Calls for action

As part of its work, ORSZCA tries to hold organisations to account for their activity (or inactivity) in the area of diarrhoea treatment. Below is a list of our current calls to action and those that have been successfully concluded.

Current calls for action

1. Encourage and support a joint policy briefing by WHO and UNICEF on the co-packaging of ORS and zinc.

A joint statement was being worked on 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 had to be dropped.

The objective of such a policy briefing, 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.

WHO and UNICEF representatives met initially to discuss this ORSZCA call for action on 16-Feb-2023 and subsequently ORSZCA met with the WHO representative on 22-Feb-2023. Following this meeting ORSZCA has produced:

  • A Position Paper on: Defining an ORS/Zinc ‘co-pack’ which is available here: – comments on this are welcome.
  • The first draft outline for a policy briefing – this will be made available for comment shortly.

2. ORSZCA Members – please contribute to our perpetual effort to maintain a picture of the ORS and Zinc status around the world.

We ask members to contribute through our simple questionnaires in English or French. As questionnaires come in we update our status pages here: ORS & Zinc status around the world.

3. 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. This will require ORSZCA 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 and we are working to ensure we are included in this review process.
Our focus will be on the current Question 615 in the Woman’s Questionnaire:
Women are asked if they gave a child with diarrhea fluid made from a packet of oral rehydration salts (ORS) such as [LOCAL NAME FOR ORS PACKET], a pre-packaged ORS liquid such as [LOCAL NAME FOR PRE-PACKAGED ORS LIQUIDS], zinc tablets or syrup, or [a government- recommended homemade fluid]. Read out each item and record the answer given for each one.
Source:’s-Manual-EN-07Jan2022.pdf (page 103).
We’d like to change this, or split it into two questions to establish the uptake of co-packaging.

4. The high price of co-packaged ORS and Zinc for UNICEF Supply Division.

One of the reasons given by the WHO for changing the diarrhoea treatment recommendation was that this is the cheapest way to deliver the recommended treatment for diarrhoea. In all markets researched, co-packaged ORS and Zinc is cheaper than purchasing ORS and Zinc separately. However, this was not the case if purchasing from UNICEF Supply Division where co-packs are more than twice the price of the components bought separately. Members lobbied UNICEF on this at the end of 2021 and this helped bring forward a re-tendering process for ORS and Zinc products – the first since 2015. During this process, UNICEF are making a big effort to broaden participation in this tender and we applaud this approach. However, to date (Oct-2023) only three new contracts have been awarded and the pricing in the UNICEF catalogue remain the same. members lobbied UNICEF again in Sep-2023 and we await the outcome of this. There is more on this story here.

Past calls for action

1. World Bank / GFF “Reclaim the Gains” initiative failed to mention Zinc as a component of diarrhoea treatment.

We were very excited when GFF announced their “Reclaim the Gains” initiative which included the objective of an additional 458 million treatments for diarrhoea. However, the original announcement only contemplated treatment with ORS only. we opened discussions on this with the GFF Team and are pleased that they changed the programme objectives to: 458 million treatments for diarrhoea with ORS and Zinc.There is more on this story here.

2. Call to UNICEF and Save the Children to properly reflect the current diarrhoea treatment guideline in their Child Health Spotlights resource.

On 23-Jan-23 a new version of the Child Health Spotlights website was launched and the “Diagnose & Treat” section for each country is now compatible with the global recommendations. Item 2 reads:

2. access to ORS and Zinc (preferably co-packaged when dispensed for use in the home) as a lifesaving essential and effective treatment for diarrhoea.

We are grateful that this change has been made. However, there are further changes we would like to see and these are:

The incorporation of the ORS/Zinc coverage rates for each country.

These are available from the following UNICEF sources:

Inclusion of all Top-10 high diarrhoea burden countries in the country look-ups

Currently Cameroon and Madagascar are missing.

Change to the download PDF feature

The ability to download different data analyses for different countries is useful. However, the downloads do not have a country label and so might cause confusion when shared or when doing multiple downloads.


Making co-packaged ORS and Zinc the "go to" treatment for childhood diarrhoea