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Writer's picture: Clear Solutions teamClear Solutions team

Clear Solutions and partners have now completed 3 months of distributions in our ORS+zinc program “Phase 3” in Dambatta LGA in Kano state, Nigeria.


We made digitisation of distribution tracking - a key requirement for rigour at scale - our primary focus for this phase. By equipping the community health workers who perform our ORSZ distributions with smartphones, recording their GPS tracks and simple survey inputs, we can clearly understand the coverage achieved and monitor day-to-day progress.


Let’s take a closer look at the mapping and digitisation methods.


Distribution Planning


Our Phase 3 approach has been to distribute to children under-5 across whole geographic wards. Depending on ward size, this typically means 5,000-15,000 under-5s. We refer to population data from the Local Government Primary Healthcare teams, from the ward itself, and also estimates from WorldPop (which fuses satellite imagery with models based on census data).


For detailed mapping of the distribution areas, we use Geographic Information Systems (GIS) data from sources including GeoPode. The image below shows part of Dambatta, the Local Government Area (LGA) in which we have worked in Phase 3

Dambatta built-up areas (orange), small settlement areas (purple), and hamlets (pink)
Dambatta built-up areas (orange), small settlement areas (purple), and hamlets (pink)

Planning and supervision of distributions involves close collaboration with the local primary healthcare teams, and they assign specific communities to individual distributors. We define target areas in our digital maps to correspond with the intended distribution coverage, fusing settlement boundary data with expected under-5 population from WorldPop.


The distribution target area maps are split into grid squares in which it is expected that at least one under-5 is resident. Distribution teams do not refer directly to these GIS maps - they use their local knowledge and on-the-ground observations - but we can track their progress against the expected areas of distribution to estimate our effective coverage.


Tracking the distribution and estimating coverage


As the Community Health Worker teams proceed on their distributions, they carry a smartphone to record GPS positions along their paths.


We used low cost Android phones with Geospatial Tracking System (GTS), a tool originally developed for supporting polio immunisation campaigns by Novel-T Sàrl.


GTS consists of a smartphone app with a backend (cloud) data store and dashboard web app. The mobile app runs as a GPS location tracker to record ORSZ distributors’ paths, and as a survey tool (integrating Open Data Kit, ODK Collect app) for capturing operational monitoring data.


The individual distribution paths are aggregated by GTS into a map of the areas that have been reached within the distribution round, and those in which we expect there to be under-5s who have not yet been reached. Each handover of ORSZ is also recorded to monitor for stock levels and detect potential losses.



A coverage map builds up during the distribution, pictured above with target areas reached in green, and not yet reached in red. The geo coverage is a pure % of target areas reached, with the % of under-5s (according to GIS data, “GIS u5s” in the image) accounting for more densely populated areas. This gives us a robust indication of the reach of distributions, and enables us to iterate upon the planning and operational methods to further increase coverage.


Incorporating digital monitoring going forward


As we reflect on Phase 3, this digitisation of distribution monitoring has provided crucial practical insights into the operation, enabling continuous iteration and improvement. We expect to incorporate these methods as a standard component of our distribution campaigns going forward.


Writer's picture: Martyn JamesMartyn James

It’s been a busy few months here at Clear Solutions and we have lots of news to share! 


First, co-founder Charlie and I are thrilled to welcome new team members, Umar, Sahar and Oli (see Team page), joining in London, UK and Kano, Nigeria. With their wealth of experience in public health, community initiatives, education, and government, their skills and perspectives will be key in advancing our mission.


I’d like to thank again everyone who applied for the roles: it was a pleasure to meet so many talented people driven by social impact!


Phase 2


Our last major distribution, “Phase 2”, in partnership with iDevPro Africa, reached an estimated 20,000 children under-5 in Wudil and Dambatta local government areas (LGAs) in Kano, Nigeria. We had survey teams visit communities before distribution, and monthly afterwards June to August '24, to observe our impact upon rates of ORS and zinc treatments of under-5 diarrhoea. Surveys extended to nearby communities outside of the distribution scope, to provide comparison for a quasi-experimental evaluation.


In Phase 2 we integrated as much as possible with the local primary healthcare system, with a supervisory structure run by the ward and LGA primary healthcare teams, and distribution by government community health workers (CHWs) of  the VCM and CHIPS cadre. We also trialled hybrid paper-digital “machine readable distribution tracker” forms for CHWs to record their distribution.


Our full analysis is in progress, and we will publish more soon, but here are some learnings that we take forward:

  1. The increased operational scale, across 8 wards in 2 LGAs, went smoothly, with the teams taking in their stride the practical challenges like heavy rain and the more rural locations.

  2. Leadership and supervision by the State Primary Healthcare Management Board and LGA Primary Healthcare teams was a key component, and we thank again them for their support. We see this integration with the health system as a foundation for scalability and sustainability going forward.

  3. Preliminary analysis of the survey data suggests impact (increase in % of children under-5 diarrhoea cases treated with ORSZ) was comparable to our pilot: more on that coming soon!

  4. The machine readable paper monitoring forms (scans processed by a machine learning system) was of mixed success: certainly more scalable than human data entry, and extraction of records into a digital structure worked well, but handwriting remains challenging even for modern systems to recognise reliably. This and other limitations are a focus in Phase 3.


Phase 3


The next iteration of the distribution program, “Phase 3”, starts this month, November 2024, in Dambatta LGA, Kano. Our focus is on establishing final missing pieces for growth to large scale: distributing to whole wards at once (to then combine to LGA-level coverage), and digitising monitoring of the distribution. (For context, our surveys have all been digital, but distribution involved paper trackers.)


To record distribution paths, and aggregate these to determine coverage across a population, we are partnering with Novel-T, former WHO engineers who have built tools to support the Global Polio Eradication Initiative. There are many operational similarities between door-to-door polio vaccinator teams and ORSZ distribution that lend themselves to a common digital toolkit.


The CHWs distributing ORSZ in Phase 3 are equipped with smartphones running Novel-T GTS tracker, giving detailed insights into geographic coverage. We will be using these insights to tune the operation to reliability and transparently reach whole populations.

Preparing settlement extents and target areas for distribution in Dambatta


We plan to post more on our experiences with GTS, and the GIS data that powers it, in a future blog. Watch this space.


Thank you!


A huge thank you again to everyone who has supported our mission against preventable child deaths from diarrhoea! To our health system partners, local partners iDevPro, our advisors, and the financial supporters who enable all of this: thank you, it really wouldn’t be happening without you!


Writer's picture: Clear Solutions teamClear Solutions team

Hello! We have just wrapped up a very busy period preparing for “Phase 2”, our first scale-up of ORSZ distribution, aiming to reach 20,000 children under-5 in two new areas in Kano, Nigeria. Community Health Workers concluded their distribution 2 weeks ago and we now await a set of follow-up surveys to ascertain how treatment of children’s diarrhoea changes.


Phase 2


What were our goals?


  • Go bigger, 3x scale-up from pilot, targeting distribution to 20,000 children under-5

  • Increase the robustness of the evaluation with a quasi-experimental design. Though this is not an RCT (due to a lack of true randomisation), we also survey nearby "no distribution" settlements for comparison.

  • Partner much more closely with existing primary healthcare structures (training and supervision of Community Health Workers and other staff) to increase scalability and reinforce the healthcare system.

  • Continued close collaboration with implementation partner, iDevPro Africa.

  • Expand to new local government areas (Dambatta and Wudil, Kano) in more rural settings.


How did it go?


We await the first follow-up survey (1 month after distribution) and have some analysis to do on baseline and operational monitoring data, but early signs are positive! Reports from the field teams indicate that distribution went ahead as planned, and though survey teams suffered transport disruption from heavy rains, they all returned safely having reached enough householders. We expect to have initial results later in June.

What next?


We have started planning for “Phase 3”, later in 2024. This continue scale-up with tests of several variants of the intervention to hone in on the most cost-effective approach. Here is some of our current thinking:


  • Consolidate government-led structure with our “Train the Trainer” model with existing primary healthcare staff.

  • Build sophistication in our use of GIS (Geographic Information Systems) to plan, distribute and evaluate with greater rigour.

  • Explore a platform-based strategy to ‘layer on’ different cost-effective interventions on top of ORS and zinc. More information on this will follow in the near future!

  • Explore different distribution modalities such as facility- or chemist-based distribution and compare the cost-effectiveness to our base model.

Clear Solutions is a project of Charity Entrepreneurship operating through a fiscal sponsorship with Players Philanthropy Fund, Inc. (Federal Tax ID: 27-6601178, ppf.org/pp), a Texas nonprofit corporation with federal tax-exempt status as a public charity under Section 501(c)(3) of the Internal Revenue Code. Contributions to Clear Solutions qualify as tax-deductible to the fullest extent of the law.

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