Tag Archives: WHO


Welcome to the ORSZCA UPDATE for November 2023

In this update we are focussing on our current four calls for action. These are always at the top of the home page of our website. Currently, they are:

1. WHO and UNICEF – encourage and support a joint policy brief by WHO and UNICEF on the new ORS/Zinc co-packaging recommendation >>more

2. UNICEF Co-pack pricing >>more

3. ORS/Zinc Status around the World >>more

4. DHS/USAID – engage with the next review of the DHS Questionnaires to incorporate questions around co-packaging >>more

1. WHO and UNICEF – encourage and support a joint policy briefing by WHO and UNICEF on the new ORS/Zinc co-packaging recommendation

A joint statement was being considered 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 stalled.

ORSZCA was able to convene a meeting with WHO and UNICEF on 22-Feb-2023. Yasir Bin Nisar (WHO) represented both WHO and UNICEF. Anne Detjen (UNICEF) couldn’t make the meeting but had met with Yasir the week before. They had agreed that a “Joint Policy Brief” would be the most appropriate instrument. The objective of such a policy brief, 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.

Following the meeting ORSZCA produced the following resources:

  1. A first draft outline for a policy briefing – this is open for comments here.
  2. A Position Paper on: Defining an ORS/Zinc ‘co-pack’ which is available in the ORSZCA Resources Library here: orszco-pack.org/resources/#copackdesign – again, comments on this are welcome. This was requested by WHO at the meeting.
  3. A summary of the meeting and key action points.

Unfortunately, our progress has hit a roadblock as our senior contacts at WHO and UNICEF have become unresponsive due to their busy schedules. Given the urgency of our cause and the impact this simple action could have on the lives of children, we plan to escalate this issue as soon as a new Head of Health is in place at UNICEF.

2. UNICEF Co-pack pricing

In the UNICEF Catalogue, the indicative price of a co-pack containing 1 L sachets of ORS and a blister pack of 10 zinc tablets is more than twice the price of its component parts. This goes against the general market trend. You can see the calculations here: ORS/Zinc product prices in the UNICEF Catalogue (Sep-2023 tab).

ORSZCA members first raised this issue with the then director of UNICEF Supply Division Director (Etleva Kadilli) in January 2022 and were referred to the re-tendering process for ORS/Zinc products that was about to get underway. This process has now finished and the catalogue prices remain virtually unchanged.

The ORSZCA Secretariat (Simon Berry) met with the Chief of the Nutrition & Medicines Unit (Francisco Blanco) and Cynthia Kamtengeni on 25-Oct-23. UNICEF are very reluctant to change the algorithm they use to calculate indicative pricing as this would mean changing it across the whole catalogue. Our concern is that the indicative pricing of co-packs in the UNICEF Catalogue is a barrier to the uptake of co-packaging and we will continue to push for the algorithm to be changed. In the meantime, FB agreed to look into the possibility of adding a note to the indicative pricing of co-packs in the UNICEF Catalogue. We agreed on the following action points and these include a follow-up meeting in Jan-2024:

ORSZCA to share improved understanding from this meeting with ORSZCA members.
ORSZCA to share ORSZCA’s current pricing information with FB.
ORSZCA to look into becoming a source of pricing information – fulfilling a similar role to the MSF Price guide (but just for ORS/Zinc).
FB to investigate putting up an explanatory note against the co-pack indicative price in the UNICEF Catalogue.
FB to look into possibility of analysing tenders received from manufactures to improve knowledge of the current price differentials between co-packs and separates, and get an idea of the number of manufacturers who tendered who produce their own ORS and Zinc (as opposed to those who have to source one or other of the components externally).
FB, CK and SB to meet again in 3 months time (Jan-2024) to review progress.

3. ORS/Zinc Status around the World

We are still keen to receive completed questionnaires (in English or French) on the ORS/Zinc status in your country – this is especially true if you have knowledge of the situation in Niger and Chad. We’ve had no completed questionnaires from these two countries. We’ve been adding to the information contained in the questionnaires through our own research and conversations with members. For example, we’ve been able to locate and link to many of the national Essential Medicines Lists from our unique snapshot of the status of ORS and Zinc around the world.

4. 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. ORSZCA is seeking 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. We now wish to gather a group of ORSZCA members around this issue with the aim of suggesting a change to DHS Woman’s questionnaire (Question 615) that would capture the extent to which co-packaged ORS and zinc is being used. If you can help by joining this group, please reply to this email.

As always, please let us have any comments you may have on this UPDATE by replying to this email.

Thank you.

Morseda and Samy
ORSZCA Co-chairs

Dr Morseda Chowdhury
Director of Health, Nutrition and Population Programme
BRAC, Bangladesh

Samy Ahmar
Head of Health
Save the Children, UK




ORSZCA congratulates Swiss Pharma Nigeria and PharmEvo (Pakistan)

Logos Swiss Pharma Nigeria and PharmEvo

ORSZCA congratulates Swiss Pharma Nigeria and PharmEvo (Pakistan) on achieving WHO prequalification (PQ) status for 20mg dispersible Zinc Sulphate tablets. Swiss Pharma Nigeria is the first African manufacturer to achieve PQ for Zinc tablets. While PharmEvo is the first manufacturer in the world achieve PQ status for a Zinc syrup.

What does prequalification mean?

Prequalification signals confidence in the quality of medicines manufactured and makes them eligible, in principle, for procurement by UN agencies and donor organisations.

How many prequalified products are there for the treatment of diarrhoea?

The short answer is not enough. There are no prequalified ORS products and only six Zinc products (seven if you include Zinc Syrup).

Zinc sulphate dispersible tablets 20mg

WHO Ref No Applicant Country Date of Prequalification
1 DI002 Nutriset France 04-Dec-12
2 DI005 Macleods Pharmaceuticals Ltd India 07-Dec-16
3 DI011 Ipca Laboratories Ltd India 15-May-20
4 DI013 The ACME Laboratories Ltd Bangladesh 02-Nov-21
5 DI014 Swiss Pharma Nigeria Ltd. Nigeria 02-May-23
6 DI009 PharmEvo (Pvt) Ltd. Pakistan 12-Jul-23

Zinc sulphate syrup 10mg/5mL

WHO Ref No Applicant Country Date of Prequalification
7 DI010 PharmEvo (Pvt) Ltd Pakistan 12-Jul-23

How do UN Agencies and donor organisations procure Co-packaged ORS and Zinc if there are no prequalified ORS products?

It would appear that they rely on certificates of Good Manufacturing Practice (GMP). However, quality is a concern. In UNICEF’s  Oral Rehydration Salts and Zinc: Market and Supply Update of September 2022 they stated as a challenge:

Due to the limited number of quality suppliers of ORS and ORS and zinc co-packaged products, there are even fewer that can meet the quality standards required for international procurement. Some of the suppliers that UNICEF had awarded supply agreements to as an outcome of its last tender were cancelled as they were not able to maintain product quality standards throughout their LTA [Long Term Agreement] duration. As ORS is an over-the-counter medication and is marketed socially in many countries, supplying demand through UNICEF does not offer sufficient incentive to improve manufacturing and product quality to meet international procurement standards.