Point-of-Use (POU) Household Water Disinfection Programs:

Angola has the third highest under-five mortality rate in the world (260/1000 live births), with diarrhea a major contributor. In addition to diarrheal prevalence (23% of under five children), cholera poses a significant threat to Angola, and recent outbreaks have been crippling. Since February 2006, cholera has claimed almost 2,400 lives and sickened more than 50,000 people. To respond to this pressing need, POUZN has supported the launch of the Certeza safe water solution program as a pilot program in Angola’s capital, Luanda, in collaboration with the Ministry of Health and with major funding from the Esso Oil Company. The program increases access to safe drinking water by making Certeza readily available at the household level at a price affordable for low-income families, and increases awareness of and commitment to water treatment and hygiene improvement at all income strata. Access to Certeza will not only serve as a preventative measure to combat diarrheal incidence, but will aid in the prevention of cholera and target cholera-prone areas.

Benin is one of the poorest countries in Africa ranking 163/177 in the UN’s Human Development Index. Only 56% of the population has access to improved sources of drinking water and the prevalence of diarrheal disease is high. POUZN is introducing a chlorine water treatment tablet into the private sector market. This is a new, easy to transport product manufactured in Ireland by Medentech. It will be marketed through PSI’s extensive network of both public and private distributors, concentrating on catchment areas surrounding seven major urban centers located throughout the country. POUZN is partnering with USAID’s Integrated Support for HIV/AIDS Prevention and Family Health (IMPACT) project – encompassing socially marketing HIV prevention, family planning, and maternal and child health products, as well as its public sector health support project, Projet Intégré de Santé Familiale (PISAF). These projects and their partner NGOS will be integral partners in the training of both MOH and NGO personnel and information, education and communication (IEC) programs.

The Democratic Republic of Congo (DRC) is the third largest country in Africa and one of the least developed countries in the world. The under-five mortality rate in the DRC is 205 per 1,000 live births. Dehydration caused by diarrhea and other waterborne diseases account for 1 in 10 of these child deaths. PSI commenced its safe water and diarrheal disease control program in the DRC in October 2006 with the point of use product, PUR Purifier of Water, with funding from Procter & Gamble (P&G). POUZN is supporting the program by funding expansion in one eastern province, Sud Kivu, where there is a need for additional channels of distribution to rural communities and hard-to-reach populations. Sud Kivu has been impacted by the last 10 years of insecurity in DRC. POUZN is collaborating with USAID’s Project AXxes and its partner NGOs, leveraging community networks and integrating POU messages into AXxes efforts to improve primary health care. In addition, POUZN is expanding commercial sector activities to ensure access to a POU water treatment product at multiple distribution points within communities throughout Sud Kivu.

Haiti is the poorest country in the western hemisphere ranking among the worst in terms of both political stability and health indicators. Twenty six percent of children under five years of age and 40 % of children 6-23 months had diarrhea in the two weeks preceding the 2000 DHS survey, making Haiti’s diarrhea prevalence rates among the highest in the world. Diarrhea is endemic in Haiti and the leading cause of death among children under one year old; it is the second cause of death among children under five years old. In 2006, USAID, through the Private Sector Partnerships for Better Health (PSP-One) project, provided funding to PSI to introduce a water treatment product, Dlo Lavi, initially in Port-au-Prince and peripheral zones. POUZN is now expanding the Dlo Lavi program to additional target areas, including 34 target communes supported by USAID’s bilateral Health Systems 2007 project covering about 40 percent of the population. The Dlo Lavi program has a two-pronged distribution strategy: a) commercial sector distribution thru shops, pharmacies, kiosks, etc. in the communes serviced by HS-2007 clinics and in urban areas of Haiti, and b) community-based distribution thru local and international NGOs. Behavior change messages are being delivered via interpersonal communication channels principally through the HS2007 health centers and community outreach workers, enabling POUZN to focus on urban and rural areas with populations that are particularly vulnerable to acute diarrheal disease and face the greatest challenges with regard to water quality.

With less than 14% of rural Malawians receiving piped water in their homes, over 70% storing their drinking water, and recontamination during storage a significant problem, POUZN is supporting the marketing of two highly effective water disinfection products in Malawi: WaterGuard, an easy to use liquid product and WaterGuard wa Ufa, a flocculent-disinfectant product manufactured by the Procter & Gamble Corporation and distributed elsewhere under the brand name ‘PuR’ which both disinfects and clears turbid water of all solid materials. POUZN is expanding distribution of these key water treatment products to rural areas where incidence of diarrhea is 28% higher than in urban areas, socio-economic and educational indicators are lower, and where 85% of the population resides. POUZN is also exploring opportunities for establishing new channels of distribution via collaborations with organizations currently working on water, sanitation, and hygiene as part of their community development activities, targeting primary caregivers, community-based health agents, and healthcare providers to motivate the purchase and consistent year round use of POU water treatment and good hygiene practices.

In Kenya, mortality among children under five is high, with one in every nine children dying before his or her fifth birthday. Diarrheal disease is a major cause of morbidity and mortality in this age group, largely because of contaminated water and unsafe storage and handling practices. Through POUZN, PSI/Kenya is expanding the WaterGuard program increasing accessibility to and demand for POU products, building upon the current POU program by leveraging partnerships with both US-based and local non-governmental, community-based and faith-based organizations to reach deeper into poor and vulnerable communities with new channels of distribution, promotion and IEC messages with a particular focus on Kenya’s Coast province, which has the highest diarrhea prevalence rates in the country.

In a country plagued by poverty, 60% of the population lives below the poverty line, 42% of children are malnourished, and diarrheal disease is second most common cause of death for children under five. Recognizing that contaminated drinking water is a significant contributor to the spread of diarrheal disease, POUZN is implementing a three-pronged program: re-launching PSI/Rwanda’s Sûr’Eau program with renewed targeting of vulnerable populations, particularly families with young children; targeting PLWHA; and, in partnership with USAID’s Health Systems 20/20 Project who is evaluating the cost/benefit of such promotion, expanding access through promotion of Sûr’Eau through community-based health insurance schemes (mutuelles). The POUZN team is distributing Sûr’Eau through private sector outlets, including pharmacies and private sector providers; public channels, including health clinics and the 21,000-strong national health animator network; mutuelles; non-governmental organizations providing home-based care to PLWHA; and schools.

POUZN Zinc Treatment Programs

In collaboration with the Benin Ministry of Health and UNICEF, POUZN Abt/PSI is introducing pediatric zinc as a treatment for diarrhea through both private and public health channels in Benin. A diarrhea treatment kit (DTK) containing two sachets of a new, orange flavored low-osmolarity ORS and 10 tablets of zinc will replace PSI’s successfully marketed ORS product. POUZN is building upon PSI’s excellent ORS marketing program and its close distribution links with both public and private sector pharmaceutical wholesalers. The program will initially reach target communities in seven major catchment areas throughout the country, partnering with USAID’s two major bilateral programs, IMPACT and PISAF, and a UNICEF-funded, PSI-implemented zinc pilot program in two departments. Development of training modules and delivery of the training at all administrative levels is being carried out in collaboration with the MOH’s Department of Family Health. The POUZN team and its NGO partners from the USAID and UNICEF projects are developing integrated diarrheal disease prevention IEC materials, tailored to local knowledge and literacy levels, to be used in all community outreach activities. Mass media campaigns for diarrhea treatment focus on selling a new and improved ORS product along with zinc that will treat diarrhea as well as lengthen the period between bouts of diarrhea and help protect the child from getting diarrhea.

In March 2006, the Cambodian Ministry of Health and PSI, in coordination with WHO, and with financial support from USAID, launched a demonstration project to introduce a diarrhea treatment kit (DTK), branded as OraselKIT®, in selected districts of two provinces of Cambodia. In February 2007, POUZN staff, together with USAID and WHO, evaluated that pilot and has prepared a report detailing the results and lessons learned. The assessment report on this successful pilot, reaching numerous rural families through commercial retail outlets and two local partner NGOs working in each of the target districts, the Reproductive and Child Health Alliance (RACHA) and the American Red Cross/Cambodian Red Cross, is now available on this website by clicking here.

The Government of Madagascar’s Ministry of Health and Family Planning (MOHFP), was one of the first health ministries in the world to embrace the new diarrhea treatment protocol, launched by WHO and UNICEF in 2004, introducing zinc as a diarrhea treatment through public sector clinics at both health center and community levels in 12 districts in 2007.

POUZN is working closely with the Government of Nepal to address the significant impact of diarrhea on the health of children, mobilizing public and private sectors for the introduction of pediatric zinc, along with oral rehydration therapy. To date the POUZN Abt/PSI team has implemented the first phase of the program with a public/private sector launch of pediatric zinc for the treatment of diarrhea in young children in the three districts of Kathmandu, Bhaktapur and Lalitpur. Accomplishments to date:

• POUZN worked closely with four Nepalese pharmaceutical manufacturers, enabling them to develop, register, manufacture and bring to market for sale several pediatric zinc products. Nepalese pharmaceutical manufacturers have been encouraged and supported to produce and distribute zinc tablets that would meet the quality standards set by the Nepal Government Department of Drug Administration as well as other international drug testing agencies (e.g. United States Pharmacopeia - USP). Three products have been introduced into the Nepalese market since May 2007.
• Behavior change communication messages have been developed and aired through mass media targeting public sector employees and private sector providers, pharmacists and child caregivers in order to increase the use of ORS and pediatric zinc and reduce the provision of often ineffective and unnecessary diarrhea treatments. A national umbrella campaign logo was developed to promote all pediatric zinc products that are part of the Nepal Government program.

• 2,243 public sector employees (central, district and community levels) and 1,660 private sector providers and pharmacists have been trained to promote pediatric zinc supplements with ORS as the first line treatment for uncomplicated diarrhea in children under five years of age.
• 129,600 pediatric zinc treatments have been distributed to public sector clinics and 50,000 treatments have been sold through the private sector since May 2007. National scale-up of the private sector program to urban and peri-urban areas throughout the country will commence in January 2008.
• 129,600 pediatric zinc treatments have been distributed to public sector clinics and 50,000 treatments have been sold through the private sector since May 2007. National scale-up of the private sector program to urban and peri-urban areas throughout the country will commence in January 2008.