PDF(Pubmed)
Abstract：
We document the development and institutionalization in Zambia of a health innovation for diarrhea treatment aimed at children aged younger than 5 years: a unique oral rehydration salts and zinc (ORSZ) co-pack. Seven recommendations from the World Health Organization/ExpandNet are used retrospectively to analyze and describe the successful scale-up of this innovation from its concept stage, including in-country expansion and policy, institutional, and regulatory changes. The 7 recommendations comprise using a participatory process, tailoring to the country context, designing research to test the innovation, testing the innovation, identifying success factors, and scaling up. The scale-up of co-packaged ORSZ in Zambia is shown to be sustainable. Five years after donor funding ended in 2018, an independent, local manufacturer continues to supply the private and public sectors on a commercially viable basis. Furthermore, national coverage of ORSZ increased from less than 1% in 2012 to 34% in 2018. A key success factor was the continuous facilitation over 8 years (spanning planning, trial, evaluation, and scale-up) by a learning and steering group chaired by the Ministry of Health, open to all and focused on learning transfer and ongoing alignment with other initiatives. Other success factors included a long lead-in of inclusive initial consultation, ideation, and planning with all key stakeholders to build on and mobilize existing resources, knowledge, structures, and systems; alignment with government policy; thorough testing and radical review of the product and its value chain before scale-up, including manufacture, distribution, policy, and regulatory matters; and adoption by the government of a co-packaging strategy to ensure cases of childhood diarrhea are treated with ORSZ. With appropriate local adaptations, this approach to scale-up could be replicated in other low- and middle-income countries as a strategy to increase coverage of ORSZ and potentially other health products.
摘要：
我们记录了赞比亚针对5岁以下儿童的腹泻治疗健康创新的发展和制度化：独特的口服补液盐和锌（ORSZ）联合包装。世界卫生组织/ExpandNet的七项建议被用来回顾性地分析和描述这一创新从概念阶段的成功扩大规模，包括国内扩张和政策，机构,和监管变化。这7项建议包括使用参与性过程，根据国家背景剪裁，设计研究来测试创新，测试创新，确定成功因素，和扩大规模。赞比亚联合包装ORSZ的扩大规模被证明是可持续的。捐赠资金在2018年结束五年后，一个独立的，本地制造商继续在商业上可行的基础上为私营和公共部门提供服务。此外，ORSZ的全国覆盖率从2012年的不到1%增加到2018年的34%。一个关键的成功因素是8年来的持续促进(跨越规划，审判,评估，并扩大规模）由卫生部主持的学习和指导小组，向所有人开放，并专注于学习迁移和与其他举措的持续一致性。其他成功因素包括长期引入包容性的初步协商，idea,并与所有主要利益攸关方一起规划，以利用和调动现有资源，知识,结构,和系统；与政府政策保持一致；在扩大规模之前，对产品及其价值链进行彻底测试和彻底审查，包括制造，分布，政策,和监管事项；政府采用联合包装策略，以确保儿童腹泻病例得到ORSZ治疗。通过适当的本地改编，这种扩大规模的方法可以在其他低收入和中等收入国家推广，作为增加ORSZ和潜在其他健康产品覆盖率的战略。
