecommendaHon: •  No 1 moAvator is repeat business – so want

to prescribe the best product •  Lack of belief in product •  Lack of confidence with product •  Lack of paAent ability to pay •  Lack of availability

Enablers to RecommendaHon: •  Confidence in product and repeat business •  High margins

36

Agency to expand on the RMP profile

Introducing our RMP

Task Map – RMP

PATH TO RECOMMENDATION

Target Audience Rural medical pracAAoners

Audience Insight “By the @me they get to me, they need something to stop the diarrhea not just some ORS”

Growth Priority Convince the RMP to prescribe ORS AND Zinc to treat diarrhea

TODAY

FUTURE Behaviour (What are they recommending?) They are recommending anAbioAcs or anA-‐diarrheals to stop the diarrhea. Antude (Why are they recommending it?) “By the @me they get to me, they need something to stop the diarrhea not just some ORS”

Behaviour (What will they recommend?) Prescribe ORS and Zinc Antude (Why will they recommend it?) “I understand that: •  ORS is essen@al to prevent life threatening

dehydra@on •  Zinc helps the child to recover quickly from diarrhea

and prevents future episodes •  An@bio@cs are not useful in most cases of diarrhea •  An@-‐diarrheals can be harmful to the child”

PRIMARY BARRIERS TO RECOMMENDATION

An@bio@cs and an@-‐diarrheals are the best medicine available to treat diarrhea

KEY KNOWLEDGE GAPS KEY MEASUREMENTS OF SUCCESS ? •  “I prescribed ORS + Zinc the last Ame I treated a child for diarrhea”

•  “I believe anA-‐diarrheals are not the best way to treat childhood diarrhea” •  “I believe anA-‐diarrheals can be harmful to a child” •  “I believe anAbioAcs are only useful in diarrhea when there is clear evidence of cholera or dysentry” •  “I believe it is important to educate mums about the importance of keeping their child hydrated during diarrhea” •  “I believe that ORS is the best way to rehydrate a child during diarrhea” •  “I am aware of zinc for the treatment of diarrhea” •  “I believe zinc speeds recovery from diarrhea” •  “I believe that zinc can help prevent diarrhea for 3 months” 37

Insight: •  “By the @me they get to me, they need something to stop the diarrhea not

just some ORS”

Single Minded Benefit: •  If I prescribe ORS and Zinc the child will not suffer and will recover quickly,

which means paAents will return to me

Reason to Believe: •  ORS stops the child suffering life threatening dehydraAon •  Zinc allows the child to recover faster and prevent re-‐occurrence

38

HCP CreaAve Strategy

InternaAonal UN/WHO

Local Government bodies: IMA / IAP

Pediatrician

GP

RMP and Drug Store Owner

Consumer

While RMP’s are our key focus, it will be essenAal to reach their key influencers

Medical RepresentaAve Medical Journals

Medical RepresentaAve

✔

✔

✔

Building on the FHI 360 Rural DistribuAon Model

OperaHonal in 18 districts of Ugar Pradesh and Gujarat the model serves close to 60,000 formal/informal providers and drug stores

60,000 providers and drug stores have been reached to promote ORS and zinc products-‐more than any big pharmaceuHcal company in the region

NGOs PharmaceuAcals

A field force of over 160 workers promote and place ORS and zinc products in towns that cut off by the distribuHon system of tradiHonal pharmaceuHcal companies

Over 1 million detailing visits have been completed so far

Over 1 million units of zinc and 500,00 units of ORS have been sold already

AddiAonal consideraAons

Path to Purchase Possible OpportuniAes to Leverage

Mass & Mid-‐Media BharA Airtel Digital Green Frog Design Lalela Project Live from Earth Sesame workshop Vodafone

Direct communicaHon Center for Interfaith AcAon Girl Scouts IPHA Gujarat Rajiv Gandhi Mahila Vikas Religions for Peace SEWA Swaasthya UNICEF SMNet

Rural Medical PracHHoners A team of detailers will be available over the 3 states

ATTRACT: INTERACT: ACT:

TOWN/VILLAGE POPULATION

>5L 50K – 5L 5K – 50K 1K – 5K <1K

% of populaHon 14% 8% 10% 44% 24%

Ease of delivery "   High road

connecAvity; channels served by urban network

"25%  

High road connecAvity;

channels served by urban network

"   High road

connecAvity; patchy service by rural

network

"   Medium road

connecAvity; few rural delivery networks exist

"   Lixle road connecAvity

Access to retail channels "   Large number of

chemists

"   Large number of

chemists

"25%  

Chemists sAll available

"   Few chemists exist "  

Few chemists exist

Availability of ORS and zinc "  

Average "  

Average "   Low

"   Very Low

"   Very Low

Further partnerships needed to reach rural markets

AddiAonal consideraAons and opportuniAes to explore

•  High-‐profile individuals that can increase visibility around campaign and potenAally endorse zinc and ORS (President Clinton, president of IAP, senior GoI officials, celebriAes)

•  State governments and child health programs with budgets to allocate to communicaAon campaigns

•  ExisAng materials and resources developed for similar campaign efforts •  ExisAng experAse and reach of Indian private sector to expand campaign

reach and fill funding gaps

44


Summary:

The Key Problem:

•  Mums don’t believe that diarrhea is a serious illness. They do not believe that it can harm their child.

•  They watch and wait for several days unAl the condiAon worsens, before they will go and visit their front line healthcare provider (HCP).

•  Once they do visit their HCP, they have come to expect that they will be given medicaAon that will stop their child’s diarrhea within a day.

•  HCP’s believe that anAbioAcs and anA-‐diarrheals are the best treatment for diarrhea to saAsfy these paAent expectaAons

The key problem

46

PATH TO PURCHASE

Target Audience Rural mums with children under the age of 5 years.

Audience Insight “I don’t need to see my HCP. Diarrhea is a bit annoying and inconvenient, but it usually goes away by itself in a couple of days”

Growth Priority Convince mums that “watch & wait” or give home fluids, to visit their doctor straight away

TODAY

FUTURE Behaviour (What are they buying/doing?) Currently doing nothing for the first day or two, then going to their local RMP to request something to stop the diarrhea. Antude (Why are they buying/doing it?) “I know that diarrhea isn’t serious, I’ll wait for a day or so to see if the diarrhea goes away by itself. If it doesn’t improve I’ll go and see my local doctor to get something to stop the diarrhea”

Behaviour (What will they buy/do?) Go and see their doctor on the first day that diarrhea starts Antude (Why will they buy it?) “I understand that diarrhea is a serious condiAon that could harm my child. I need to see my doctor when the diarrhea starts”

PRIMARY BARRIER


47

Task map – immediate acAon

Insight: •  “I don’t need to see my HCP. Diarrhea is a bit annoying and inconvenient,

but it usually goes away by itself in a couple of days”

Single Minded Benefit: •  If I see my HCP soon arer the diarrhea starts, my child will not suffer and

will recover quickly

Reason to Believe: •  My HCP will give me ORS that will stop my child becoming dehydrated •  My HCP will give me zinc that will allow my child to recover faster

48

Consumer creaAve strategy

Task Map – RMP

PATH TO RECOMMENDATION

Target Audience Rural medical pracAAoners

Audience Insight

“By the @me they get to me, they need something to stop the diarrhea not just some ORS”

Growth Priority Convince the RMP to prescribe ORS AND Zinc to treat diarrhea

TODAY

FUTURE Behaviour (What are they recommending?) They are recommending anAbioAcs or anA-‐diarrheals to stop the diarrhea. Antude (Why are they recommending it?) “By the @me they get to me, they need something to stop the diarrhea not just some ORS”

Behaviour (What will they recommend?) Prescribe ORS and Zinc Antude (Why will they recommend it?) “I understand that: •  ORS is essen@al to prevent life threatening

dehydra@on •  Zinc helps the child to recover quickly from

diarrhea and prevents future episodes •  An@bio@cs are not useful in most cases of

diarrhea •  An@-‐diarrheals can be harmful to the child”

PRIMARY BARRIERS TO RECOMMENDATION

An@bio@cs and an@-‐diarrheals are the best medicine available to treat diarrhea

49

Insight: •  “By the @me they get to me, they need something to stop the diarrhea not

just some ORS”

Single Minded Benefit: •  If I prescribe ORS and Zinc the child will not suffer and will recover quickly,

which means paAents will return to me

Reason to Believe: •  ORS stops the child suffering life threatening dehydraAon •  Zinc allows the child to recover faster and prevent re-‐occurrence

50

HCP CreaAve Strategy


•  Can not refer explicitly to Rural Medical PracAAoners •  Can not feature any one brand of product in communicaAons

51

Mandatories

QuesAons?

Contact: Melinda Stanley [email protected] Ph: 9910 461 341

52

QuesAons?

•  The Private Sector Market for Diarrhea Treatment in India •  MART research •  PATH research

53

Appendices

increasing*access*to*diarrheatreatmentin*india:*...recent scientific advances have informed these...

Documents

increasingaccesstodiarrheatreatmentinindia:*...recent scientific advances have informed these...