3 Years of Clear Solutions: Taking Layering to Scale
This October, Clear Solutions celebrates its third anniversary! In three years we have gone from a two-person team with a seed grant to programs reaching hundreds of thousands of children across two countries. Along the way we have tested, measured, and sometimes changed course, always in pursuit of one goal: a world in which no child dies a preventable death from diarrhoea.
Since our founding in 2023, we have provided free “co-packs” of oral rehydration solution and zinc (ORSZ), the simple, low-cost treatment for childhood diarrhoea, to the caregivers of an estimated 900,000+ children under-5.
Year Three at a Glance
Over 800,000 children under-5 reached with ORSZ in 2026
Over 1.5 million co-packs produced by manufacturers and received for 2026 distributions.
2 countries, 2 delivery models: adding ORSZ to health campaigns with Malaria Consortium and Helen Keller Intl in Nigeria and Chad, and reusable vouchers to redeem at NAPPMED-registered chemists and community health workers in Kano
74.1 percentage point (pp) increase in ORS use measured when ORSZ was layered onto Chad’s 2025 malaria campaign
1,326 children’s lives expected to be saved by our 2026 programs if they reach their targets (according to our internal modelling, which is adapted from GiveWell’s cost-effectiveness analysis)
Our Story So Far
Sadly, diarrhoea remains one of the leading killers of children under 5. Most of those deaths occur due to dehydration, which can be treated effectively and cheaply with oral rehydration solution (ORS) and zinc. Both are on the World Health Organization’s list of essential medicines, but many children are still not receiving ORSZ when they need it. Clear Solutions was founded to close that gap.
Founding (June–August 2023): Clear Solutions was launched by co-founders Martyn James and Charlie Jeong through the Charity Entrepreneurship Incubation Program, with a seed grant to test free, door-to-door delivery of ORSZ in Nigeria.
Pilot (Dec 2023–Feb 2024): Proving the concept. With our implementing partner iDevPro Africa, community health workers went door-to-door in Kano State, northern Nigeria, reaching roughly 6,900 children under-5. Follow-up surveys found that the share of children with diarrhoea that were treated with ORS rose by more than 42 percentage points, and with both ORS and zinc by more than 61.
Phase 2 (Q2–Q3 2024): Scaling with government. We reached around 20,000 children, integrated supervision into the state Primary Healthcare system, and tested scalability with a quasi-experimental design.
Phase 3 (Q4 2024–Q1 2025): Going digital. Reaching an estimated 35,000 children, we equipped community health workers with GPS-enabled smartphones to track distribution in communities that often lack reliable household addresses.
Phase 4 (2025): Testing new ways to reach families. Door-to-door distribution worked, but was expensive to run. So we tested four new models at once. Three "layered" ORSZ onto health services that already reach families: malaria-prevention campaigns in Chad; childhood vaccination clinics in Kogi State, Nigeria; and health centres ("ORS Corners") in Kano. The fourth gave families in Kano vouchers to collect free ORSZ from a local chemist.
→ Scaling what works (2026): The strongest of those models are now scaling up, and new layering partnerships are being tested.
2026: Scaling Up and Expanding
The standout result came from our work in Chad. Each rainy season, health workers with Malaria Consortium and Chad’s Ministry of Health go door to door giving children medicine to prevent malaria, a campaign known as seasonal malaria chemoprevention (SMC). In 2025, in one district, they also gave caregivers ORSZ and showed them how to use it, reaching 13,376 children. An evaluation led by Dr Zachary Wagner of the University of Southern California found that the share of children with diarrhoea treated with ORS rose by 74 percentage points, and with zinc by 69, with no drop in the malaria campaign’s reach (manuscript under review).
1. Scaling Up in Chad
Building on the 2025 pilot, this year we expanded our partnership with Malaria Consortium to two provinces in Southwestern Chad, Mayo-Kebbi Est and Mayo-Kebbi Ouest, targeting 634,389 children under-5 with two co-packs each. It’s our largest program yet, in an area where only about 1 in 5 children with diarrhoea get ORS.
Getting there was a feat of logistics: more than a million co-packs spent three months travelling by sea from Lagos, Nigeria, to Douala in Cameroon, then by truck to Chad’s capital, N’Djamena.
Health workers handed out ORSZ alongside the malaria campaign in August and October.
2. Taking the Model to Nigeria
Within a few months, we took the Chad model to a second country. With Malaria Consortium Nigeria and local health officials, we added ORSZ to the malaria campaign in one district each of Kebbi and Sokoto states, in northwestern Nigeria, aiming to reach about 124,000 children. Surveys after distribution found that 95–96% of targeted children received ORSZ.
3. Adding ORSZ to Vitamin A Week
Twice a year, Nigeria holds a child health week when children receive vitamin A and other services. With Helen Keller Intl and health officials in Taraba State, in northeastern Nigeria, we layered ORSZ onto vitamin A supplementation in one district in June. Early data suggest about 70% of eligible children, roughly 52,000, received ORSZ, helped by follow-up home visits to families who missed the event.
4. Expanding Vouchers in Kano
Many families in northern Nigeria go first to a local chemist shop (a “kemi”) when a child is sick. In our pilot, families received vouchers for free ORSZ at their kemi: 84% used them, and ORS use among children with diarrhoea rose from 49% to 81% (zinc use from 19% to 90%). This year we expanded to two whole wards covering more than 12,000 children, with vouchers redeemed at local chemists or, where there isn’t one, community health workers and volunteers. Through this program, families have already collected over 24,000 co-packs. We also built our own app to scan vouchers and track stock in real time, and we’re exploring whether these redemption points could offer other household health products too, such as chlorine for safe drinking water. Clean water is a natural pairing with ORS: unsafe water is a major cause of diarrhoea, and caregivers need clean water to mix ORS correctly.
What We Learned
Three years of piloting has taught us as much from what didn’t work as from what did. A few lessons now shape every program we design.
Proven isn’t the same as affordable at scale. Our door-to-door pilots showed large, consistent increases in treatment, but running a dedicated door-to-door distribution network is less efficient and scalable than leveraging existing distribution platforms. Layering ORSZ onto services that already reach children cuts most of that cost, and it’s why our reach has been able to grow so quickly this year.
ORSZ needs to be in reach before a child falls sick. Our “ORS Corners” pilot trained and resupplied staff at seven health centres in Kano, where more than 13,000 children with diarrhoea received ORSZ. But only about 30% of local caregivers knew free ORSZ was available, and overall treatment rates in the community didn’t measurably change. Facilities are often far from the home, and can only help families who come to them. Campaigns that visit every household, like the malaria campaigns and vitamin A week, put co-packs in the home ahead of need. Our vouchers show a second route: a voucher delivered to the door, redeemed at the local chemist within walking distance where caregivers already go first when a child is sick. The voucher evidence is still early, and we are now testing whether it holds up at a larger scale.
Deeper evaluation investments enable clearer decision-making. Our pilot with Notify Health in Kogi, layering ORSZ onto routine immunisation sessions at health facilities, showed promise but would need a larger study to prove itself. We have built increased evaluation sophistication and capacity in 2026, which make this a true strength for the organisation.
A sachet only saves a life if it’s mixed correctly. Our baseline study for vouchers scale-up in Kano found that fewer than one in ten caregivers could find and read the water-volume instructions on ORS packaging. Qualitative research in Chad and focus groups in Kano are now shaping clearer, picture-led leaflets and counselling scripts.
Building the Organisation
Scaling our programs has meant scaling our team. In Year 3, we have doubled in size, bringing on experienced senior hires:
Harrison Bowers, Operations Lead
Dr Estelle Altazin, Programs Lead
Heena Tariq, Research & Impact Evaluation Lead
Souha Ouassou, Project Delivery Manager
We successfully registered Clear Solutions UK as an independent charity in late Q3 2025. Having previously worked under a “fiscal sponsorship” umbrella of US non-profit ppf.org, we are now fully independent and we have built many crucial systems through 2026. As part of this shift, we are now able to claim Gift Aid uplift on UK taxpayer donations!
The Path Ahead: Year Four
Our approach stays the same: add free ORSZ to health services that already reach children, and scale up what the evidence supports. In the next year, we plan to:
Roughly double our reach in Chad to nearly 1.25 million children under-5, working with Malaria Consortium and our funders.
Scale what works in Nigeria following this year’s results, possibly including all of Taraba, Kebbi, and Sokoto, about 3 million children.
Grow our vouchers program to cover 210,000 children.
Expand to a third country, starting with Cameroon, where a first pilot of around 15,000 children is being planned with partners, and scoping further new countries.
Work towards government adoption, so that ORSZ becomes a routine part of child health campaigns.
Acknowledgments
None of this would be possible without our partners: Malaria Consortium, Helen Keller Intl, iDevPro Africa, Notify Health and Fidson Healthcare; the Chad Ministry of Health and the State Ministries of Health in Kano, Kogi, Taraba, Kebbi and Sokoto; and the community health workers, local chemists, data collectors and survey staff who carry out this work in challenging environments.
Thank you to Charity Entrepreneurship, which helped launch us, and to our funding partners, including GiveWell, Coefficient Giving, Ultra Philanthropy and their donors funding the Mid-Stage Global Health Fund, Founders Pledge, Effektiv Spenden, Nadační fond Kladné nuly, Aliya Kanji Foundation, and many individuals for their trust and support.
Most of all, thank you to the caregivers who open their doors to us. Here’s to year four!
Clear Solutions UK is a registered Charitable Incorporated Organisation (Charity Number 1214767).
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