Children in front of a wall painting advertising the Kit Yamoyo ORS/Zinc co-pack. George Compound, Lusaka, Zambia
Image credit: Laurence Wilbraham
Please comment on this strategy below.
We are currently developing our 3-year strategy and workplan here where you can comment and suggest edits.
To make co-packaged ORS and Zinc the “go-to” treatment for childhood diarrhoea in high incidence countries.
Four-pronged approach underpinned with data & evidence
This four-pronged approach is adapted from the approach to driving scale-up of ORS and Zinc suggested in the 2016 report: “Progress over a Decade of Zinc and ORS Scale-up” published by the Clinton Health Access Initiative (CHAI). It was also the model that drove CHAI’s work in India, Kenya, Nigeria, and Uganda (Schroder et al, 2019):
1 Ensure an Enabling Environment
1.1 Get co-packaged ORS and Zinc on the WHO Model Essential Medicines List
This was achieved through and application by the Diarrhoea Innovations Group in 2018. The entry in the WHO Model Essential Medicines List (2019) for the treatment of diarrhoea treatment now reads:
1.2 Encourage Global Financing Facility (GFF) to align with current global recommendations for diarrhoea treatment
The Global Financing Facility (GFF) has a new campaign to raise $2.5B called “Reclaim the Gains” – to implement the next stage of their work. One of their new 2025 goals is to have 458 million additional children receive oral rehydration treatment for diarrhoea. See: ‘Reclaim the Gains‘. When first announced the GFF made no mention of Zinc. They only mentioned ORS. We engaged with the GFF on this over several weeks and from mid-October (2021) they changed their publicity materials to include Zinc alongside ORS.
See: ORSZCA applauds the endorsement of the importance of Zinc by the Global Financing Facility
1.3 Encourage action by WHO and UNICEF
[note that we need to check with WHO and UNICEF that these targets are reasonable ie challenging but achievable]
- Encourage UNICEF to adopt and support these targets:
- 80% coverage of ORS/Zinc for children with diarrhea by 2030
- 80% procurement of ORS/Zinc in co-pack by 2025
- 90% of national EMLs to reflect WHO ORS/Zinc co-pack recommendation by 2025
- Encourage UNICEF to update their Standard Operating Procedures for Country Offices on procurement for diarrhoea treatment
- UNICEF and WHO to publish global and national estimates of co-packaged ORS/Zinc coverage in annual child mortality reports (eg the annual State of the World’s Children report), and on respective websites by 2022.
- UNICEF and WHO to publish and circulate a joint statement to countries detailing the cost-benefits of procuring co-packaged ORS and Zinc by 2022. Members of ORSZCA could help with the content of such a statement if required and provide support to local champions for the ORS/Zinc Playbook.
1.4 Encourage national level policy change
- Encourage national governments to update their Essential Medicines Lists to reflect the WHO Model EML with respect to co-packaged ORS and Zinc.
- Ensure that co-packaged ORS and Zinc is registered as an ‘over the counter’ (OTC) medicine.
- Encourage the local manufacture of co-packaged ORS and Zinc.
2 Ensure Supply Availability
- Encourage local manufacturing capability to supply the private sector market (ensures a rhythm of local production which is also then available to the public sector and donors when they wish/are able to place orders)
3 Ensure Provider Demand
- Encourage tendering and procurement of co-packs by government.*
- Encourage tendering and procurement of co-packs by donors and NGOs.*
- Encourage UNICEF to update their Standard Operating Procedures for Country Offices on procurement for diarrhoea treatment (a repeat of one of the actions in section 3.1.2 above). This will avoid situations where UNICEF Country Offices procure ORS alone for treatment of diarrhoea in children.
- Drastically reduce the procurement of ORS and Zinc as single items.
CURRENT URGENT ACTION
A key immediate ORSZCA action will be to engage with UNICEF Supply Division on the prices of co-packaged ORS and Zinc in their catalogue. At the moment (Sep-21) the cost of co-pack products is between 1.5 and 2.2 times more expensive than buying the ORS and Zinc separately (see orszco-pack.org/data-evidence (section 2) for a full explanation of this).
We are encouraging ORSZCA members and others to consider writing to UNICEF about this and provide a template letter here for this purpose.
Clearly, provider demand for co-packaged ORS and Zinc is going to be reduced in these circumstances.
4 Ensure Caregiver Demand
- Ensure that at least one affordable commercial product exists in the market.
- Ensure co-packaged products are aspirational – engage caregivers in the product design process.
- Ensure effective marketing to caregivers.
- Ensure effective awareness raising and correct usage
- Create and respect the value chain of co-packaged ORS/Zinc products
- If subsidies are used, ensure they are applied in a way that strengthens the value chain rather than destroy it (see the ‘How to subsidise’ section of the ORS/Zinc Playbook)
5 Data & Evidence
Although sufficient evidence was gathered to effect a change in the WHO recommendation which now recommends co-packaged ORS and Zinc, there is still a need for more data and evidence in this area. ORSZCA will encourage new research and improve awareness of existing data and evidence.
All comments and suggested edits welcome – please post these below.