Oral rehydration solution (ORS) + zinc co-pack

Feb 01, 2019

Special features

Boxing gloves labeled with ORS and zinc

In July 2019, the World Health Organization set the global norm to deploy a simple, powerful game-changer: the ORS + zinc co-pack. 

Now, we need to encourage more countries to follow suit with their own essential medicine lists. Read on.




We have a winning team of solutions to defeat diarrheal disease. But tenacious obstacles to access have a field advantage — to the detriment of the children who need these tools the most.

ORS + zinc: stats and endorsements*

Deadly diarrhea is simple to treat with oral rehydration solution (ORS): a mixture of sugar, water, and salt. Already credited with saving millions of lives, The Lancet has called ORS one of the most important medical advances of the twentieth century.

Zinc is an essential nutrient that becomes depleted during diarrhea. When given as a supplement, it reduces the duration and severity of illness and even helps prevent future episodes.

In 2004, the World Health Organization (WHO) set a global recommendation to formalize ORS + zinc as the gold standard treatment for diarrheal disease.

When ORS and zinc team up together, diarrhea doesn’t stand a chance.

*ORS and zinc are brought to you by entities in every sector that believe every child, everywhere should survive childhood and thrive to their full potential. Read the letters of support from nonprofits, donors, high-burden countries, academia, and the private sector. 


Mother feeding a cup of ORS to her baby


The state of play

But there’s a problem. The global use rate of powerful, inexpensive ORS + zinc treatment for childhood diarrhea is at a dismal 15%. Lack of awareness and barriers to access keep these All-Stars stuck at a disadvantage.

A riddle: Your baby has diarrhea, and it’s only getting worse. On the radio, you hear about two medicines that can help her. You travel to a clinic, but only one is available. Why? Because they aren’t supplied together.  

You can’t afford the cost of getting to the clinic again or taking more time away from your income-earning activity. You try to decide if you should just make do with what you have. Maybe a traditional medicine your in-laws swear by. 

No one should have to make that choice.


Our move: the co-pack effect

If ORS + zinc is the winning strategy against deadly diarrhea, the game plan is to ensure that both are available. The most obvious way to do that is to package them together. Combining ORS + zinc amplifies their lifesaving power, cost-savings, and access.


Sliding scale of increased access with ORS and zinc co-pack in Zambia
With the introduction of co-packaged ORS + zinc at health centers in Mongu District, Zambia, the rate of treatment of childhood diarrhea with both products doubled from 44% in 2016 to 87% in 2017.


Thanks to a petition by PATH and partners, in July 2019, WHO added co-packaged ORS + zinc to its Model List of Essential Medicines for Children (EMLc), a policy document that will help encourage countries to also prioritize the co-pack in their expenditures, procurement and supply, and training of healthcare providers. 

Six countries have already introduced the co-pack into their national essential medicines lists: Ghana, Senegal, Ethiopia, Kenya, Vietnam, and Zambia.


Color coded map of countries that have introduced co-packaged ORS and zinc


We have two highlight reels so far from the Zambia experience: one from Simon Berry, co-owner of ColaLife, which helped get a locally produced ORS/zinc co-pack off the ground, and another from John Phiri, a pharmacy owner in Lusaka who shares common concerns of parents seeking diarrhea treatment. The post also features Irene Mirembe, a pharmacy owner in Uganda. 

Read this essay from Alfred Ochola and Mathu Santosham two pediatricians who have spent decades witnessing the power of ORS and zinc in India and Kenya.


Your move

We have the game plan. We need to make sure leaders get the ORS + zinc co-pack All-Star off the bench and into national defensive game plans against diarrheal disease. Here are two ways to take action:

1. Join the ORS/Zinc Co-pack Alliance (ORSZCA), an effort focused on accelerating implementation of WHO's policy.

2. Share one of these posts, along with one of these graphics, on Twitter, Facebook, LinkedIn, or other social media platform of choice:


  • .@WHO lists co-packaged ORS and zinc as an essential med for children. http://bit.ly/2RZO8Sx Now countries must take the baton to improve access to this lifesaving diarrhea treatment: #DefeatDD  
  • % of children treated with ORS + zinc is lowest where the diarrhea burden is highest. @WHO’s inclusion of these co-packaged meds changes the state of play: http://bit.ly/2RZO8Sx #DefeatDD  
  • The cascading impact of an ORS + zinc co-pack: improved uptake, effectiveness, and cost. http://bit.ly/2RZO8Sx #DefeatDD
  • An estimated 64% of diarrhea deaths in children could be prevented with full coverage and use of ORS and zinc. http://bit.ly/2RZO8Sx #DefeatDD
  • Combined approach = cost-savings. The ORS + zinc co-pack is 46% more affordable than the average price of separate purchases. http://bit.ly/2RZO8Sx #DefeatDD