Reflection activity

Using the case study outlined below, consider what were the main barriers and facilitators to uptake of the evidence that zinc was an effective treatment for diarrhoea in children. It will help if you identify the essential stakeholders who were involved in the productive dialogue leading to policy change, and why they might resist/accept such a new body of evidence.

An example of implementation research supporting KT from Bangladesh

The scale up of zinc use for childhood diarrhoea in Bangladesh illustrates the use of KT strategies in encouraging the uptake of implementation research by policy-makers. Systematic reviews of the research literature and on a joint UNICEF/WHO recommendation established that zinc provides a very effective treatment for diarrhoea among children under the age of five, by reducing the severity and duration of diarrhoea as well as the likelihood of future episodes of diarrhoea and the need for hospitalization. It was estimated that zinc treatment could save the lives of 30,000 to 75,000 children per year in Bangladesh alone.

As a first step towards implementing this promising intervention two committees were established: A National Advisory Committee, headed by the Health Secretary, and a Planning and Implementation Committee, headed by the Joint Secretary, Public Health and WHO. These committees acted as platforms for collaboration between policy-makers and researchers, facilitating the sharing of tacit knowledge and policy positions and the setting of common priorities and goals.

Based on available evidence, the National Advisory Committee approved the policy on using zinc in addition to oral rehydration solution (ORS) for under-five children suffering from diarrhoea and incorporated zinc into a revised National Diarrhoea Treatment Guideline. Research also guided the development of the product, a dispersible zinc tablet, as well as its pricing, leading to the following national evidence-based policy changes being approved: