Layering ORS and Zinc provision onto existing health delivery infrastructure

In our first 15 months operating in Nigeria, the team at Clear Solutions are proud to have distributed ORS and zinc (ORSZ) to caregivers of an estimated 65,000 children under-5 in Kano state. We iterated in 3 major phases to build scalability and robust monitoring & evaluation methods, collaborating with the state primary healthcare system to engage community health workers (CHWs). The CHWs distribute ORSZ door-to-door in communities, giving caregivers a co-packaged box including ORS and zinc (“co-pack”) for each child under-5, to use as and when the child suffers from diarrhoea.

As we wrapped-up Phase 3 ORSZ distributions in February 2025, we set ourselves the challenge to further evolve the model to be as cost-effective, scalable, and sustainable as possible.

Through that lens, we think that layering ORSZ provision onto carefully selected existing health delivery infrastructure can be a major advance. “Infrastructure” in this context can vary from door-to-door health services that reach the same target populations, eg. seasonal malaria chemoprevention for under-5s; or fixed points where caregivers of under-5s already interact with health services, eg. immunisation sessions or local medicine vendors.

“Layering” isn’t a panacea for intervention delivery: there are trade-offs with complexity, potentially also with reach; and not all interventions serve the same populations at the same time of need. But ORS and zinc are well-suited to layering (light, durable in dry environments, with flexible timeframe for “preemptive” distribution), and we see several distribution models that complement our ORSZ program well and may unlock significant extra cost-effectiveness and scale.

This month, we will start provision of ORSZ co-packs to caregivers of infants at routine immunisation clinics and community outreach sessions in Kogi, Nigeria, in partnership with Notify Health and the Kogi State Primary Healthcare Development Agency. Layering upon the immunisation delivery infrastructure reaches infants under 2 years old, who are at especially high risk of death from diarrhoea. Our pre-post evaluation of this approach will give us insights into ORSZ treatment rate increase amongst other metrics to help evaluate the effectiveness of this type of layering approach.

We are also planning to layer ORSZ provision onto a door-to-door distribution to under-5s in Chad, starting July this year. We’ll be able to write more soon, but suffice to say, this is a crucial opportunity to serve children who suffer terribly high rates of mortality from diarrhoea in a cost-effective and scalable manner.

Thank you as ever for your interest, and we look forward to sharing more about these opportunities soon!