Each year, almost 1.5 million children around the world die from diarrheal disease* due to unsafe water, inadequate sanitation and poor hygiene practices. PSI currently manages diarrhea control programs in more than 30 countries across Africa, Asia and the Caribbean.
In order to effectively prevent diarrheal diseases it is essential that households have good hygiene practices and access to safe drinking water and improved sanitation. To this end, PSI applies its expertise in social marketing to change hygiene behaviors and make markets work for the poor to ensure affordable water, sanitation and hand washing with soap products and services are in demand and easily accessible to consumers at the bottom of the pyramid.
For the management of diarrhea cases, PSI promotes the use of oral rehydration salts (ORS) and zinc. In May 2004, WHO/UNICEF issued a joint statement recommending the use of zinc with ORS as the best way to decrease the incidence, severity and recurrence of diarrheal disease in children. In 2011, PSI distributed 1.3 million DTKs and averted 58,000 DALYs. PSI’s diarrheal disease treatment programs identify the most significant factors that influence diarrhea treatment seeking among caregivers to develop communications and product distribution strategies that respond to their needs and preferences. PSI promotes the benefits of diarrhea treatment, educates caregivers and health providers on why ORS and zinc is the most effective way to manage acute diarrhea, and ensures availability of these life-saving products through private and public sector channels, including community case management of diarrhea.
* United Nations Children’s Fund and World Health Organization, ‘WHO/UNICEF Joint Statement: Clinical management of acute diarrhoea’, UNICEF, New York, 2004.
- Household Water Treatment
PSI improves access to clean water by promoting and distributing point-of-use household water treatment products. Household water treatment is a water-quality intervention that uses chlorine based solutions that are effective, easy-to-use, and inexpensive. Through numerous field-based studies, chlorine-based water treatment prevents roughly 50% of new episodes of diarrhea. PSI currently has national-scale safe water programs to prevent diarrheal disease in more than 30 countries across Africa, Asia and the Caribbean. PSI delivers water treatment products using multiple channels, including community health workers, trained public and private health providers, private pharmacies, and free distribution in emergencies, such as outbreaks of cholera. PSI’s household water treatment interventions address water quality issues where they are needed most, and are part of an integrated WASH strategy that includes hygiene, and sanitation interventions.
Safe Water Solution
Safe water solution is a dilute sodium hypochlorite (chlorine) solution used to disinfect water at the household level. One capful of solution treats about 20 liters of water, about the size of most containers used to obtain and store water. The solution is easy to use and extremely inexpensive —a bottle typically costs less than thirty cents to protect a family of six for one month.
PSI markets and distributes safe water solution in 18 countries and has become the largest distributor in the world. The solution is locally-manufactured, which allows PSI to engage and develop the local private sector, improve sustainability of the program, and reduce production costs.
Chlorine tablets are water purification tablets that have an effervescent base comprised of pharmaceutical and food grade compounds. Each tablet treats 20 liters of water and can be sold in small quantities (typically strips of ten individually sealed tablets), which allows consumers with minimal disposable cash to afford safe drinking water for their families. As a tablet is dissolved, free available chlorine is released, disinfecting the water and preventing water-borne diseases.
Through numerous field-based studies, chlorine-based water treatment prevents roughly 50% of new episodes of diarrhea.
Developed by Procter and Gamble in collaboration with the CDC, the P&G Sachet is a robust household water treatment technology that effectively removes turbidity (dirt), bacteria, viruses and parasites from water through a combined process of disinfection with calcium hypochlorite and flocculation with iron sulfate. Using the same technology utilized by municipal water treatment facilities, the product is a powder packaged in 4 gram sachets with each packet treating 10 liters of water. It is effective in removing bacteria, viruses, parasites, arsenic and DDT. Because of its efficacy in visibly removing dirt and parasites from water, PSI often targets P&G Sachets to people living with HIV/AIDS and to those drinking turbid surface water.
- Oral Rehydration Salts and Zinc
For the management of diarrhea cases PSI promotes the use of Oral Rehydration Salts (ORS) and zinc. PSI works with local partners to train community health workers and medical providers on health promotion and diarrhea case management, in line with the integrated management of childhood illness (IMCI) protocol. Where feasible, PSI promotes diarrhea treatment kits (DTKs) with a pre-packaged combination of two ORS sachets and ten dispersible zinc tablets. PSI’s diarrheal disease treatment programs identify the most significant factors that influence diarrhea treatment seeking among caregivers to develop communications and product distribution strategies that respond to consumer needs and preferences. PSI promotes the benefits of diarrhea treatment, educates caregivers and health providers on why ORS and zinc is the most effective way to manage acute diarrhea and ensures availability of these life-saving products through private and public sector channels, including community case management of diarrhea. Globally, PSI socially markets ORS and zinc, packaged into DTKs where possible, in 13 countries.
Handwashing with soap at key times has been shown to decrease the incidence of diarrhea in the general population by 48%*, making it the most cost-effective of ALL major disease control interventions**. Even though studies suggest that soap is available in more than 95% of households, handwashing with soap is not a common practice. PSI programs work to increase the practice of handwashing with soap at key times among caregivers of children under five, primary school children, and vulnerable populations including people living with HIV/AIDS. Formative research is used to understand the most important factors that influence adoption of handwashing with soap behaviors. This consumer insight is used by PSI to develop marketing strategies that include dissemination of key messages through a variety of communication channels such as mass media campaigns, community level events and interpersonal communications.
*Cairncross S, Hunt c, Boisson S et al. Water, sanitation and hygiene for the prevention of diarrhea. International Journal of Epidemiology 2010; 39:i193-i205.
**World Bank/WHO Disease Control Priorities Project
- Sanitation Marketing
An estimated 2.5 billion people lack access to improved sanitation facilities, which contributes to 1.5 million deaths from diarrheal diseases among children under five. PSI’s programs address urban and rural sanitation through the whole value chain, including latrine construction and maintenance, and use complementary demand creation activities to encourage consumers to climb the sanitation ladder from open defecation to the use of improved sanitation. PSI contributes to a decrease in open defecation and an increase in access to and use of improved sanitation by working through the private sector to make markets work for the poor.
PSI overcomes supply and demand barriers to latrine access and use by developing an understanding of what makes investment in sanitation attractive to households and what makes investment of capital attractive to the private sector. In urban areas, PSI facilitates the development of pay-for-use toilet franchises run by local entrepreneurs in urban slums to provide affordable, safe, private, clean, and well maintained environments for populations that lack the ability—due to cost, space, or land ownership constraints—to construct household toilets. In rural areas, PSI creates franchises of one-stop sanitation shops where consumers can purchase a range of context appropriate sanitation products and services as well as access finance options.
- Emergency Response
PSI has been an instrumental partner in responding to natural disasters and other crisis situations around the globe. PSI’s commitment to effective and efficient interventions combined with its strong procurement and distribution capacity allow PSI to offer swift help when countries are faced with emergency situations. Through its affiliate organization Greenstar Social Marketing Limited, PSI collaborated with numerous aid agencies to help those affected by the severe 2005 earthquake in Pakistan access safe water.
In 2008, PSI responded to the cholera outbreak in Chitungwiza, Zimbabwe with point-of-use water treatment tablets and hygiene promotion IPC activities. PSI was able to distribute more than 300,000 tablets within a 3 day period while performing a door-to-door hygiene promotion and household water treatment campaign.
In response to the 2010 earthquake in Haiti, PSI secured water purification solution to provide survivors with 30 million liters of safe drinking water. As the rainy season approached shortly after the earthquake, the risk of malaria, dengue and water born disease increased; PSI mobilized its existing communications network to target highly concentrated populations with key disease prevention messages.
- Integrated Case Management
PSI contributes to global efforts to reduce child mortality by two thirds in 2015 compared to 1990 levels, by implementing integrated case management (ICM) programs that focus on treatment of pneumonia, diarrhea, malaria, and severe acute malnutrition. PSI is focused on improving access to effective treatment, enhancing quality of care, and increasing informed demand among caregivers to seek prompt and effective treatment from trained providers. To increase access, PSI works through pharmacy networks, franchised and non-franchised private clinics, and community health workers (CHWs) to reach caregivers of children under five with the quality services and commodities they need. By leveraging the most appropriate channel to reach caregivers, PSI will provide high quality, cost effective integrated health services that address the main causes of childhood morbidity and mortality in a given country.
Integrated Community Case Management (iCCM) is an ICM strategy to prevent child deaths in settings where access to facility based care is limited. PSI works with Ministries of Health to develop iCCM programs that involve clinical diagnosis and treatment provided by trained and supervised community health workers who promote timely treatment seeking, encourage appropriate home care, and facilitate referrals to facilities. In addition to improving access to care, PSI’s iCCM interventions focus on preventing child deaths by increasing quality of and demand for iCCM services. Children with danger signs are referred to health facilities. iCCM may include the treatment of malaria (with ACTs), pneumonia (with antibiotics) and diarrhea (with ORS and zinc). When CHWs diagnose uncomplicated malaria, pneumonia or diarrheal disease, treatment is provided free of charge. An iCCM intervention typically includes training and supervision of CHWs, appropriate treatment, and behavior change communications targeting mothers and caregivers. PSI implements iCCM programs in Malawi, Mali, DRC, South Sudan, Madagascar, and Cameroon, with funding support from CIDA, Global Fund, and other donors.