Programme for the Awareness and Elimination of Diarrhoea (PAED)
Diarrhoea is the 3rd largest killer of children under the age of 5 (U5) in Zambia. Every year, children U5 experience 10.5 million episodes of diarrhoea, over 60,000 are hospitalised, and it causes an estimated 15,000 deaths.
The effects of diarrhoea on Zambian children are intensified by the weak health system infrastructure and the lack of human and financial capacity to include: the low doctor and nurse to population ratio; insufficient vaccine cold chain capacity; erratic access to essential medicines; and poor public awareness of appropriate behaviours for lifesaving measures against diarrhoea.
The Programme for Awareness and Elimination of Diarrhoea (PAED) takes a comprehensive approach to tackling diarrhoeal disease in children.
The 3 major pillars of PAED are:
- To accelerate the national introduction of the rotavirus vaccine into Zambia through a pilot introduction of the vaccine. The World Health Organization (WHO) recommends the use of rotavirus vaccines as part of a comprehensive public health strategy to combat diarrhoeal disease.
- To improve clinical case management of diarrhoea in public health clinics by identifying and addressing bottlenecks on demand and supply chain issues for zinc and Oral Rehydration Salts (ORS), and enhancing the capacity of health care workers through training, mentorship and supportive supervision through a government-led and approved curriculum in the case management of diarrhoea.
- To provide caregiver and community education targeted at behaviour change that promotes prevention of diarrhoea-related illness and death (including hand washing with soap, exclusive breast feeding and use of ORS and zinc) and increasing access and utilisation of ORS and zinc among care givers.
PAED is an innovative example of a successful Public Private Partnership that has taken on a complex health systems problem and yielded tangible achievements in a sustainable manner.
We play a catalytic role by leveraging on existing government leadership and political will to combat diarrhoea, along with the provision of modest seed funding that is attractive to other funders and stakeholders. PAED is completely integrated within the Zambian Ministry of Health (MOH) and Ministry of Community Development Mother and Child Health (MCDMCH) activities - aligning with government priorities. PAED operates within the national Expanded Programme on Immunisations (EPI) and our experts train and work with government frontline health workers. Our overall implementation plan is actively supported by both the MOH and MCDMCH.
Community involvement has been one of the cornerstones of PAED, with initiatives that involve church leaders and neighbourhood health committee members taking a lead role in educating their communities. PAED has also sought support from multiple donors and diversified to areas of water, sanitation and hygiene through partnering with the UNICEF WASH programme.
We work in 105 public health clinics and catchment areas in Lusaka Province serving a total of 2.1 million Zambians.
In the fight to prevent diarrhoea and secure the future of Zambian children, we have been able to achieve the following:
- Approval for national rotavirus vaccine and other lifesaving vaccine introduction by the GAVI Alliance;
- Expansion of national and provincial cold chain with efforts to secure district and health centre gaps;
- Construction of an Maternal Child Health clinic and training facility integrated within the Lusaka District health clinics;
- Full immunization of over 90,000 Zambian children against rotavirus;
- Training and mentoring of over 400 frontline health workers in improved case management of childhood illnesses;
- Training of over 400 community leaders on diarrhoea prevention and treatment messages to disseminate in the community;
- Implementing a pilot to address the challenge of access to essential medicines, with particular attention to ORS and zinc, through a total market approach strategy, including both public and private sectors, while advocating for increased supplies at the government and manufacture levels;
- Collaboration with the private sector to streamline supply chain of ORS and zinc to small scale vendors.