Abt Associates Inc.

SHOPS is funded by the U.S. Agency for International Development.Abt Associates leads the project in collaboration withBanyan GlobalJhpiegoMarie Stopes InternationalMonitor GroupO’Hanlon Health Consulting

Lessons Learned: Implementing Zinc Treatment Programs Using a Commercial Approach

Susan MitchellAbt Associates

June 2, 2011

What is a Commercial Model

A social marketing program implemented in partnership with one or more commercial manufacturers where the commercial partner retains control of branding, pricing and distribution.

Social Marketing Models for Product-Based RH Programs: Francoise Armand, 2003

Conditions for a Zinc Program Using a Commercial Model

Strong local pharmaceutical manufacturing

Market potential

High use of ORT/ORS

A safety net for the

poorest

Commercial Programs: Design Considerations

Nepal• 61% of cases treated ORS/ORT

use (DHS)• 58% of diarrhea treatment in

private sector (DHS)• 3 companies in the process of

developing pediatric zinc products

• Strong commercial distribution system: 10,000+ pharmacies

• Price of treatment $0.19 - $0.52 & $0.11 for ORS

• Public Sector safety net

Pakistan• 55% of diarrhea treated with

ORS/ORT (DHS)• 70% of diarrhea treatment in

private sector (DHS)• 4 companies with registered

pediatric zinc products• Strong commercial distribution

system• Price of treatment zinc $0.53 -

0.88 & $.0.08 for ORS• Public sector safety net

Commercial Zinc Program - Nepal

Partnered with three local manufacturers. Partners produced and distributed a range of affordable products throughout the country

Developed training materials for pharmacists and providers and trained over 8000 individuals

Provided demand creation through television advertisements aired at prime evening viewing periods and radio spots targeted at women during daytime hours

Safety net provided by public sector clinics and female volunteers

Communication Campaign Poster - Nepal

Commercial Program - Pakistan

Partnered with pharmaceutical companies already marketing zinc in private sector and selling to public sector

Cost-shared marketing activities of pharma partners Supported training of pediatricians and GPs through CME

programs facilitated by Pakistan Pediatric and Medical Associations

Developed and aired mass media campaign: television, radio, billboards, posters, rickshaw ads, and zinc program logo

Public sector safety net provided by Lady Health Workers

Motivated Pharmaceutical Industry

For countries with strong pharmaceutical manufacturing sector (Nepal and Pakistan):

• Ability to produce quality products in either syrup or dispersible tablet form

• Existing distribution and marketing systems that can make the product accessible to target populations

• New firms moved quickly into the market to take advantage of demand creation opportunities offered by POUZN

Lessons Learned Working with Commercial Manufacturers of Zinc

When pharmaceutical companies see market demand and potential to grow market, including potential for sales to government sector, they move quickly into the market

Partnering with local pharmaceutical manufacturers and co-funding marketing activities can be a mutually beneficial strategy for introducing pediatric zinc products.

Challenges in Supporting Commercial Markets

Zinc is a therapeutic agent that must comply with drug regulations surrounding quality, registration, Good Manufacturing Practices (GMPs), distribution, and promotion.

Initial efforts to introduce a new product are usually centered in urban or peri-urban areas thus extra effort is often needed to assure access to treatments in rural areas

Zinc enters an entrenched antibiotic and antidiarrheal market, which necessitates sustained efforts to displace existing behaviors.

Overarching Conditions for Success

Public sector support for including zinc in diarrhea management and for a private sector role

Zinc champions

Mass communications with national reach

Thank you

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