This is a collection of links that might be useful to those championing co-packaged ORS and Zinc. If you know of resources that aren’t listed here please provide details in a comment and they will be added when the page is next updated.
- The ORS/Zinc Playbook
- ORS/Zinc training and reference flash cards
- DefeatDD resources
- Funding – Global Financing Facility (GFF)
- Funding – Global Fund (GF)
- Child Health Task Force
- Data – Global Burden of Disease
- Data – Global Diarrhoea Burden
- The successful application to WHO to add co-packaged ORS and Zinc to the Essential Medicines List
- WHO Model Essential Medicines Lists
- Progress in the use of ORS and zinc for the treatment of childhood diarrhea (Robert E Black 2019)
- Progress over a decade of Zinc and ORS scale-up – best practices and lessons learnt
- Diarrhoea: Why children are still dying and what can be done (UNICEF) (2009)
- The International Zinc Nutrition Consultative Group (IZiNCG) resources
- The case for co-packaging (the ColaLife website)
- Clinical management of acute diarrhoea: WHO/UNICEF joint statement (2004)
- What is a DALY?
- ORSZCA Position Paper: Defining an ORS/Zinc co-pack
1. The ORS/Zinc Playbook
The ColaLife Playbook builds on ColaLife’s experience in Zambia trialling and scaling up co-packaged ORS and Zinc. It is for those seeking to improve access to co-packaged Oral Rehydration Salts (ORS) and Zinc for the treatment of diarrhoea who don’t want to completely re-invent the wheel.
The playbook is published alongside a commitment from ColaLife to support its users. ColaLife do this by responding to comments made and questions asked in the playbook itself.
2. ORS/Zinc training and reference flash cards
These flash cards built on the learning from the ColaLife co-packaging trial in Zambia and where produced for the national scale-up. They were designed for use by retailers and Community Health Workers (CHWs). There are 11 double-sided cards in the set. Both sides have the same image. One side has the text in English, the other has no text to enable translation into a different language during training of retailers and CHWs. The 11 cards are numbered from 0 to 10. Cards 0 and 10 are specific to the Kit Yamoyo co-pack and can be discarded, the other nine are generic and can be used with any co-pack. Print-ready PDFs and printing instructions are here.
3. DefeatDD resources
PATH’s Defeat Diarrheal Disease Initiative is an advocacy movement to raise awareness of the burden of diarrheal disease and help increase access to the solutions.
They have a page dedicated to co-packaged ORS and Zinc: https://www.defeatdd.org/ors-zinc-copack
4. Funding – Global Financing Facility (GFF)
The Global Financing Facility for Women, Children and Adolescents (GFF) is a multi-stakeholder global partnership housed at the World Bank that is committed to ensuring all women, children and adolescents can survive and thrive.
Critically, one of their new 2025 goals is to have 458 million additional children receive oral rehydration treatment for diarrhea. There is no mention of Zinc or co-packaging. A high priority early task for ORSZCA will be to seek to change this to bring the GFF in line with the current global diarrhoea treatment recommendation.
*Update – ORSZCA successfully lobbied for this change. See the ORSZCA UPDATE 26-Oct-2021
5. Funding – Global Fund (GF)
There has been 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. More details and links to supporting materials can be found in the ORSZCA UPDATE 20-Dec-2022.
6. Child Health Task Force
The goal of the Child Health Task Force is to strengthen equitable and comprehensive child health programs – focused on children aged 0-19 years in line with Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) – through primary health care, inclusive of community health systems.
It has organised itself into 10 subgroups and we are engaging with three of them:
Strategic plan (PDF)
7. Data – Global Burden of Disease
Global Burden of Disease Study 2019 (GBD 2019) Under-5 Mortality by Detailed Age Groups 1950-2019, coordinated by the Institute for Health Metrics and Evaluation (IHME), estimated the burden of diseases, injuries, and risk factors for 204 countries and territories and selected subnational locations.
8. Data – Global Diarrhoea Burden
Good basic information on diarrhoeal disease from the Centres of Disease Control and Prevention:
However, the treatment recommendations on this page are out of date and we have alerted the CDC to this via Twitter (on 8-Oct-21).
9. The successful application to WHO to add co-packaged ORS and Zinc to the Essential Medicines List
Download application: Application_WHO EML_DIG_12Nov2018
This is the successful application to WHO requesting that they change their model Essential Medicines Lists to recommend that ORS and Zinc should be co-packaged.
This resource might be useful to those making the case to get their own government to change the national essential medicines list in line with the new WHO recommendation.
10. WHO Model Essential Medicines Lists
The WHO Model Lists of Essential Medicines has been updated every two years since 1977.
The current versions are the 21st WHO Essential Medicines List (EML) and the 7th WHO Essential Medicines List for Children (EMLc) updated in June 2019.
– General information
– Core List (21st, 2019)
– Children’s list (7th, 2019)
In 2019 both lists were modified to specify that ORS and Zinc should be co-packaged for the treatment of diarrhoea.
A key objective of ORSZCA is to accelerate the uptake of this recommendation by national governments in high incidence countries.
11. Progress in the use of ORS and zinc for the treatment of childhood diarrhea
Robert E Black 2019
This editorial was published in 2019 in the Journal of Global Health, Bloomberg School of Public Health, Johns Hopkins University, by one of the leading academics in the field of ORS and Zinc, Robert E Black. It highlights the strategic importance of co-packaging ORS and Zinc. The editorial was published on the 50th anniversary of the discovery of ORS.
12. Progress over a decade of Zinc and ORS scale-up – best practices and lessons learnt
This report was written by Nancy Goh and Katherine Pollak of the Clinton Health Access Initiative and published in 2016. It is now difficult to find online and so a copy has been uploaded to this website (see Download link below).
The report contains a table entitled:
FOUR-PRONGED APPROACH TO DRIVING SCALE-UP OF
CO-PACKAGED ORS AND ZINC and the ORSZCA Strategy for impact builds on this table.
13. Diarrhoea: Why children are still dying and what can be done
This joint report by UNICEF and the World Health Organisation (WHO) was published in 2009 and was one of the first publications to suggest the co-packaging of ORS and Zinc.
14. The International Zinc Nutrition Consultative Group (IZiNCG) resources
The International Zinc Nutrition Consultative Group promoting and assisting efforts to reduce Zinc deficiency in low and middle income countries. While ORSZCA focusses specifically of the use of Zinc for the treatment of diarrhoea, IZiNCG is concerned more generally with Zinc deficiency.
15. The case for co-packaging (the ColaLife website)
This page on the ColaLife website makes the case for
co-packaging and includes some of the evidence presented to WHO in the application to get the change to the 2019 essential medicines lists mentioned above.
16. Clinical management of acute diarrhoea: WHO/UNICEF joint statement (2004)
In May 2004 WHO and UNICEF issued a joint statement on the clinical management of acute diarrhoea. This recommended the use of Zinc and low osmolarity ORS. A copy of the statement can be downloaded from the WHO website here. There is also a copy in the ORSZCA Library here.
17. What is a DALY?
DALY stands for Disability Adjusted Life Years and it’s a way of measuring the impact or burden of a disease in a population from premature death and years of sub-optimal health (mortality and morbidity). DALYs allow the impact of different diseases to be compared and are therefore helpful in deciding priorities. In this case the “cost per DALY averted” is calculated and used as the comparator. By this measure investments to improve child survival are very cost-effective in improving the health of a population.
Source: Public Health England (2015).
Reproduced under Open Government Licence.
When a 3 year old child dies of diarrhoea, with no years suffering a disability, the years of life lost is 77 or 77 DALYs given a life expectancy of 80 years (80-3).
Things get a bit more complicated when accounting for years lost due to disability. However, this is explained very well here: Using DALYs to understand young people’s health.
18. ORSZCA Position paper: Defining an ORS/Zinc ‘co-pack’
How many ORS sachets should a co-pack contain and what size should they be? How many zinc tablets should be provided? This position paper (Release 1.1) reviews the current evidence and makes recommendations:
Defining an ORS_Zinc Co-pack Release 1.2 (PDF)
Last reviewed: 18-Apr-2023