Bottleneck analysis and strategic planning using Tanahashi model for childhood diarrhea management in Gujarat, Western India

• Published in: Evaluation and program planning 2016-10, Vol.58, p.82-87
• Main Authors: Rupani, Mihir Prafulbhai, Gaonkar, Narayan T., Bhatt, Gneyaa S.
• Format: Article
• Language: English
• Subjects: Behavior change; Bottleneck analysis; Bottlenecks; Call-To-Action RMNCH + A strategy; Childhood; Childhood diarrhea; Children & youth; Diarrhea; Disease management; Drinking water; Gujarat; High priority districts; Hygiene; Information management; Latrines; Management Systems; Oral rehydration; Sanitation; Strategic planning; Supply; Tanahashi model; Unsafe
• ISSN: 0149-7189; 1873-7870
• DOI: 10.1016/j.evalprogplan.2016.05.017

•National health programs for childhood diarrhea management are being run since many years now in India. It was necessary to pinpoint the bottlenecks in childhood diarrhea management and identify strategies for addressing the same. Evidence-based strategic planning with the existing opportunities currently available in India for addressing the gaps in childhood diarrhea management have now been identified.•Use of Zinc tablets for Childhood Diarrhea Management should be scaled up across the globe with emphasis on the importance of compliance of Zinc therapy for 14days.•Inter-sectoral coordination between Water and Sanitation Hygiene (WASH) and Health Department is the need of the hour for addressing the bottlenecks in Childhood Diarrhea Management.•Use of appropriate technology like Drug Logistics Information Management System (DLIMS) for Supply Chain Management should be scaled up to entire country for effective distribution of drugs and logistics up to the Front Line Worker (FLW) level.•Strategic Planning should be tailored to the needs of the individual districts/states with the existing opportunities available there. In spite of continued efforts, India is still lagging behind in achieving its MDG goals. The objectives of this study were to identify stake-holders who have a role to play in childhood diarrhea management, to identify gaps in childhood diarrhea management and to propose strategic options for relieving these gaps. Bottleneck analysis exercise was carried out based on the Tanahashi model in six High Priority Districts (HPDs) of Gujarat in period between July–November 2013. The major bottlenecks identified for Childhood Diarrhea management were poor demand generation, unsafe drinking water, poor access to improved sanitation facility and lack of equitable distribution and replenishment mechanisms for Oral Rehydration Solution (ORS) packets and Zinc tablets till the front-line worker level. The main strategic options that were suggested for relieving these bottlenecks were Zinc-ORS roll out in scale-up districts, develop Information Education Communication/Behaviour Change Communication (IEC/BCC) plan for childhood diarrhea management at state/district level, use of Drug Logistics Information Management System (DLIMS) software for supply chain management of Zinc-ORS, strengthening of chlorination activity at household level, monitoring implementation of Nirmal Bharat Abhiyaan (NBA) for constructing improved sanitation facilities at household l