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Ever Heard of the Life-Saving Box?

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Earlier this month I joined my fellow Stars in Global Health and other Grand Challenges grantees at the international Grand Challenges Conference in Ottawa. The conference, cohosted by Grand Challenges Canada and the Bill and Melinda Gates Foundation, was inspiring and provided me the opportunity to meet global health innovators from around the world.

The diversity of projects which all the grantees were undertaking was immense, but a theme that stood out for me was how innovation is enabled by partnership. It was evident throughout the conference the importance given to fostering an environment of creativity and collaboration, encouraging us to work with diverse partners to spur further innovation and progress, building on our best programs to improve health results.

My Guatemala project has this same sense of partnership and creativity. Its roots are with my colleagues at the Guatemalan Ministry of Health who, after the initial success in the roll-out of the zinc and oral rehydration salts (ORS) treatment program for diarrhea at health centres across the country, started thinking of ways to improve the program and its potential impact. They had the initial idea for what's become the cajita salvavida or "Life-saving Box," one of the packaging options that we're testing with health workers and caregivers.

2012-12-20-mariongcccajita.jpgIt may seem like a simple project that we're undertaking -- having caregivers use zinc and ORS together to treat their children's diarrhea -- but when you're dealing with health issues, there are some many complexities that must be taken into account.

Packaging the zinc with the ORS might seem like an easy solution to get caregivers to use them both when treating diarrhea but there are numerous reasons why this can't be done in one central location in most countries. In some countries, ORS is listed as an over-the-counter medication while zinc is by prescription only.

One manufacturer or importer might be providing the ORS and shipping it to different storage facilities; another manufacturer might be providing the zinc and are contracted to ship the zinc and another medication in smaller quantities to more remote locations to make logistics easier. Smaller children need a different dose of these medications than older children so there isn't a "one size fits all" solution to the co-packaging that every health service can use. There can also be confusion for the mothers as the ORS is taken for two to three days, while the zinc should be given for ten days.

The cajita salvavida and other co-packaging that we are looking at, a small plastic bag and a simple elastic band with printed instructions, will also have to make it to these remote locations in the right quantities so that they're available when needed but aren't taking up too much valuable space in a small health centre. We're working with the logistics experts within the Ministry of Health and field level providers on what the best ways of shipping these items and what the added burden might be to the health system.

Like so many global health challenges, what seems like an easy problem to tackle -- put the zinc and ORS together -- can come up against many different obstacles along the way. It was interesting to learn how my fellow "Grand Challengers" are tackling some of their own obstacles, using innovation not only in their product or concept design but also in the way they're approaching project implementation. Innovation and partnership have helped create this project and its success will depend on these two factors moving forward.

Also, I want to share with you some good news from the project site. Thanks to the quick and well-organized response to the earthquake and related landslides in the San Marcos area, most of the health services have reverted to their normal programming. Our dedicated team is back at work interviewing health workers, caregivers and other community members about how they currently treat diarrhea and what they need to improve access to health services. However, we're not sure how long it will take to rebuild the destroyed water systems and related infrastructure so access and proper use of zinc and ORS to treat diarrhea may be more important than ever.

Hasta pronto!