All posts by Simon Berry

ORSZCA Update: 14-Dec-21

Welcome to the latest *pre-launch* ORSZCA Update. 

UNICEF responds on co-pack prices and invites ORSZCA to join pre-tender consultation
In our last update we explained that discussions with UNICEF on co-pack pricing had stalled. We asked ORSZCA members to consider writing to the Director of UNICEF Supply Division to express concern about the fact that, in the UNICEF catalogue, an ORS/Zinc co-pack is more than twice the price of its component parts.

We’d like to thank all those who used our template letter to help re-start discussions. This approach worked. We received replies from the Director, Ms Etleva Kadilli, and the Chief of the Medicines and Nutrition Centre, Dr Akthem Fourati. These responses explained why the 2020 re-tendering for ORS/Zinc products did not happen – COVID – another example of the way COVID has disrupted health services for children. However, both UNICEF respondents reassured us that they were finalising tender preparations for ORS/Zinc products for issuance early in Quarter 1 of 2022 and have asked the ORSZCA team to be part of our pre-tender consultations with key partners. This is good news.

Various reasons were given as to why the current catalogue co-pack prices (from 2015) are more expensive than their component parts but we believe that these reasons should not apply in 2022. In their response, the ORSZCA Co-chairs welcomed the imminent re-tendering but stated:

…we wish to reiterate our utmost concerns that, going forward, […], attention should be paid to whether ORS/Zinc co-packs appear to be more expensive than the sum of their parts. This would be an active disincentive to the purchase of co-packs and this has a real, concrete impact on child morbidity and survival.

This is the second example of how, by acting together, ORSZCA can remove barriers to the uptake of the 2019 WHO ORS/Zinc co-packaging recommendation. In October this year the GFF changed the publicity around their ‘Reclaim the Gains’ initiative from “oral rehydration treatment” to “oral rehydration solution and zinc treatment”. This will affect how 458 million additional diarrhoea treatments are delivered between now and 2025.

Latest on the ORSZCA launch
Preparations are advancing for the ORSZCA Launch on 19-Jan-22 at 9am EST. This will take the form of an interactive webinar. So far, we have confirmed contributions from Prof Dr Robert Black (Johns Hopkins Bloomberg School of Public Health) and Dr OP Singh (Stop Diarrhoea Initiative/Save the Children India). We will send a full programme shortly, once all elements are confirmed, to all ORSZCA and Child Health Task Force members.In the meantime, please add the launch date to your calendar and forward this email to anyone you think might be interested:

Add the ORSZCA Launch webinar to your calendar:
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Once again, we thank the Child Health Task Force for hosting the launch.

Replies to this email are open; please get back to us with your comments.

Simon and Leith

Simon Berry and Leith Greenslade
ORSZCA Start-up catalysts




ORSZCA Update: 30-Nov-21

Welcome to the latest *pre-launch* ORSZCA Update.

We have two big announcements and one call to action.

1. ORSZCA Co-chairs confirmed
We are pleased to announce the ORSZCA Co-chairs. They are Dr Morseda Chowdhury, Director, Health, Nutrition and Population Programme, BRAC, Bangladesh and Samy Ahmar MSc, Head of Health, Save the Children, UK.

Dr Morseda Chowdhury, BRAC, Bangladesh
As Director of HNPP in BRAC, Dr. Morseda Chowdhury heads the largest non-governmental healthcare network in the world with ~50,000 community health workers (CHWs) serving a 110m population in Bangladesh. Currently, the program reaches around 10m people through CHWs with Essential Health Services (EHS) and Reproductive Healthcare which includes Orsaline and zinc packages for mothers, children and adolescent girls.
With nearly 20 years of work experience and PhD from Sydney School of Public Health, Dr. Morseda brings decades of experience in Public Health from practical project management to strategic research. Her specialty lies in reproductive healthcare, nutrition, communicable and non-communicable diseases through community-based healthcare at national scale.
As ORSCZA co-chair, she brings the insight of practical ground-level realities of a nation-wide program combined with academic research for advocacy with the Government.

Samy Ahmar, Save the Children, UK
Samy Ahmar is Head of Health at Save the Children UK, where he and his team oversee a global portfolio of maternal, newborn, and child health projects in 20 countries with a focus sub-Saharan Africa and South Asia. Samy has 14 years of experience in international development, global health and evidence-based programming. Recent work includes diarrhoea-control in India and Nigeria, adaptive MNCH programming in rural DRC, the development of evidence-based strategies for pneumonia control in nine countries and the development of global health partnerships with a private sector organisations. Samy’s blog page is here.

Leadership like this will ensure that co-packaged ORS and Zinc gets the attention it needs to trigger the step-change in the coverage of ORS and Zinc we are seeking.

2. ORSZCA launch date set
Our Co-chairs will introduce themselves at the ORSZCA Launch webinar which has been set for 19-Jan-22 at 9am EST. Please hold the date – add the event to your calendar using the links below. We thank the Child Health Task Force for their offer to host the launch and a formal invitation will be sent in due course with the details of the interactive agenda and speakers.

Add the ORSZCA Launch webinar to your calendar:
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3. Call to action: A letter to UNICEF on Co-pack pricing – template provided
We are pleased to have started a positive dialogue with UNICEF Supply Division on their co-pack pricing but this has stalled, so we are asking ORSZCA members to consider writing to the Director of UNICEF’s Supply Division, Ms Etleva Kadilli, to ask for her support on this issue. To help with this we have provided a template letter here.

And finally, replies to this email are open, please get back to us with your comments.


Simon and Leith

Simon Berry and Leith Greenslade
ORSZCA Start-up catalysts

ORSZCA Update: 26-Oct-21

ORSZCA updates sent by email

>> GFF, WHO, UNICEF and launch latest

Welcome to the latest *pre-launch* ORSZCA news. This is a summary of what ORSZCA and friends have achieved in recent weeks.

Global Financing Facility (GFF)

ORSZCA applauds the clarification made in mid-October by the GFF to their Reclaim the Gains campaign endorsing the importance of Zinc together with ORS in the treatment of childhood diarrhoea. Reclaim the Gains stands out as being the most significant current global initiative aimed at improving access to diarrhoea treatment. It is essential that such a significant effort is in line with the current WHO and UNICEF treatment recommendations.

Over the last three months ORSZCA has been engaged in a positive and productive dialogue with GFF which has resulted in their reference to an additional 458 million “oral rehydration treatments” being amended to “oral rehydration solution and zinc treatments”. This simple change could save hundreds of thousands more young lives. We thank ORSZCA members who sent letters to the GFF. They made a difference!
See the ORSZCA blog for more details.

WHO Virtual technical meeting on the prevention and management of childhood pneumonia and diarrhoea

Both ORSZCA start-up catalysts (Leith Greenslade and Simon Berry) were invited to this key three-day virtual event aimed at re-energising efforts to combat the two top infectious killers of young children. This was the first time this group had met since the addition of co-packaged ORS and Zinc to the WHO Essential Medicines List (EML) in 2019. Surprisingly, co-packaging was not mentioned in the diarrhoea paper circulated before the event. However, this was addressed very effectively during the meeting and featured in the summary feedback. We await the full report of this meeting.

UNICEF Supply Chain catalogue / Co-pack price

While developing the Data & Evidence section of the ORSZCA website, we included the evidence that the Diarrhoea Innovations Group (DIG) and partners presented in their application to WHO to modify the EML and one subsequent survey in Uganda (Lam et al 2019) on co-pack prices. All of these sources indicate that buying an ORS/Zinc co-pack is cheaper than buying the components separately.

We then checked the prices in the UNICEF Supply Chain catalogue only to find that a co-pack is more than twice as expensive than ORS and Zinc bought separately from the same catalogue. We immediately sought to engage UNICEF on this, and we are pleased to report that a conversation has started. We understand that these prices were last updated in 2015 – four years before the EML recommendation changed (in 2019) and at a time when co-packaging was seen as an innovation, not mainstream. Moving forward ORSZCA will be providing all the support we can to expedite an update to the UNICEF catalogue. We consider this to be an urgent task. We will be sharing a template letter to UNICEF with ORSZCA members next week and we will be encouraging you to share it and create your own version to send to the Director of UNICEF Supply Division.

Clearly, UNICEF customers are unlikely to implement the current WHO co-packaging recommendation if it will cost them more than twice as much to do so. The other concern is that the UNICEF pricing is used as a benchmark by donors, policy makers, and strategists and currently the UNICEF catalogue gives a very misleading picture of what is happening elsewhere in the market where co-packaging is the cheapest way to deliver both ORS and Zinc for diarrhoea treatment.

ORSZCA launch

In parallel with the urgent activities above, we have been planning the launch of ORSZCA and are in the final stages of securing two co-chairs: one from an organisation in the global south and the other from the global north. We anticipate sharing news on this next week.


What recent weeks have underscored is the need for advocacy for co-packaged ORS and Zinc for diarrhoea treatment. Without it, the current global diarrhoea treatment recommendation is too often overlooked. Aligning all the key players should not be difficult to do, as the GFF example shows above, and doing so has the potential to prevent more than 400,000 child diarrhea deaths each year.[1]


Leith and Simon

Leith Greenslade and Simon Berry
ORSZCA Start-up catalysts


ORSZCA applauds the endorsement of the importance of Zinc by the Global Financing Facility

ORSZCA applauds the clarification made last week by the Global Financing Facility (GFF) to their Reclaim the Gains campaign endorsing the importance of Zinc together with ORS in the treatment of diarrhoea.

Reclaim the Gains stands out as being the most significant current global initiative aimed at improving access to diarrhoea treatment. It is essential that such a significant effort is inline with the current WHO and UNICEF treatment recommendations.

Over the last 3 months ORSZCA has been engaged in a positive and productive dialogue with GFF which has resulted in their reference to “oral rehydration treatment” being amended to “oral rehydration solution and zinc treatment”. This simple change could save hundreds of thousands more young lives.

New GFF text on ORS and Zinc

This important, top level clarification leaves the question open as to how the global community might ensure that children receive both ORS and Zinc in practice. All the available evidence seems to point to co-packaging  as the best way to ensure this. Please see: Is co-packaging of ORS and Zinc important?




Is co-packaging of ORS and Zinc important?

It has been interesting to see how different organisations have reacted to the establishment and imminent launch of the ORS/Zinc Co-pack Alliance (ORSZCA).

Some have said that, as far as they are concerned, it doesn’t really matter if ORS and Zinc is co-packaged or not, as long as diarrhoea cases are treated with both. TECHNICALLY this is totally correct and can’t be disputed on purely technical grounds. However, what’s important is what actually happens IN PRACTICE. On the ground, on the front line, co-packaging is crucial if our objective is to have more children treated with both ORS and Zinc. This is the primary reason that WHO now recommends that ORS and Zinc is co-packaged. The other reason WHO recommends co-packaging is that it is usually the cheapest way to deliver the 17-year-old recommendation that diarrhoea in children should be treated with both ORS and Zinc.

Table 6 - ORS-Zinc co-pack prices
Source: DIG’s application to the WHO to add co-packaged ORS and Zinc to the Essential Medicines List

We have seen, over the last 17 years, what happens when co-packaging is not the norm. Before the change to the co-packaging recommendation in 2019 less than 7% of cases were treated with both ORS and Zinc even though this had been the recommendation since 2004. IN PRACTICE, when ORS and Zinc are not co-packaged,  ORS and Zinc are procured separately, they are supplied separately and delivered separately and rarely dispensed together. There are a whole range of reasons for this, among them:

  • One component might be out of stock – if there’s a 50% chance that either will be in stock at any one time then there’s only a 25% they will both be in stock at the same time.
  • The person dispensing might not know that the recommended treatment is ORS and Zinc and only give one (usually ORS).
  • In resource-poor situations it can ‘feel’ wrong to give two medicines to those who are first in the queue.

In 2015 a trial run in Ethiopia which bundled ORS and Zinc centrally or at health centre level, with appropriate messaging, increased adherence the recommended treatment (ORS and Zinc) from 72 to 86% (Gebremedhin et al (2016)).

ORS Zinc bundling study - EthiopiaClick to view image full-size on Flickr

In Zambia, management information contained in rural health centre reports from Mongu District was analysed to give an insight into the impact of co-packaging. Firstly, stock levels of both ORS and Zinc were investigated over two years (2016 and 2017) for the month of October – the usual peak month for diarrhoea incidence. Only 8 of the 30 health centres had both ORS and Zinc in stock throughout October in both years. In these 8 health centres the treatments dispensed for childhood diarrhoea in October of each of the years were analysed. These fully stocked health centres together treated a total of 176 and 389 cases of diarrhoea in 2016 and 2017 respectively. In 2016, before ORS/Zinc co-packs where available, 44% of cases received both ORS and Zinc even though both were in stock throughout the month. In 2017, when co-packaged ORS and Zinc was also available (as well as ORS and Zinc separately), the number of cases that received both ORS and Zinc nearly doubled to 87%. Of those that received both ORS and Zinc, 87% received them as a co-pack. It is a coincidence that both percentages are 87.

Diarrhoea treatment given
Click to view image full-size on Flickr

It was this analysis that led to the Zambian Government adding co-packaged ORS and Zinc to their Essential Medicines List. The Zambia experience indicates that co-packaging can increase the number of cases treated with both ORS and Zinc even in situations when both ORS and Zinc are also available separately. It goes without saying that co-packaging solves the problem of both elements of the recommended treatment being in stock at the same time.

Co-packaging also overcomes the problem of the person dispensing having to know that ORS should be given together with Zinc and removes the difficulty frontline staff face in resource-poor situations when giving two medicines to treat a single case of diarrhoea.

So, TECHNICALLY, it is true to say that it doesn’t matter if ORS and Zinc are administered from a co-pack or separately but PRACTICALLY the chance of this happening is greatly increased if ORS is co-packaged with Zinc and, in addition, the cost of treatment is likely to be lower than giving ORS and Zinc from separate sources.




Please submit your co-chair nominations by 25-Aug-21

Would you or a colleague benefit from being at the helm of an alliance to take forward the new WHO recommendation on ORS and Zinc for children’s diarrhoea?

At the pre-launch meeting of the ORS Zinc Co-pack Alliance (ORSZCA) on 11-Aug-2021 it was agreed that we would seek two Co-chairs for ORSZCA – one from an organisation in the global south and one from the global north. Co-chairs may be from any sector and should represent organisations with a strong track record in child survival and a focus on reducing child diarrhoea deaths.

Interested organisations are invited to submit individual nomination(s) for these roles and we also welcome self-nominations. Nominate now through the ORSZCA website.

The role of ORSZCA Co-chair will carry significant influence and involve attendance at major international, regional, and national child survival and diarrhea fora. Whilst not remunerated, Co-chair roles will not be time-consuming or onerous (e.g., 4-6 Zoom meetings a year). The role would also strengthen the child survival advocacy and communications work that Co-chairs would be doing anyway as part their institutions, and bring with it the contacts, potential partnerships and profile that are so important to increase the impact of existing programs and for new project development.

Co-chair activities will be supported by a strong ORSZCA secretariat which will include development of a multi-year strategy and annual workplan, meeting scheduling and report writing, website maintenance and social media, and more.

Please nominate yourself or others here by 25-Aug-2021.

This invitation was first sent out through the ORSZCA mailing list. To be added to the mailing list please sign up here.


Action points from the first pre-launch meeting (11-Aug-21)

Thanks to those who attended the first ORSZCA pre-launch meeting on 11-Aug-21.

Here are the action points from that meeting. Please use the comments box below for any comments or queries or email

The next pre-launch meeting will be on 1-Sep-21 and the details of this will be sent out next week.

Action points

SB = Simon Berry, ORSZCA start-up catalyst
LG = Leith Greenslade, ORSZCA start-up catalyst

ORSZCA co-chairs

SB/LG to reach out through the Diarrhoea Innovations Group (DIG) mailing list for nominations/self-nominations of organisations to put forward co-chairs of ORSZCA. It was agreed that we should seek a co-chair from one organisation in the global south and one in the global north. ASAP.
NOTE: there is already strong engagement with ORSZCA from icddr,b
NOTE ALSO: that co-chairs would have strong support from an ORSZCA admin function

ORSZCA launch on 15-Sep-21

Members to draw up lists of their own media channels by 1-Sep-21

SB/LG to reach out to ORSZCA members to create template launch materials for local adaptation by 8-Sep-21

Members to adapt the launch materials as appropriate and push them out through their own media channels on 15-Sep-21

Second pre-launch meeting to review progress towards the launch on 1-Sep-21 (SB to send out meeting invitations on 18-Aug and 25-Aug)

Letter to GFF

Members to consider the draft template letter to GFF (available here).

Members to consider sending this letter to GFF under their own letterhead as soon as possible and before the ORSZCA launch.

Please follow ORSZCA on Twitter @ORSZCA

Please point others to the ORSZCA website: and encourage them to sign up here:



Pre-launch invitation sent to Diarrhoea Innovations Group members

Today we sent a pre-launch email invitation to all Diarrhoea Innovations Group (DIG) members inviting them to joint the ORS/Zinc Co-pack Alliance.

The text of the invitation was as follows:

ORSZCA website banner


I’m writing to you as a fellow member of the no-longer active Diarrhoea Innovations Group (DIG) to invite you to become a founder member of the ORS/Zinc Co-pack Alliance (ORSZCA).
You can sign up here

ORSZCA is an informal global network advocating for the rapid uptake of the new WHO recommendation for the treatment of diarrhoea – co-packaged ORS and Zinc – which we (DIG) successfully lobbied for in 2019.

WHO and UNICEF first recommended the use of both ORS and Zinc for the treatment of diarrhoea in 2004. Today, 17 years later, less that 10% of child diarrhoea cases receive this treatment and diarrhoea remains the second biggest infectious killer of under-5 children, while at the same time being a significant contributor to stunting.

ORSZCA is being created to ensure that we do not see the same unacceptable delay in the uptake of the new co-packaging recommendation and make rapid progress lessening the severity of the tens of millions of diarrhoea episodes that occur among children each year and reduce the 500,000 preventable deaths.

By coming together as an alliance, we dramatically increase our chances of quickly making co-packaged ORS and Zinc the ‘go-to’ treatment for childhood diarrhoea.

Please join us: and forward this email to anyone who may also be interested in supporting this global effort.

You can also follow ORSZCA on Twitter @ORSZCA

Founder members of ORSZCA include individuals from (in alphabetical order):

  • ColaLife
  • JustActions
  • PATH
  • University of Witwatersrand

Thank you


Simon Berry
For the ORS/Zinc Co-pack Alliance (ORSCA)

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