All posts by Simon Berry

ORSZCA UPDATE: 9-Nov-2023

Welcome to the ORSZCA UPDATE for November 2023

In this update we are focussing on our current four calls for action. These are always at the top of the home page of our website. Currently, they are:

1. WHO and UNICEF – encourage and support a joint policy brief by WHO and UNICEF on the new ORS/Zinc co-packaging recommendation >>more

2. UNICEF Co-pack pricing >>more

3. ORS/Zinc Status around the World >>more

4. DHS/USAID – engage with the next review of the DHS Questionnaires to incorporate questions around co-packaging >>more

1. WHO and UNICEF – encourage and support a joint policy briefing by WHO and UNICEF on the new ORS/Zinc co-packaging recommendation

A joint statement was being considered following the introduction of the co-packaging recommendation in the 2019 edition of the WHO Essential Medicines List. However, the COVID-19 pandemic meant it stalled.

ORSZCA was able to convene a meeting with WHO and UNICEF on 22-Feb-2023. Yasir Bin Nisar (WHO) represented both WHO and UNICEF. Anne Detjen (UNICEF) couldn’t make the meeting but had met with Yasir the week before. They had agreed that a “Joint Policy Brief” would be the most appropriate instrument. The objective of such a policy brief, which would go to all WHO and UNICEF Country Offices, would be to raise awareness of the new co-packaging recommendation in the expectation that this would help with the institutionalisation of co-packaging at the country level.

Following the meeting ORSZCA produced the following resources:

  1. A first draft outline for a policy briefing – this is open for comments here.
  2. A Position Paper on: Defining an ORS/Zinc ‘co-pack’ which is available in the ORSZCA Resources Library here: orszco-pack.org/resources/#copackdesign – again, comments on this are welcome. This was requested by WHO at the meeting.
  3. A summary of the meeting and key action points.

Unfortunately, our progress has hit a roadblock as our senior contacts at WHO and UNICEF have become unresponsive due to their busy schedules. Given the urgency of our cause and the impact this simple action could have on the lives of children, we plan to escalate this issue as soon as a new Head of Health is in place at UNICEF.

2. UNICEF Co-pack pricing

In the UNICEF Catalogue, the indicative price of a co-pack containing 1 L sachets of ORS and a blister pack of 10 zinc tablets is more than twice the price of its component parts. This goes against the general market trend. You can see the calculations here: ORS/Zinc product prices in the UNICEF Catalogue (Sep-2023 tab).

ORSZCA members first raised this issue with the then director of UNICEF Supply Division Director (Etleva Kadilli) in January 2022 and were referred to the re-tendering process for ORS/Zinc products that was about to get underway. This process has now finished and the catalogue prices remain virtually unchanged.

The ORSZCA Secretariat (Simon Berry) met with the Chief of the Nutrition & Medicines Unit (Francisco Blanco) and Cynthia Kamtengeni on 25-Oct-23. UNICEF are very reluctant to change the algorithm they use to calculate indicative pricing as this would mean changing it across the whole catalogue. Our concern is that the indicative pricing of co-packs in the UNICEF Catalogue is a barrier to the uptake of co-packaging and we will continue to push for the algorithm to be changed. In the meantime, FB agreed to look into the possibility of adding a note to the indicative pricing of co-packs in the UNICEF Catalogue. We agreed on the following action points and these include a follow-up meeting in Jan-2024:

ORSZCA to share improved understanding from this meeting with ORSZCA members.
ORSZCA to share ORSZCA’s current pricing information with FB.
ORSZCA to look into becoming a source of pricing information – fulfilling a similar role to the MSF Price guide (but just for ORS/Zinc).
FB to investigate putting up an explanatory note against the co-pack indicative price in the UNICEF Catalogue.
FB to look into possibility of analysing tenders received from manufactures to improve knowledge of the current price differentials between co-packs and separates, and get an idea of the number of manufacturers who tendered who produce their own ORS and Zinc (as opposed to those who have to source one or other of the components externally).
FB, CK and SB to meet again in 3 months time (Jan-2024) to review progress.

3. ORS/Zinc Status around the World

We are still keen to receive completed questionnaires (in English or French) on the ORS/Zinc status in your country – this is especially true if you have knowledge of the situation in Niger and Chad. We’ve had no completed questionnaires from these two countries. We’ve been adding to the information contained in the questionnaires through our own research and conversations with members. For example, we’ve been able to locate and link to many of the national Essential Medicines Lists from our unique snapshot of the status of ORS and Zinc around the world.

4. DHS/USAID – engage with the next review of the DHS Questionnaires to incorporate questions around co-packaging

ORSZCA wishes to institutionalise the monitoring of the uptake of the ORS/Zinc co-packaging recommendation. One way of doing this would be to update the appropriate DHS template questionnaire. ORSZCA is seeking to engage with the next DHS review process which was due to start in Sep-2023. We now believe this will take place in Mar-2024. We now wish to gather a group of ORSZCA members around this issue with the aim of suggesting a change to DHS Woman’s questionnaire (Question 615) that would capture the extent to which co-packaged ORS and zinc is being used. If you can help by joining this group, please reply to this email.

As always, please let us have any comments you may have on this UPDATE by replying to this email.

Thank you.

Morseda and Samy
ORSZCA Co-chairs

Dr Morseda Chowdhury
Director of Health, Nutrition and Population Programme
BRAC, Bangladesh

Samy Ahmar
Head of Health
Save the Children, UK

 

 

 

ORSZCA congratulates Swiss Pharma Nigeria and PharmEvo (Pakistan)

Logos Swiss Pharma Nigeria and PharmEvo

ORSZCA congratulates Swiss Pharma Nigeria and PharmEvo (Pakistan) on achieving WHO prequalification (PQ) status for 20mg dispersible Zinc Sulphate tablets. Swiss Pharma Nigeria is the first African manufacturer to achieve PQ for Zinc tablets. While PharmEvo is the first manufacturer in the world achieve PQ status for a Zinc syrup.

What does prequalification mean?

Prequalification signals confidence in the quality of medicines manufactured and makes them eligible, in principle, for procurement by UN agencies and donor organisations.

How many prequalified products are there for the treatment of diarrhoea?

The short answer is not enough. There are no prequalified ORS products and only six Zinc products (seven if you include Zinc Syrup).

Zinc sulphate dispersible tablets 20mg

WHO Ref No Applicant Country Date of Prequalification
1 DI002 Nutriset France 04-Dec-12
2 DI005 Macleods Pharmaceuticals Ltd India 07-Dec-16
3 DI011 Ipca Laboratories Ltd India 15-May-20
4 DI013 The ACME Laboratories Ltd Bangladesh 02-Nov-21
5 DI014 Swiss Pharma Nigeria Ltd. Nigeria 02-May-23
6 DI009 PharmEvo (Pvt) Ltd. Pakistan 12-Jul-23

Zinc sulphate syrup 10mg/5mL

WHO Ref No Applicant Country Date of Prequalification
7 DI010 PharmEvo (Pvt) Ltd Pakistan 12-Jul-23

How do UN Agencies and donor organisations procure Co-packaged ORS and Zinc if there are no prequalified ORS products?

It would appear that they rely on certificates of Good Manufacturing Practice (GMP). However, quality is a concern. In UNICEF’s  Oral Rehydration Salts and Zinc: Market and Supply Update of September 2022 they stated as a challenge:

Due to the limited number of quality suppliers of ORS and ORS and zinc co-packaged products, there are even fewer that can meet the quality standards required for international procurement. Some of the suppliers that UNICEF had awarded supply agreements to as an outcome of its last tender were cancelled as they were not able to maintain product quality standards throughout their LTA [Long Term Agreement] duration. As ORS is an over-the-counter medication and is marketed socially in many countries, supplying demand through UNICEF does not offer sufficient incentive to improve manufacturing and product quality to meet international procurement standards.

 

 

 

UNIQUE OPPORTUNITY: Would you like to be supported to set up a new NGO to improve access to co-packaged ORS and Zinc?

Charity Entrepreneurship Logo
Charity Entrepreneurship is a very interesting organisation. It seeks to have a big impact by researching and selecting ideas that, if successfully implemented, would have a huge positive impact on society. They then select and support individuals to set up new non-profit organisations to make these ideas happen. Successful applicants are given the in-depth research already undertaken, and are supported with intensive training and start-up funding of up to $200,000.

They have just launched the current set of five ideas and one is: Distributing life-saving Oral Rehydration Solution and zinc co-packages to treat life-threatening diarrhea in under five year olds.

You can read about the overall programme here: Background on the incubation program

And you can find out more about the current opportunities here: Announcing our 2023 Charity Ideas. Apply now!

The deadline for applications is 12-Mar-2023.

If you’d like to talk to someone at Charity Entrepreneurship before applying, please contact Ula Zarosa <ula@charityentrepreneurship.com>

This is an amazing opportunity for someone to catalyse a huge impact.

 

 

 

ORSZCA UPDATE: 20-Dec-2022

Subject: ORSZCA UPDATE: Global Fund to support improved ORS/Zinc access
Subheading: Global Fund gets more holistic

Welcome to the ORSZCA UPDATE for Dec 2022

GLOBAL ORS/ZINC STATUS

We continue to update and share our resource on the ORS and Zinc status around the world – orszco-pack.org/orsz-status. You can help by adding to the resource either by commenting on the ORSZCA website or by completing a questionnaire in English or French.

THE GLOBAL FUND WILL FINANCE ORS AND ZINC IN THE NEXT FUNDING ROUND

ORSZCA welcomes a major new policy shift by The Global Fund, to provide co-financing to eligible countries for the provision of ORS and Zinc to children under five years, as part of their support for Integrated Community Case Management (iCCM) programmes. 

A highly informative webinar, run by the Child Health Task Force on 7-Dec-22 can be reviewed here: THE GLOBAL FUND WILL FINANCE ORSZ FOR UNDER-5 DIARRHOEA IN ELIGIBLE ICCM PROGRAMMES (English only). This is an excellent document with detailed advice and methods on how one might make the case for diarrhoea treatment with ORS and Zinc. It also contains background for those new to The Global Fund and links to the key materials.

If you’d like to listen to the webinar again the recording is here: https://www.childhealthtaskforce.org/events/2022/12/information-session-new-opportunities-improving-funding-iccm-through-global-fund

The recording includes interpretations in different languages.

So, what are the key messages and next steps for those advocating for improved access to co-packaged ORS and Zinc?

  • Until now, The Global Fund has focussed on HIV/AIDS, Malaria and TB. As the Fund expands to support Community Health Worker (CHW) distribution of a wider range of essential medicines for children, we need a proactive effort to make sure ORS and Zinc are included in bids, and specifically in co-pack form. This will require the active engagement of new advocates in LMIC, outside the specialisations of HIV/AIDS, Malaria and TB, who may not have previous experience of The Global Fund.
  • You are encouraged to contact the Country Coordinating Mechanism (CCM) in your country to see how to engage and participate. You would do this through the CCM administrative contact. As well as an administrative contact, there is normally a CCM Chair and Vice Chair. The full CCM details for all countries can be found here: https://data-service.theglobalfund.org/viewer/cm_contacts
    As a quick reference, the current CCM Administrators for the Anglophone countries in the  top 10 high burden childhood diarrhoea countries are

ETHIOPIA
Mr. Abayneh  ADMAS
abayneha74@gmail.com
Mr Dagim  MENGISTU
martadagim@gmail.com 

INDIA
Ms Gitanjali  MOHANTY
India CCM Coordinator
iccmsect-mohfw@gov.in
Ms Sandhya  GUPTA
India CCM Coordinator
dr.sandhyagupta@live.com
Dr Shobini  RAJAN
shobini@naco.gov.in

NIGERIA
Mrs Ishioma  JOHN
Finance and Admin. Officer
isiskie@gmail.com

PAKISTAN
Mr Hafiz Hammad  MURTAZA
CCM Coordinator
hamad@ccmpakistan.org.pk 

SOMALIA
Mr Ahmed  HASSAN
Secretariat Coordinator
assistant@gfscs.org

Some of the key features of the 2023-2025 Global Fund Strategy are:

  • The Global Fund Strategy has CHWs and iCCM at its heart. It will support the provision of ORS and Zinc at the community level. It will NOT support the management of diarrhoea cases in health facilities.  For this reason, co-packaging has huge potential to improve the likelihood that children receive both ORS and Zinc when treated in the home, helping to underpin  the ‘rational use’ requirements of successful bids. 
  • The focus is on children under five years of age.
  • Co-financing is needed.
  • Funding is not just for provision of medicine: applicants will have to identify gaps in their CHW expansion plans, to include Human Resources for Health (HRH) planning and recruitment, training, remuneration etc. Note that HRH may sometimes be abbreviated as HHR (Health Human Resources).
  • Financing is part of The Global Fund’s Resilient and Sustainable Systems for Health (RSSH) grants: successful applications will need strong Health Management Information Systems (HMIS), access to data and alignment with national health strategies.

Key resources:

Please let us know about your experience engaging with this new opportunity, especially in areas where ORSZCA might be able to support.

Thank you.

Morseda and Samy
ORSZCA Co-chairs

Dr Morseda Chowdhury
Director of Health, Nutrition and Population Programme
BRAC, Bangladesh

Samy Ahmar
Head of Health
Save the Children, UK

ORSZCA UPDATE: 14-Nov-2022

Subject: ORSZCA UPDATE: Global ORS/Zinc Status, Child Health Spotlights, DHS, Website now in French

Welcome to the ORSZCA UPDATE

GLOBAL ORS/ZINC STATUS

We continue to update and share our resource on the ORS and Zinc status around the world – orszco-pack.org/orsz-status. You can help by adding to the resource either by commenting on the ORSZCA website or by completing a questionnaire in English or French.

CHILD HEALTH SPOTLIGHTS – UNICEF & SAVE THE CHILDREN

UNICEF and Save the Children have collaborated to share 15 “high-burden” country profiles focussed on pneumonia and diarrhoea and in particular how to protect, prevent and diagnose and treat these two diseases – see childhealthspotlights.org. Our concern is that the resource makes no mention of ORS or Zinc for the treatment of diarrhoea. We are in communication with those behind the site in an attempt to get this corrected. This is particularly important as the site is designed to “help inform policy and decision-making at national and global levels”. We have also suggested that profiles are added for Cameroon and Madagascar which are both in the top 10 high-burden diarrhoea countries.

DHS QUESTION ON CO-PACKAGED ORS AND ZINC

As a network focussed on accelerating the uptake of co-packaged ORS and Zinc, we are interested in how we monitor the uptake of this 2019 WHO recommendation. With this in mind, we have been in contact with ICF, which has implemented the USAID-supported Demographic and Health Surveys (DHS) Program since 1984, with a view to modifying the questions within the DHS that relate to diarrhoea treatment to gather information on co-pack usage. The DHS questionnaires are reviewed every five years and the next opportunity to engage in this process will be in the last quarter of 2023. Between now and then we will be consulting with the ORSZCA network on how the DHS questionnaire might be usefully modified to collect this data. If you can contribute to this effort please email simon.berry@orszco-pack.org.

ORS/ZINC CO-PACK MANUFACTURERS

We have updated our information on ORS/Zinc Co-pack manufacturers around the world but would like your input in ensuring the list is as complete and correct as possible. Please add any amendments or additions by commenting on our manufacturers page here: ORS/ZINC CO-PACK MANUFACTURERS. Your comments will not be published directly on the website but will be used by our website editor to update the page.

ENGAGING WITH FRANCOPHONE AFRICA ON CO-PACKAGING

Of the top 10 countries with the highest -burdens of diarrhoea, five are Francophone: Cameroon (8th), Chad (5th), DRC (7th), Madagascar (9th) and Niger (6th). However, engagement with ORSZCA from these countries is very low. As part of a strategy to improve this we have now launched a French version of the ORSZCA website. We have also split our mailing list and in future we will be issuing different versions of this ORSZCA UPDATE for English and French speaking members. If you would like to receive the French version of the ORSZCA UPDATE in future please email simon.berry@orszco-pack.org. If you have contacts in Francophone countries you might benefit from the ORSZCA UPDATE please direct them here: INSCRIVEZ-VOUS ICI

Thank you.

Morseda and Samy
ORSZCA Co-chairs

Dr Morseda Chowdhury
Director of Health, Nutrition and Population Programme
BRAC, Bangladesh

Samy Ahmar
Head of Health
Save the Children, UK

ORSZCA UPDATE: 8-Aug-2022

ENABLERS & BARRIERS TO ORS/ZINC COVERAGE – RESOURCES AVAILABLE

Welcome to the August ORSZCA UPDATE

As announced in our June update, on 15-Jul-22, thirty two experts gathered to share their views on the Enablers & Barriers to increased ORS and Zinc coverage. These included two co-pack manufacturers (Nigeria and Zambia), those with experience delivering ORS/Zinc programmes and academics who had evaluated such activities. These Enablers & Barriers were captured in our Enablers & Barriers table which is still open for additional views and comments here. The columns in this table are based on the framework suggested in the review: Progress over a Decade of Zinc and ORS Scale-up (Feb-2016) – Diarrhoea & Pneumonia Working Group.

We also recorded the key contributions made during the event here. This document is also open for comments.

We will now be encouraging follow-up conversations to dig deeper into some of the key issues.

A resource offered by USAID during the roundtable was the slidedeck from the Dec-2020 USAID Partners meeting: Building on over a decade of progress in ORS/Zinc. This can be downloaded from the ORSZCA website here.

THINGS TO LOOK OUT FOR

We continue to update and share our resource on the ORS and Zinc status around the world – orszco-pack.org/orsz-status – you can help by adding to the resource either by commenting on the ORSZCA website or by completing a questionnaire in English or French.

Thank you.

Dr Morseda Chowdhury and Samy Ahmar
ORSZCA Co-chairs
BRAC, Bangladesh and Save the Children, UK 

 

 

 

 

ORSZCA UPDATE: 29-Jun-22

Welcome to the June ORSZCA UPDATE with opportunities to contribute and help.

ROUNDTABLE ON ENABLERS & BARRIERS TO ORS/ZINC COVERAGE – CAN YOU CONTRIBUTE?
We are organising an invitation-only roundtable to improve our understanding of the enablers and barriers to increasing ORS/Zinc coverage particularly in the top 10 high burden countries. We have invited all the people we know with experience implementing or evaluating ORS/Zinc programmes to participate. If you’ve not received an invitation and are able to participate, please email simon.berry@orszco-pack.org for an invitation. The key output will be the completion of this table of enablers and barriers.
The 90-minute roundtable will take place on 15 July 2022 from 10:00am to 11:30am (EST).

ORS/ZINC STATUS AROUND THE WORLD – EXTRA HELP NEEDED
Thanks to all those who responded to our Call to Action in the last ORSZCA UPDATE and completed our an online questionnaire (en Français) to gather information on the ORS/Zinc status around the world. We now have a unique public resource developing here: ORS/Zinc status from around the world. However, we do need a bit more help to obtain questionnaires from Cameroon, Chad, Madagascar and Niger. If you are from one of these countries, or have appropriate contacts, please complete a questionnaire on the link above. The questionnaire will take less than 10 minutes to complete and is designed to quickly collect the information you have at your fingertips.

THINGS TO LOOK OUT FOR
We will be sharing the outcome of the above enablers and barriers to ORS/Zinc coverage roundtable before the end of July for you to use to help support child health strategy development (local and international), funding bids, research plans, local proposals for action and so on.
We are also sharing back information harvested for the ORS/Zinc status questionnaires as they come in here: orszco-pack.org/orsz-status

Thanks again for your support.

Dr Morseda Chowdhury and Samy Ahmar
ORSZCA Co-chairs
BRAC, Bangladesh and Save the Children, UK

Call for assistance: What is the ORS/Zinc status in your country?

ORS:Zinc status Screenshots graphic
We are slowly building a unique and valuable dataset on the status of ORS and Zinc around the world to raise awareness and generate interest in co-packaged ORS and Zinc. If you have 10 minutes to spare and are familiar with the status of ORS and/or Zinc in a particular country (or countries) please help us by completing a questionnaire on this in English or French. You do not have to know the answer to every question; our aim is to quickly gather insights from the information you have at your fingertips and between us we will build a complete picture.

This dataset seeks to answer the most frequently asked question, that no one can answer, which is “What is the current status of ORS and Zinc across LMICs?”:

  • Which countries are using ORS/Zinc co-packs?
  • Where does Zinc have “over the counter” status?
  • Which countries have co-packaged ORS/Zinc on their Essential Medicines List?
  • Co-pack brands, pricing and so on

Please head over the English questionnaire or the French one now or pass this to a friend.

Thanks.

 

 

 

ORSZCA UPDATE: 4-Mar-22

Faites défiler vers le bas pour lire et remplir le questionnaire en français

CALL TO ACTION

With the launch of ORSZCA complete, we have moved on to the ORSZCA work plan. In our discussions so far with UNICEF, would-be donors and partners, the most frequently asked question, that no one can answer, is “What is the current status of ORS and Zinc across LMICs?”:

  • Where does Zinc have “over the counter” status?
  • Which countries are using ORS/Zinc co-packs?
  • Which countries have co-packaged ORS/Zinc on their Essential Medicines List?
  • Co-pack pricing, availability, and so on

Working together, we, the ORSZCA Network, can bring this information together for everyone to see and enable strategic planning to help ensure that the new WHO co-packaging recommendation is implemented on the front line, and save hundreds of thousands of lives.

To enable this, we have developed and piloted an online questionnaire (in French and English) to gather this information from each country. It takes less than 10 minutes to complete. You do not have to know the answer to every question; our aim is to quickly gather insights from the information you have at your fingertips. We hope to receive multiple questionnaires from each country.

Please click on the link below to submit the information for your country:

The information contained in submitted questionnaires will be anonymised and published as country summaries on the ORSZCA website here: orszco-pack.org/orsz-status

ORSZCA LAUNCH
The launch on 19-Jan-22 was a great success and once again we wish to thank the Child Health Task Force for hosting the event. More than 200 people registered for the event and around 75 people attended. All 200 registrants were sent a link to a recording of the launch. The launch was rich in content with six international speakers and panellists. This content has been curated here: orszco-pack.org/launch – with key points and transcripts in both French and English.

We look forward to receiving your questionnaires and sharing the information back to you.

Dr Morseda Chowdhury and Samy Ahmar
ORSZCA Co-chairs
BRAC, Bangladesh and Save the Children, UK

Please register to join the ORSZCA Launch – 19-Jan-22

Launch of the ORS/Zinc Co-pack Alliance (ORSZCA)

Date: Wednesday, 19 January, 2022
Time: 9am – 10:30am EST [GMT-5]
Zoom: Register here


Photo credit: Kate Holt/MCSP, Nondwe Iganga, Uganda

Please register to join a webinar to launch the ORS/Zinc Co-pack Alliance. We are grateful to the Child Health Task Force for hosting our launch. ORSZCA brings together organisations and individuals to identify and remove barriers to co-packaging to accelerate uptake and save lives. The Child Health Task Force will collaborate closely with ORSZCA towards the common goal of strengthened equitable and comprehensive child health programs. Join the event to hear from a distinguished panel of experts on this topic, meet the ORSZCA leadership, and become a part of this global collaborative effort.
Register here.

Speakers & Panelists

Dr. Alison Morgan
Senior Health Specialist
MNCH
Global Financing Facility
Audrey Battu
Director
Essential Medicines
Clinton Health Access Initiative
Malia Boggs
Senior Technical Advisor
Child Health
USAID
Dr. Om Prakash Singh
Head of Health and Nutrition
Save the Children India
Dr. Robert Black
Professor
Global Disease Epidemiology and Control, Johns Hopkins University
Dr. Tahmeed Ahmed
Executive Director, icddr,b

Moderators

    • Dr. Morseda Chowdhury, Director, Health, Nutrition and Population Programme, BRAC Bangladesh, ORSZCA Co-chair
    • Samy Ahmar, Head of Health, Save the Children UK, ORSZCA Co-chair
    • Dyness Kasungami, Director, Child Health Task Force, Senior Child Health Advisor, JSI Research & Training
    • Simon Berry, ORSZCA Start-up Catalyst, ColaLife

Please register using the link below in order to access the meeting connection information and add the webinar to your personal calendar.

REGISTER HERE