Evaluation of the Pakistan national oral rehydration program

Special evaluation covers the period 1/83-4/84 and is based on visits to urban and rural health facilities and interviews with pharmaceutical, media, and marketing professionals; Government of Pakistan (GOP) and private health care providers; and consumers. The availability of ORS packets in Pakistan is impressively high; 5 pharmaceutical companies produce ORS, and GOP supplies have increased from 5 million packets at project inception to a proposed 17 million for 1984. However, only 38.3% of mothers have heard of oral rehydration therapy (ORT) and only 10% have used it. Major constraints limiting ORS use are the lack of a full-time ORT manager, limited promotional and public education efforts, especially in rural areas (although relevant materials are now being developed), and the inadequacy of the existing epidemiological surveillance system. Other constraints include: underuse of the existing and impressive GOP training infrastructure and (by the public) of GOP health facilities; the difficulties of recruiting female medical technicians and of contact between the latter and female community health workers working in villages; insufficient support from doctors, who continue to prescribe ineffective drugs to combat diarrhea, and from traditional healers; lack of standard instructions on how to mix and administer ORS (currently, the GOP and the pharmaceutical companies are producing, respectively, 0.5 and 1.0 liter packets of ORS); and the uncertain quality of the ORS being produced. It is recommended that the GOP appoint a full-time, national ORT program manager (and a Pakistani counterpart if the manager is expatriate) as well as provincial and district supervisors; initiate a privately-marketed multimedia campaign to promote ORS use; conduct research on promoting the complementary use of home salt/sugar solutions; and improve surveillance (by restructuring and standardizing the system, upgrading reporting, etc.). Other recommendations addressing the other problems noted above include stressing the actual rehydration of children during training of health personnel.