The first Clear Solutions newsletter is out

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I’m excited to pass on Clear Solutions‘ first newsletter. They’ve only been going for 4 months and they’ve got lots to report. If you’d like to receive your own copy in future (as we will not be re-publishing them here), please subscribe by going to their website and clicking on the Newsletter link.

January 2024 Newsletter

Hello, thank you for reading!

Clear Solutions is 4 months old and we have lots to share in our inaugural newsletter!

ORS & Zinc Distribution Pilot

Our Kano, Nigeria, pilot in Dec’23 had local Community Health Workers (CHWs) distributing free co-packaged Oral Rehydration Solution and Zinc (ORSZ) door-to-door with detailed guidance to parents on using it to treat diarrhoea in children under-5.

Diarrhoea is the 2nd largest cause of death in under-5s; ORSZ is cheap (<$1 per co-pack) and highly effective at reducing deaths. During the pilot, over 7000 co-packages of ORZ were provided to approximately 4000 households in Kano.

Robust impact evaluation is core to our approach. We survey householders’ diarrhoea management norms beforehand (“baseline”), verify that ORSZ and usage guidance were correctly provided (“spot-checks”), then return >4 weeks later to determine post-intervention ORSZ usage patterns (“follow-up”). Follow-up surveys for the pilot are starting this week.

Our backstory

We are thrilled to have been able to realise the pilot so quickly – it’s been an intense few months! Here is a brief look back.

Listening to the veterans

Millions of diarrheal deaths have been prevented in countries where ORSZ usage has been successfully increased. We truly appreciate the experience shared with us by ORSZ veterans from R4D, CHAI, USAID, ColaLife, ARFH-NG, SFH and others.

The relatively-novel ”free pre-emptive community-level distribution” intervention that we are evaluating in Nigeria, based on the Wagner 2019 Uganda RCT, may be a crucial catalyst where ORSZ usage remains low despite previous efforts. Our ability to scale and sustain an approach, perhaps institutionalising free community-level provision through government, will be key in the longer-term.

Building partnerships

We narrowed our geographic focus to a final 3 countries (Nigeria, Ethiopia, Madagascar) with factors including diarrheal under-5 mortality, current ORS/zinc usage, and tractability. In each country, we identified potential on-the-ground implementation partners to execute our pilot and began governmental outreach in the first two. In Nigeria, we found several highly-capable local NGOs in different states, and began planning for up to 3 parallel “mini pilots”.

On the ground in Nigeria

Visiting communities, partners and government in Nigeria in November was fundamental to us truly understanding the context and growing partnerships with local NGOs and Government Primary Health Care agencies.

We met potential partners in Federal Capital Territory, Gombe, and Kano, with online workshops for Enugu state. Focus groups with caregivers and community health workers rooted us in the day-to-day reality of the people we seek to support.

The visits culminated in an opportunity to go bigger & faster than originally planned, with Kano State Ministry of Health approval and partner iDevPro-Africa having a window to start a larger pilot with pre-post ORSZ usage evaluation round, if we could get all the details in order in 2 weeks!

Pilot execution

Clear Solutions co-founder Charlie spent most waking hours with iDevPro in Kano in the run-up to and first week of the pilot. Though the intervention is conceptually simple, every implementation detail needed to be determined: target communities; health worker staffing & supervision; survey staff, questions & tooling; procurement & co-packaging; detailed roles and staff training.

A huge collaborative effort saw Pilot stage 1 (¼ of the volume) begin early-December, with a 2-week offset for us to incorporate learnings into the larger stage 2 from mid-December.  A brief pause, some initial analysis to validate the data collected so far, and it’s on to the Follow-Ups now until mid-February!

Support us!

Our accelerated progress has shortened our financial runway, but thanks to the generosity of donors at seed funding and beyond, we project that we are funded until Autumn 2024. However, we have ambitious plans for the final quarter, with a funding gap of $100,000, and we expect to start fundraising around July’24.

You can donate here any time, but for materials to support a larger funding decision, please do get in touch:

A huge thank you to everyone who has supported us to date, with partnership, funding, advice, and encouragement!