Collaborating with Helen Keller Intl to integrate ORSZ distribution with vitamin A supplementation during MNCHW in Nigeria

At Clear Solutions, we are exploring the potential of layering oral rehydration solution and zinc (ORSZ) distribution onto existing delivery platforms to expand access efficiently and at scale. This journey began last year through our partnership with Malaria Consortium in Chad, where we piloted the integration of ORSZ distribution into Seasonal Malaria Chemoprevention. The program outcome reinforced the promise of layering as a practical strategy for reaching children with life-saving treatments (results to be published soon).

We are now excited to announce a new partnership with Helen Keller Intl to pilot the integration of ORSZ distribution into vitamin A supplementation during Maternal, Newborn and Child Health Week (MNCHW) in Taraba state, Nigeria. Together, we aim to test whether this established child health platform can be used to get effective diarrhoea treatment into households before a child becomes sick, while preserving the quality and reach of existing services.

Why this matters

Diarrhoeal disease remains a major cause of illness and death among children under 5 in Nigeria, with 15% of children in Taraba experiencing diarrhoea annually. Despite ORS and zinc being simple, inexpensive, and highly effective treatments, only 25.5% of children with diarrhoea receive them.

Why MNCHW is a promising platform

MNCHW is a government-led campaign platform that already reaches large numbers of children with essential services, including vitamin A supplementation (reaching more than 80% of children), deworming and routine immunisation, through health facilities and outreach sites. It benefits from structured microplanning, standardised training and daily supervision. Since caregivers are already bringing children to these service points, MNCHW offers a strong opportunity to layer in ORSZ distribution without creating a separate delivery system.

Health workers registering Children at the facility

What the pilot will do

The pilot will be implemented during MNCHW in Bali LGA, Taraba State. Caregivers of children aged 0-59 months attending MNCHW services will be eligible to receive 2 ORSZ co-packs. Children aged 6-59 months will continue to receive vitamin A supplementation under the standard protocol.

Caregiver education is a central part of the model. At service delivery points, caregivers will receive a short group health talk. This will cover risks of diarrhoeal disease, the efficacy of ORSZ treatment, proper ORS preparation, administering the full course of zinc, and identifying danger signs that require further care. This will be reinforced with a brief check at handover and an illustrated take-home instruction leaflet.

Our monitoring and evaluation approach

The pilot’s M&E strategy is designed to be rigorous while also being practical and embedded in existing systems.

The main evaluation will be integrated into Helen Keller’s standard post-event coverage survey (PECS), which is conducted after the campaign by a third-party survey firm. The survey will mainly assess whether caregivers report receiving ORSZ and whether children received both vitamin A and ORSZ as intended.

Alongside this, monitoring will be adapted to include ORSZ indicators in tally sheets and summary forms. This will allow the team to track administrative coverage, review day-to-day implementation, monitor stock flow and stock-outs, and identify areas that may require corrective action or mop-up. Importantly, the pilot will also monitor vitamin A coverage in the pilot area to ensure that the addition of ORSZ does not compromise the reach or quality of existing MNCHW services.

A child receiving VAS

What we hope to learn

This pilot is designed not only to deliver ORSZ, but to generate practical evidence on whether and how this approach could be expanded, especially since fixed point delivery is relatively new to Clear Solutions. We want to understand whether ORSZ can be layered onto MNCHW in a way that is operationally feasible, scalable, and cost-efficient, while maintaining the strength of existing vitamin A services.