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Who is a diarrheal disease advocate?

YOU are. Whether you’re a nongovernmental (NGO) or civil society (CSO) staffer, a health care worker, a doctor, a parent, a researcher, or an academic, you can help bring more attention and urgency to diarrheal disease. Below are some examples of how advocates are already shining a spotlight on the issue. No matter who you are, you can take action. Here are some ideas.

• If you are a civil society or grassroots advocate, you can:

  Raise awareness. Look for #DefeatDD on social media to start. The variables that give rise to diarrheal diseases are an ongoing emergency driven by a lack of access to clean water and basic healthcare. Behind disease outbreak headlines, children are suffering and dying every day, but funders can’t help if they don’t know about it.

  Call for increased budgets for diarrheal disease solutions in your country. Solutions for diarrhea are simple and cost-effective, but they require resources, which are often ignored or under-funded. Encourage your policymakers to elevate these tools when they apply for donor funding vehicles like the Global Financing Facility or Gavi, the Vaccine Alliance. Consider areas that might be traditionally overlooked by health budgets, like WASH in healthcare facilities.

  Familiarize yourself with the facts and figures. The data on the global crisis and the impact of cost-effective, simple solutions is strong—so if you’re talking about diarrhea, facts and figures should be part of your messaging. Start here. If you are an advocate or policymaker in a country where disease burden is high, precision data mapping can help you prioritize.

  Learn about how impacts from diarrheal disease can be reduced with strong and accessible primary health care systems. Strong primary health care systems provide care that removes financial and geographic barriers to access and provide services on time. All of these are critical for children suffering from diarrhea to access the treatment they need before diarrhea causes irreparable physical or mental harm.

  Advocate for gender-equitable approaches to child health, and consider how other social inequities increase the toll of diarrheal disease. Like any other health issue, diarrheal disease doesn’t occur in a vacuum. It’s influenced by the conditions in which families, caregivers, and children live. Whether a child gets sick can be influenced by gender roles, poverty, cultural norms, and climate. As advocates, we have to think broadly, and partner to develop solutions that take these conditions into account.

   

  Examples and opportunities:

  • US advocates and policymakers successfully advocated for the passage of the Water for the World Act, which ensures a coordinated approach to water, sanitation, and hygiene focused on the countries and communities that need it most.
  • In Zambia, a coalition succeeded in including diarrheal disease interventions in newborn health policy.
  • Studies have shown that immunization is an effective form of entry for WASH education. After a successful pilot, WaterAid scaled up hygiene education during rotavirus vaccine appointments nationwide in Nepal.
  • In DRC, PATH supports the Ministry of Health and the EPI in advocating for an increase in domestic resources for immunization, including rotavirus vaccines. In 2019, DRC was the first Gavi-supported country in Africa to introduce ROTASIIL®, a newly available heat-stable rotavirus vaccine made in India.

• If you are a donor, you can:

  Increase financial support for adaptable, context-appropriate diarrheal disease interventions within broader initiatives. Solutions to address diarrhea are multi-faceted, which means that the best programs ensure coordination among partners to ensure that the collective risk factors to child health are addressed. Diarrheal disease control should be a critical priority in funding for primary health care and overall child health and well being.  

  Provide resources for programs. Provide resources for programs and research that feature innovative, cost-effective ways to deliver integrated approaches. As a donor, you can ensure more solutions reach larger populations by incentivizing, funding, and measuring flexible approaches that combine and deliver the most-needed solutions. Specifically, include requirements in your calls/requests for proposals that prioritize programs implementing the GAPPD approach.

  Examples and opportunities:

  • The Global Financing Facility, which supports the Every Woman Every Child initiative, is a funding mechanism that prioritizes country plans for addressing a range of child health issues, including diarrhea and pneumonia.
  • Pledging opportunities for elements of diarrhea control are on the horizon through Gavi, the Vaccine Alliance and the Nutrition for Growth Summit.
  • Support evidence-based plans for diarrheal disease control, within the context of child health. One example is the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), developed by UNICEF and the World Health Organization (WHO).

• If you are a multilateral leader (especially at WHO and UNICEF), you can:

  Champion best practices and global guidance for a multifaceted approach to diarrhea. You provide technical assistance to donors and national governments to implement evidence-based tools, such as those outlined in the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. Harness the strength of regional and national program staff to work with member countries on effective implementation of global and national strategies for diarrhea treatment and prevention.

  Work with donors to allocate and track funding that promotes global best practices and recommendations. Improve the tracking of multi-sectoral investments to better understand return on investment and enable stronger accountability.

  Provide guidance to national and subnational governments to ensure interventions focus on high-impact solutions. Serve as an advocate for regular national policy updates to ensure harmonization with global best practices and recommendations.

  Procure high-quality commodities and tools to improve access and accountability to proven treatment solutions and vaccines. Ensure efficient prequalification of relevant, high-quality, effective interventions—especially those manufactured locally—to lower costs and ensure WHO-approved commodities are available to all children. Ensure procurement decisions are in lockstep with technical guidelines.

  Examples and opportunities:

  • WHO and UNICEF set the gold standard and roadmap for integration by launching the GAPPD.
  • Following a 2019 World Health Assembly resolution, WHO and UNICEF have established a global network to exchange latest evidence and tools on WASH in health care facilities.
  • In July 2019, the World Health Organization added co-packaged oral rehydration solution (ORS) and zinc to its Model List of Essential Medicines (EML), as well as to the EML for children’s medicines (EMLc). UNICEF must now ensure adequate supply of co-packaged ORS and zinc.

• If you are a national or subnational government decision-maker, you can:

  Adapt normative global standards that address diarrheal disease to your local policy and programmatic needs. Use the GAPPD and IMCI to determine what specific plans, investments, and partners can be tailored to the national and subnational level to achieve the greatest health impact. Ensure your national list of essential medicines for children includes co-packaged oral rehydration solution and zinc to reflect the updated global standard from WHO and UNICEF.

  Prioritize the fight against diarrhea in child health policies and in increased domestic and partner resource mobilization. Prioritizing more domestic funding demonstrates greater commitment to improving child health. Ensure that diarrheal disease solutions are included in Global Financing Facility Country Investment Case frameworks (especially WASH, which is often lacking in GFF applications), as well as other funding mechanisms.

  Encourage and incentivize cross-sectoral action and collaboration to bring integrated solutions to all communities. All too often, WASH, health programs, and departments are segmented into silos—creating barriers to reaching a common goal of addressing diarrheal disease. Creating linkages can help to promote a comprehensive protect, prevent, and treat approach.

  Invest in primary health care to mitigate the toll of diarrhea and other common childhood illnesses on families and children. Investments in primary health care can stem the long-term consequences of diarrhea. When parents and caregivers can access preventive healthcare and treatment from a stable primary health system, their children suffer less diarrheal disease and grow to their potential.

  Examples and opportunities:

  • In Vietnam, health officials worked with policy advocates and program experts to revise national guidelines that could impact diarrheal disease programs on the ground.
  • Kenya, Zambia, Senegal, Ghana, Uganda, and Vietnam have co-packaged ORS and zinc on their national Essential Medicines Lists. Countries interested in updating their lists can find resources here.
  • The Government of Madagascar adopted a joint approach to include nutrition-sensitive interventions, such as food and hand hygiene, to its nutrition strategy to help address stunting.
  • The Government of Uganda carries out twice-annual Integrated Child Health Days, which increase access to a package of child health interventions, including immunizations and basic medicines.
  • Thanks to strong national investments, Uganda and Nigeria stood out as exceptions to overall decrease in routine immunization coverage during the height of the COVID-19 pandemic, and in August 2022, Nigeria’s introduction of rotavirus vaccine marked a new chapter for the nation’s children.
  • The PATH Kenya Early Childhood Development (ECD) project integrates nutrition and works at the sub-county with the Governor and his wife as one of the key champions of ECD.