Implementation Process

Objectives

The ultimate objective of the SUZY project is to implement a zinc treatment scheme for Bangladesh that will reach all children, but most importantly those in greatest need: the poor and undernourished.

After many years of research, ICDDR,B decided that the effectiveness and benefits of zinc as a treatment for childhood diarrhoea have been sufficiently proven and it is time to move to the next step: to make zinc available as a treatment to the population. This requires, in addition to further research, innovative solutions for the production of zinc tablets, strategies to promote the use of zinc among providers and caretakers and the establishment of a sophisticated distribution system.

Technology Transfer and Zinc Tablet Production
 
ICDDR,B, through the SUZY Project, purchased the patent license from Nutriset for Bangladesh and subcontracted the technology to ACME Laboratories Limited. The formulation of dispersible tablets containing 20 mg Zinc Sulfate was jointly developed by two French companies Rodael Laboratories and Nutriset Ltd. Nutriset, a company specializing in the production of nutritional products for emergency and disaster situations, owns the patent rights for this product. And Rodael produces the premix for the zinc tablets. Nutriset signed the patent licensed agreement with ICDDR,B to transfer the technology of producing zinc dispersible tablet to the research center in Bangladesh.. Under the agreement, ICDDR,B became the sole owner of the patent. Another confidentiality agreement was signed between Nutriset and ACME paving the way for planned technology transfer in fall 2006. A delegation came to check the quality of zinc dispersible tablet produced by ACME and finally Baby Zinc tablets were launched on November 23, 2006.

The tablets quickly become syrup with the addition of a few drops of water. Zinc’s metallic taste is masked using a non-encapsulation technology and vanilla flavour highly acceptable to children. The tablets are enclosed in a 10-tablet blister pack.
 
The advantages of a blister pack over bottles syrup are several:

less than one-half the cost

lightweight and easy to distribute

unique formulation that can be identified as a diarrhea medication

easier to know how many doses have been given.
 
Conducting clinical, formative and operations research

A large scale formative research project was completed to provide critical information required for the marketing campaign. This includes:

What are people currently doing to treat diarrhoea?

How much are they spending for the treatment of diarrhoea?

What types of diarrhoea are recognized and how does this influence management decisions?

What is known about zinc and what messages will most effectively lead caretakers to treat their children with zinc?

The results of the formative research will be used for the development of a targeted marketing campaign. For more information on current research projects on zinc at ICDDR,B, click here.

Mass marketing campaign

Like any new product, zinc as a treatment for childhood diarrhoea needs to be marketed to its target group. There are two target groups to consider: caretakers and providers. With respect to the former, we will design our messages to reach relatively poorer populations. In Bangladesh this will represent 70-80% of the population. Promotion of zinc among providers will be tailored to reach varied target groups, beginning with licensed allopaths (MBBS degree), lower-level trained health providers and then the unlicensed providers who serve the large majority of the poor.

Development of a distribution system

ICDDR,B and its partners are working to establish an innovative distribution system for the zinc tablets. This will involve partners in NGOs, in the Ministry of Health and Family Welfare (MOHFW) and in the private sector. Training manuals and videos have been developed. Trainings are also being conducted for those who will be involved in the distribution process.

Zinc tablets will also be available via the facilities of the Ministry of Health and Family Welfare (MOHFW). Initially, ICDDR,B will provide MOHFW facilities with the zinc blister packs free of charge. Later, a fee will need to be considered that reflects commitment and sustainability. The price will also be at an affordable cost.