ORS & Zinc status around the World

This section of the website summarises data submitted by ORSZCA members on the ORS and Zinc status in their country, or a country they are familiar with. 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 add to this dataset using this questionnaire or by leaving a comment at the bottom of the individual country page.  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. It takes less than 10 minutes to submit the questionnaire and helps us provide a unique resource for would-be donors and strategists.

Country Questionnaires Comments Co-packaged
ORS/Zinc on
National EML?
Bangladesh 1 0 No EN
Burkina Faso 1 1 No FR
Cameroon (8th) 1 0 Unknown FR
Chad (5th) 0 0 Unknown FR
Côte d’Ivoire 1 0 Yes FR
DRC (7th) 1 0 No FR
Ethiopia (4th) 3 0 Yes (since 2020) EN
Ghana 1 0 No EN
India (2nd) 4 3 No EN
Indonesia 1 1 No EN
Iraq 1 0 No EN
Kenya 3 1 Yes (since <2018) EN
Madagascar (9th) 2 2 Yes (since 2019) FR
Malawi 2 0 No EN
Mali 1 0 No FR
Myanmar 1 0 No EN
Nepal 4 3 No EN
Niger (6th) 0 0 Unknown FR
Nigeria (1st) 7 4 Yes (since 2016) EN
Pakistan (3rd) 1 1 Yes (since 2020 at national level)
but health issues are devolved
to provinces and co-packaging
does not feature in provincial lists
Rwanda 1 0 No EN
Senegal 4 0 Yes (since <2018) FR
Somalia (10th) 1 0 No EN
South Africa 1 0 No EN
South Sudan 1 0 No EN
Uganda 2 2 Yes (since 2018) EN
Zambia 1 2 Yes (not actually on NEML
but gov’ment policy is to
distribute co-packs)

Top 10 countries for diarrhoea deaths with ranking in red >>more

While we build the above dataset, the table below is the best information we have. It shows the status of ORS and Zinc on selected national essential medicines lists. It  is based on internet research and includes 55 countries. The top 10 countries for diarrhoea mortality are covered except for Niger and these all have both ORS and Zinc on their respective national essential medicines lists. However, only two list co-packaged ORS and Zinc (Nigeria and Ethiopia).
Source: The successful application to WHO to add co-packaged ORS and Zinc to the Essential Medicines List updated with information from the dataset above.

Status of ORS and Zinc on national Essential Medicines lists (internet research – 55 countries).

ORS/zinc co-pack (7 countries) Côte d’Ivoire,(i) Ethiopia,(f) Kenya, Madagascar,(h) Nigeria,(g) Pakistan,(e) Senegal, Vietnam.
Both ORS and zinc separately, NOT co-pack (24 countries) Afghanistan, Angola, Argentina, Bangladesh, Bolivia, Botswana, Burkina Faso,(b) Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Eritrea(c), Ghana, Guinea, India, Nepal,(d) Rwanda, Somalia, Sri Lanka, Sudan, Tanzania, Uganda.
ORS only, not Zinc (14 countries) Algeria, Armenia, Bahrain, Barbados, Belize, Cambodia, China, Cook Islands, Indonesia, Malaysia, Mauritania, Myanmar, Timor-Leste, Togo, Zambia.(a)
Zinc only, not ORS (5 countries) Brazil, Chile, El Salvador, Mali, Republic of Congo.
Neither ORS nor zinc (5 countries) Cape Verde, Colombia, Croatia, Lesotho.
Countries in the top 10 high burden countries whose status we do not know Niger.

Top 10 countries for diarrhoea mortality are highlighted in red.

(a) Co-packaged ORS and Zinc is not listed in the latest published national EML. However, the strategy of the Ministry of Health is to distribute co-packs to its health facilities where they are given free.
(b) Does not specifically list co-pack, but does make a note: “En case de diarrhée aiguë, le sulfate de zinc doit être utilisé comme adjuvant de la réhydratation orale chez l’enfant.”
(c) Does not specifically note that medicines should be taken together, but they are listed together under “Medicines used in Diarrhoea.” There is no indication they are listed as a co-pack.
(d) A note is made: “In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts .”
(e) Since 2020. National level only – not get featured in provincial EMLs.
(f)  Since 2020. Although ORS and Zinc are listed separately, a note under the Zinc entry states that: “zinc sulfate should be used as an adjunct to oral rehydration salts (co-packaged ORS/zinc)”.
(g) Since 2016. The first section of the EML lists ORS and zinc separately but the subsequent sections, which list the medicines required at each level of the health system, state that ORS and zinc should be co-packaged.
(h) Since 2019. The 2019 edition, using the French abbreviation for ORS, i.e. SRO (Sels de réhydration orale), lists “SRO+Zinc” as well as listing ORS and zinc separately.
(i) Needs verification (May 2024)



Last reviewed: 16-May-2024

One thought on “ORS & Zinc status around the World”

  1. It is beginning to appear on some packets of ORS in Nigeria where the tablets of zinc are also enclosed in the pack of ORS. However, it is a widely practiced phenomenon across most ORS sachets sold in the country. A lot still needs to be done. The parents and physicians actually knows the importance of zinc tablets and ORS for acute diarrhea.

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