Today (27/3/25) the fourth peer-reviewed paper* from our work in Zambia was published in the PLOS Global Public Health journal entitled:
Impact of co-packaging oral rehydration salts and zinc on diarrhoea treatment dispensing behaviour in selected rural health facilities in Zambia (2025)
This paper provides new evidence on how co-packaging ORS & zinc into a single co-pack can significantly improve dispensing practices at health facilities in low-resource settings.
The key findings were::
- Introducing the co-pack increased the odds of dispensing both ORS and zinc together by over 8 times, increasing the percentage of children receiving both ORS and Zinc from 44% to 87%.
- The greatest improvements were seen in less well-resourced health facilities, where adherence to guidelines is often lowest.
- It also reduced variability in dispensing practices, ensuring more consistent, evidence-based treatment.
At a time when global health and sustainable development funding is under immense pressure, we need to double down on interventions that are simple, scalable, high-impact, and evidence-based. Zambia’s ORS & zinc co-pack — developed using a design thinking process — is a prime example of how innovative partnerships can strengthen local markets, improve health system performance, and save lives. By leveraging international development assistance and multidisciplinary implementation teams — acting as catalysts under the guidance of local leadership and expertise — these initiatives can drive sustainable impact while strategically transitioning out.
These findings add to the strong foundation we have been building for scaling up co-packaging strategies globally. Let’s ensure that every child with diarrhea has access to the right treatment, every time.
Thanks to my co-authors Dario Domingo, Jane Berry, Akufuna Ngenda and Rohit Ramchandani.
* the other peer-reviewed papers are:
- Emulating value-chains of fast-moving consumer goods to improve uptake of co-packaged ORS and zinc for childhood diarrhoea: evaluation of the ColaLife trial (2022)
Rohit Ramchandani, Simon Berry, Jane Berry, Stephen Tembo, Robert E Black. BMJ Innovations 2022;8:169-182. - Design thinking to improve rational use of oral rehydration salts: lessons from an innovative co-packaged diarrhoea treatment kit (2023)
Rohit Ramchandani, Simon Berry, Jane Berry, Beth Anne Pratt, Albert Saka, Robert E Black. BMJ Innovations 2023;9:132-143. - Institutionalizing Innovation: From Pilot to Scale for Co-Packaged Oral Rehydration Salts and Zinc—A Case Study in Zambia (2024)
Jane Berry, Simon Berry, Elizabeth Chizema, Bonface Fundafunda, Davidson H. Hamer, Stephen Tembo and Rohit Ramchandani. Global Health: Science and Practice 2024, 12(1):e2300286
In addition, we’ve participated in a BMJ debate and had an opinion piece published on the BMJ Global Health Blog:
- BMJ debate – Should we welcome multinational companies’ involvement in programmes to improve child health? (2015)
S Berry, J Berry, R Ramchandani, N Spencer. BMJ 2015;350:h3046 - BMJ Global Health Blog – Expanding ORS/zinc coverage for childhood diarrhoea: is institutionalising free distribution the answer? (2024)
We were also the subject of another peer-reviewed paper written by others. This focussed on the unique and very effective way we worked to ensure that the change we helped create was sustainable and continued to scale after our involvement. Please see:
- Social Entrepreneurs as Ecosystem Catalysts: The Dynamics of Forming and Withdrawing from a Self-Sustaining Ecosystem (2024)
Paulo Savaget, Pinar Ozcan, Tyrone Pitsis. Journal of Management Studies 2024, Volume 62, Issue 1
