This research set out to improve the uptake of ORS, by improving rural medical practitioners (RMPs) access to ORS and providing them with the best treatment practices of diarrheal cases. A state-wide program that directed detailing of ORS to RMPs was initiated and scaled, yet after three years of investments, the level of ORS usage among children did not improve. As such, the Surgo Foundations\' objective was to identify the barriers to ORS update and identify strategies to improve it.
A mixed-methods approach, combining quantitative with innovative behavioural science methods, was used. This consisted of a three-phases. 1) Insight were analysed and integrated across several surveys including a state-wide large scale quantitative survey and a survey map of the ORS treatment cascade. This included several variables such as patients and outcomes and the use of, and effectiveness of ORS. 2) Context mapping and a behavioural deconstruction was undertaken to qualitatively capture broader views of RMPs and the perspectives of key influencers, decision-makers and their lives, motivations and treatment decisions. This included semi-structured ethnographic research, enabling the formation of several hypotheses. 3) A customised decision-making game was used to identify and test the RMPs decision drivers. The qualitative results were reviews were assessed by independent researchers.
Each phase of the research had its own specific outcomes for different key influencers, but the overall results led to a revised theory of change, which addressed multiple layers of the system, driven by behaviour, and focused on the caregivers. New strategies were developed to bridge the knowledge gap and improve the usage of ORS among caregivers. The new changes also led to cost-saving measures and an overall increase in the uptake of ORS from 30% to 50% in less than two years.