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Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. , 10,  p. (USAID Contract No. DPE-5969-00-7064-00)A visit was made to Uganda to meet with the oral rehydration solution (ORS) promotion committee to review on ORADEX sales targets, formulate regional sales goals based upon current national sales targets, and discuss product distribution concerns; to draft a document with Medipharm, ARMTRADES, and Media Consultants to review the effectiveness of promotional materials; to meet the PRITECH representative and coordinate the supervision of promotional communications between Medipharm, ARMTRADES, and Media Consultants; to meet with USAID/KAMPALA to determine the status of additional monies and provide an update on current project status; and to meet with UNICEF and review roles for continued interaction on the ORS promotional program between USAID/Kampala, UNICEF, and Medipharm. 90,837 sachets of ORADEX were sold through the end of January, 1992; above the target of 79,000. ARMTRADES, however, sold only 42,741 of its 60,000 target, while Medipharm sold 48,096 sachets; substantially more than its 19,000 target. Medipharm expressed concern over ARMTRADES' weak ability to distribute amd market ORADEX, despite ARMTRADES' claim that its sales efforts are being undermined by freely available UNICEF sachets. In response, PATH worked to improve the operational efficiencies of both Medipharm and ARMTRADES. Medipharm's present transportation facilities and institutional capabilities are insufficient to allow it to handle national distribution independently. For now, it must rely upon ARMTRADES to distribute and market ORADEX. Moreover, Medipharm needs continued supervision to properly manage distributor relations to ensure that distributors receive timely and accurate invoices, monthly statements, and payment due notices. These steps combined with accurate production and inventory planning will eventually provide Medipharm with sufficient experience to distribute and maintain stock on its own. Otherwise, the promotion committee suggested revisions for new materials future support and sales personnel and pharmacist training were discussed; and reports were cited which indicate that ARMTRADES is doing well distributing and marketing condoms through a parallel social marketing program.
[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.