Increasing acceptance and use of recommended treatment for childhood diarrhea with Bicycle Doctors (Sehat Mitras) in Uttar Pradesh, India

Introduction:  The World Health Organization recommends zinc and ORS as the mainstay treatment for childhood diarrhea. Indian children under the age of five comprise one-fourth of the total global deaths due to diarrhea-related causes. 81% of caregivers in India seek treatment from the private health sector, mostly from informal providers where antibiotic and anti-diarrheal overuse is common. The “Alleviation of Diarrhea Through ORS and Zinc” (DAZT) project aims to increase private sector demand and supply of zinc and ORS by changing prescription practices and increasing availability of and access to zinc and ORS.

Methods: “Sehat Mitra” (Health Friends) was conceptualized and piloted in Faizabad district of Uttar Pradesh. Many RMPs travel on bicycles/motorbikes and regularly cover an area of 3-4 villages to visit patients and provide care. Ten Sehat Mitras received training before entering the field. They were expected to educate caregivers and prescribe ORS and zinc for diarrhea management.

Results:  Over 10 months, 17,668 households were visited sensitizing more than 85,000 caregivers. In total, 2,390 diarrhea cases were reported and over 2,200 children were treated with ORS and zinc therapy. During this time, 5,108 ORS packets and 2,233 units of zinc were sold. The approach also allowed repeated caregiver visits to ensure appropriate administration of zinc and ORS and adherence to treatment.

Conclusions: Sehat Mitra offers a promising approach to reach receptive caregivers in the remotest areas through RMPs with different MNCH interventions. It is being scaled up to over 600 Sehat Mitras throughout 12 districts of UP.