I remember being forced as a child to gurgle salt and water solution whenever I would get a mouth sore in Nigeria. The solution was never pleasant and I can’t imagine what drinking it must taste like. Even then, I always distrusted the potency of this “drug”, believing it to be an old wives’ tale and wondered why I simply wasn’t given a drug from the Pharmacy. 15 years later in New York and I often yearn for some of those “drugs” my grandmother would prescribe to me whenever I got a mild to moderate illness. It’s difficult to understand from a health specialist point-of-view why such a seemingly easy, and not to mention, effective remedy has such as slow uptake in developing countries. The Oral Rehydration Therapy (ORT) case study from Harvard Business School presents the facts, among which is the aforementioned example from my childhood, in hopes of stimulating discourse and innovative solutions.
The use of ORT as a first line treatment for diarrhea is not more widespread despite its proven effectiveness because of a myriad of interconnected issues which compound to create a negative synergistic effect that has resulted in slower than expected adoption and implementation of ORT. As is sometimes the case with global health recommendations, delivery from the country level and community/individual preferences and/or beliefs were overlooked during the first implementation stages.
I believe the first issue on the agenda for ORT scale up should be increasing demand for ORT. Currently, individuals and providers do not demand ORT because of a distrust of its effectiveness, lack of understanding of the severity of diarrhea and the challenging fact that ORT does not treat the symptoms of diarrhea (which caregivers observe), but simply prevents death from mortality (which is harder to observe unless a child is in that situation). Addressing demand issues will ensure that there will be sufficient demand in the population for ORT to be successful should the supply side issues be resolved as well. In terms of supply issues, pulling a script from the global response to tuberculosis, creating a supply committee to aid countries in understanding the logistics involved with ensuring adequate availability and distribution of ORT to those in need would help resolve some of the supply issues. Also, working with the pharmaceutical companies to create a solution that tastes better for children will ensure that children are willing and happy to use ORT.
Lastly, while encouraging homemade ORT solutions sounds appealing, there is a huge margin for error because of lack of standardization. Caregivers should be educated on the specific proportions for the solution and should be encouraged to use this first line response for when the symptoms first appear. It is not only enough to discover effective solutions to some of the world’s trying health issues, it is also important to understand what factors on the ground, sometimes health-related other times not, might affect implementation and scale up.