1. Abt Associates Inc. SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting Lessons Learned: Implementing Zinc Treatment Programs Using a Commercial Approach Susan Mitchell Abt Associates June 2, 2011

2. 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

3. 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

4. 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

5. 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

6. Communication Campaign Poster - Nepal

7. 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

8. 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

9. 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.

10. 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.

11. 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

12. Thank you www.shopsproject.org