title: Bottleneck analysis and strategic planning using Tanahashi model for childhood diarrhea management in Gujarat, Western India.
abstract: 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 level and to develop an IEC/BCC plan for hygiene promotion and usage of sanitary latrines. Use of Zinc tablets need to be intensified through an effective scale-up. Adequate demand generation activity is needed. There is need to address safe drinking water and improved sanitation measures at household levels. Multi-sectoral engagements and ownership of Zinc-ORS program is the need of the hour.
authors.affiliation: Knowledge Manager, Diarrhea Alleviation through Zinc-ORS Therapy (DAZT), UNICEF State Office for Gujarat, Plot no. 70, Road no. 4th B, Opp. Punit van, Sector 19, Gandhinagar, 382019 Gujarat, India. Electronic address: mihirrupani@gmail.com.
authors.forename: Mihir Prafulbhai
authors.initials: MP
authors.lastname: Rupani
authors.affiliation: Health Specialist, UNICEF State Office for Gujarat, Plot no. 70, Road no. 4th B, Opp. Punit van, Sector 19, Gandhinagar, 382019 Gujarat, India. Electronic address: ngaonkar@unicef.org.
authors.forename: Narayan T
authors.initials: NT
authors.lastname: Gaonkar
authors.affiliation: Knowledge Manager, Diarrhea Alleviation through Zinc-ORS Therapy (DAZT), UNICEF State Office for Gujarat, Plot no. 70, Road no. 4th B, Opp. Punit van, Sector 19, Gandhinagar, 382019 Gujarat, India. Electronic address: gneyaa@yahoo.co.in.
authors.forename: Gneyaa S
authors.initials: GS
authors.lastname: Bhatt
mesh_terms: D003967:Diarrhea / Q000517:prevention & control* / Q000628:therapy*; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration*; D006280:Health Workforce; D006801:Humans; D007194:India; D007256:Information Systems / Q000706:statistics & numerical data; D009313:National Health Programs / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D012499:Sanitation / Q000379:methods; D000070318:Strategic Planning; D014881:Water Supply / Q000592:standards; D015032:Zinc / Q000600:supply & distribution / Q000627:therapeutic use
chemical_list: D015032:Zinc
keywords: Bottleneck analysis; Call-To-Action RMNCH + A strategy; Childhood diarrhea; Gujarat; High priority districts; Strategic planning; Tanahashi model