ORSZCA Update: GFF, UNICEF and more

If you haven’t already done so, please join ORSZCA, the open global network to accelerate the adoption of the new WHO recommendation for diarrhoea treatment: co-packaged ORS and Zinc. Please also follow us on Twitter: @ORSZCA. Supporting the ORSZCA global alliance will lead ColaLife to achieve the final phase of our global impact strategy.

The ColaLife Impact Strategy

ORSZCA will be launched before the end of the year but it is already making progress in some key priority areas – see below. We and founding partners agree, that if not addressed, these key priority areas could severely negatively impact the uptake of the new WHO co-packaging recommendation.

As a landmark decision in the prevention and treatment of childhood diarrhea deaths, the WHO added co-packaged ORS and zinc to both the Model List of Essential Medicines for Children (EMLc) and the WHO’s Model List of Essential Medicines (EML) in July of 2019.
Prof R E Black, Pneumonia & Diarrhoea Progress Report 2020


Current priority actions for ORSZCA

1. World Bank > Global Finance Facility (GFF) > Reclaim the Gains

GFF Logo            Reclaim the Gains Logo

Within the global health community, the focus has switched away from diarrhoea treatment in recent years. So, we heartily welcome the new “Reclaim the Gains” initiative, which has an objective to treat an additional 458 million children for diarrhoea to prevent a major cause of child deaths. However, currently the initiative aims to do this through the provision of “oral rehydration treatment”. There is, so far, no explicit mention of Zinc or co-packaging. It is important that this is amended for two reasons:

  1. Simple “oral rehydration treatment” is not consistent with the current global recommendation
  2. Flooding the the market with ORS (only) will delay the uptake of new global recommendation: co-packaged ORS and Zinc

After careful research and a level of persistence, ORSZCA met (virtually) with the key people within GFF on 16-Sep-21 to discuss this issue. It was a very positive meeting and we expect the materials associated with the GFF programme to be amended and clarified, to include the recommended reference to Zinc. Watch this space.


2. UNICEF > Co-pack prices


In our successful application to WHO to change the global recommendation for diarrhoea treatment to co-packaged ORS and Zinc, we presented evidence that this could be the cheapest way to provide both ORS and Zinc. See the table below from the application.

Table 6 - ORS-Zinc co-pack prices

Subsequently, Lam et al (2019) also reported that a co-pack of ORS and Zinc was less expensive (mean = USD 0.75, n = 39) than buying ORS and Zinc separately (mean = USD 1.21, n = 319) across retail outlets in Uganda.

This is in stark contrast to the prices quoted in the current UNICEF Supply Division catalogue:

UNICEF Catalogue ORS Zinc Co-pack prices

In the UNICEF catalogue, a co-pack containing 2 x 1 L sachets of ORS and a blister pack of 10 Zinc tablets costs USD 0.57 which is more than twice the cost of buying the ORS and Zinc separately from the same catalogue (USD 0.26).

This is clearly not conducive to the uptake of the new global recommendation: co-packaged ORS and Zinc.

Again, after some persistence, ORSZCA have secured a commitment to a meeting with UNICEF Supply Division to discuss this issue.


This is clearly important work to ensure the uptake of the new co-packaging  recommendation. Around 500,000 children die each year from diarrhoea and only 15% get the recommended treatment – ORS and Zinc. Please join ORSZCA to change that.


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