BANGALORE, India -- Each year about 800,000 Indian children age 5 and younger die from dehydration and diarrhea, many during the summer months when wells dry up and water quality plunges.
A U.S.-backed program to market a life-saving remedy could be the answer, but it is threatened by sanctions imposed on India for conducting nuclear tests last month. Officials for the U.S. Agency for International Development hope the program will be spared under a clause that exempts humanitarian aid from sanctions.
Diarrhea is one of the major causes of mortality among children in developing countries. More than 12,000 die each day from related diseases, according to the World Health Organization. The most common culprit is drinking water, which poor families often get from ponds or lakes that are used for bathing, laundry, washing pots and watering livestock.
Dr. Jon Rohde, a former UNICEF chief in India and an expert on child health, says the problem is worse than a Bhopal tragedy everyday. A toxic gas leak in 1984 at a Union Carbide facility in Bhopal killed at least 2,000 people. Despite these numbers, dehydration and diarrhea among Indian children is not a top priority, says Dr. Rohde.
"No one talks about diarrhea, and it is accorded no importance," he says.
India figured out how to beat dehydration caused by diarrhea about 25 years ago. The remedy, a powder called oral rehydration salts, or ORS, was hailed as a medical breakthrough. It is easy to prepare, effective and inexpensive. The water-soluble formula of sodium, potassium, glucose and chloride has saved millions of children worldwide.
But for cultural and marketing reasons, neither the government nor private industry has succeeded in getting Indian parents to use the salts. U.S. health experts hope T. T. Jagannathan, a no-nonsense southern Indian entrepreneur, can overcome the hurdles.
As head of the diversified TTK Group, the Cornell University-educated Jagannathan, 50, has proved he can crack tough markets as well as turn profits from social causes. His "Manttra" is the biggest-selling brand of pressure cooker in the United States. In India, his kitchenware, shoe polish and herbal medicine are household names. He has turned the TTK condom factory into one of the world's largest producers and exporters of prophylactics.
USAID and the Industrial Credit and Investment Corporation of India, a leading financial institution, teamed up to persuade Jagannathan to use his marketing smarts to make oral rehydration salts a profitable business.
"We convinced him that there is a business opportunity here," says Lucia Ferraz-Tabor, an adviser to the project. "The potential market is huge."
After poring over market surveys for 18 months, Jagannathan accepted the challenge. The strategy is to jump-start new demand for ORS by selling the powder under his brand name, Woodward's. The name is popularly known for "gripe water," a mild medicine for indigestion that Indian mothers have given their children for three generations. The syrup is the best-selling product of TTK's pharmaceutical unit.
Fewer than a third of Indian mothers use ORS. Jagannathan says he will not be satisfied until powder packs become as common a treatment as aspirin is for headaches.
"I'm going after this project until oral rehydration salts are established," he says.
To catapult him into the market, USAID has committed to lending Jagannathan $1 million to $2 million for mass marketing. Though that assistance is in jeopardy because of U.S. sanctions, Jagannathan is going ahead with his plans.
The ORS project is part of a USAID program to involve private business in the production and marketing of child-survival and reproductive-health products and services in India. The agency provides technical and financial support to businesses willing to participate.
"We want ORS to be business-driven, or it won't succeed in India," says Ferraz. "It's useless being a token product. It has to make money."
About 40 pharmaceutical companies produce ORS in India, but none considers it a priority. Small drug makers don't have the resources or the marketing expertise. For drug giants such as Searle India Ltd. and E. Merck (India) Ltd., "ORS is a footnote to their business," says Ferraz, the USAID adviser.
Promoting ORS has been left almost exclusively to the government, which buys the product in bulk and gives it away at health centers. The government has wide market reach, but it also has a credibility problem. No matter how poor Indians are, many disdain handouts, especially from the government.
"Anything we get free we regard as worthless," notes Jagdish Sobti, a prominent New Delhi pediatrician who has campaigned for ORS usage.
This attitude has also weakened the government-sponsored AIDS-prevention program, which distributes free condoms. Indians generally do not have faith in the products, though the quality is the same as those sold at pharmacies, social marketers say.
In rural areas, where three out of every four Indians live, the rehydration powder has suffered from other cultural barriers. When mothers take their children to a medical practitioner, who may not be a doctor, they demand antibiotics. Because the rural medical practitioners can make more money selling antibiotics, they often do not push ORS.
The powder is useful for all cases of diarrhea, regardless of the cause. It replenishes lost fluids and prevents dehydration. Certain antibiotics help only a minority of cases.
On average, treating a single case of child diarrhea can cost a family 31 percent of its monthly income. Often, parents of sick children borrow money from relatives and neighbors to pay for doctors' fees, drugs and hospitalization. Yet the rehydration powder costs less than a penny a serving in India, where annual per capita income is $350.
Jagannathan is optimistic that he can overcome these barriers and succeed. "We're going to make the consumer buy it," he says. "That's what we are good at."
His company is launching Woodward's ORS in the Indian states of Andhra Pradesh, Maharashtra and Tamil Nadu. He is also sending salesmen into the field, planning to sponsor radio and television talk shows with doctors, and considering spreading the word in villages through vans that show short videos.
With an initial investment of $1 million, he expects to break even in three years. By then he hopes Woodward's rehydration salts will be sold in at least 100,000 pharmacies and groceries across India.
"We'll be in the business to make money, but sell products that benefit India," he says.
Pub Date: 6/16/98