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Plan of action for the control of diarrheal diseases in the region of the Americas. Interagency Coordinating Committee for the Control of Diarrheal Diseases (ICC/CDD). Plan de accion para el control de las enfermedades diarreicas en la region de las Americas.
[Unpublished] . , 32, , 32 p.The American made remarkable strides in reducing diarrheal mortality and morbidity during the 1980s. All of the nations here had in place a control of diarrheal diseases (CDD) program or CDD activities by early 1989. 1 goal for CDD projects in the region included ORS availability to 80% of all children <5 years old. 17 nations even produced their own oral rehydration solution (ORS). This contributed to the fact that more countries proportionally produced ORS in the Americas than in any other region. Still diarrhea continued to be 1 of the 3 leading causes of death and illness in children <5 years old in most countries in the Americas. Accordingly an Interagency Coordinating Committee (ICC/CDD) Task Force composed of representatives from PAHO, UNICEF, and USAID formed in 1989 to develop a framework for the region and countries to follow in designing plans of action. Each country in the Americas should foster effective cooperation among all organizations involved in CDD activities within that country. If an interagency process, e.g., child survival programs, already exists, the country should include the CDD program into it. National ICC/CDDs should define policies and prepare the plan of action incorporating both technical and financial support from the public and private sectors. They must also coordinate CDD training activities, especially those emphasizing correct case management. Further they should concur on communication projects and coordinate message development and relations with the mass media. These committees must also recognize problems, develop solutions, foster research, and amend national CDD programs as needed. PAHO is the technical secretariat for the regional ICC/CDD which works to foster optimum cooperation among PAHO, UNICEF, and USAID thereby providing maximum assistance to these programs.
[Columbia Maryland], Westinghouse Electric Corporation, Public Applied Systems, 1984 Sep. 26,  p. (Contract No. PDC-1406-I-02-4062-00, W.0.2; Project No. 936-5939-12)Westinghouse Health Systems, under a US Agency for International Development (USAID) contract, ass ssed the global supply and demand of oral rehydration salts (ORS) and developed a set of recommendations concerning USAID's future role as a supplier of ORS. 1.5 billion ORS packets (assuming each packet is equivalent to 1 liter of ORS solution) would be required to treat all ORS treatable cases of diarrhea which occur annually among the world's children under 5 years of age. Currently, about 200 million packets are manufactured/year. In 1983, international sources supplied slightly less than 37 million packets, and the remaining packets were produced by local or in-country manufacturers. UN Children's Fund (UNICEF), which currently provides 81% of the international supply, contracts with private firms to manufacture ORS and then distributes the packets to developing countries, either at cost or free of charge. UNICEF purchases the packets for about US$.04-US$.05. USAID provides about 12.3% of the international supply. Prior to 1981, USAID distributed UNICEF packets. Since 1981, USAID has distributed ORS packets manufactured by the US firm of Jianas Brothers. USAID must pay a relatively high price for the packets (US$.08-US$.09) since the manufacturer is required to produce the packets on an as needed basis. Other international suppliers of ORS include the International Dispensary Association, the Swedish International Development Authority, the International Red Cross, and the World Health Organization. Currently, 38 developing countries manufacture and distrubute their own ORS products. These findings indicate that there is a need to increase the supply of ORS; however, the supply and demand in the future is unpredictable. Factors which may alter the supply and demand in the future include 1) the development of superior alternative formulations and different type of ORS products, 2) a reduction in the incidence of diarrhea due to improved environmental conditions or the development of a vaccine for diarrhea, 3) increased production of ORS in developing countries, 4) increased commercial sector involvement in the production and sale of ORS products, and 5) the use of more effective marketing techniques and more efficient distribution systems for ORS products. USAID options as a future supplier of ORS include 1) purchasing and distributing UNICEF packets; 2) contracting with a US firm to develop a central procurement system, similar to USAID's current contraceptive procurement system; 3) contracting with the a US firm to establish a ORS stockpile of a specified amount; 4) promoting private and public sector production of ORS within developing countries; 5) including ORS as 1 of the commodities available to all USAID assisted countries. The investigators recommended that USAID should contribute toward increasing the global supply of ORS; however, given the unpredictability of the ORS demand and supply, USAID should adopt a short-term and flexible strategy. This strategy precludes the establishment of a central procurement system; instead, USAID should contract a private firm to establish an ORS stockpile and to fill orders from the stockpile. Consideration should be given to altering the ORS packets size and to alternative ORS presentations. USAID should also promote the production of quality ORS products within developing countries and continue to support research on other diarrhea intervention strategies. This report also discusses some of the problems involved in manufacturing and packaging ORS. The appendices contain 1) a WHO and UNICEF statement on the ORS formulation made with citrate instead of bicarbonate, 2) a list of developing countries which manufacture ORS, and 3) statistical information on distribution of ORS by international sources.