This post comes to you from the domestic departure lounge at Abuja airport, Nigeria, where we’ve spent most of the day waiting for a flight to Gombe, northeast Nigeria. Dry, dusty conditions and strong winds in Gombe are causing dust clouds that reduce visibility below the minimum for aircraft to land.
We are now in Week 9 since our new charity, Clear Solutions, was confirmed funded and we kicked-off in earnest; and so we find ourselves visiting partners, communities and state/national healthcare agencies across Nigeria. The previous 8 weeks have really been a build-up to this, working to establish our organisation, learn from a growing network of people+organisations who have worked in Reproductive, Maternal, Newborn & Child Health (RMNCH) in regions with limited healthcare access, and building our ability to work in Nigeria (partnerships, government outreach, etc).
Weeks 1-4: Learning from ORSZ veterans & finding our niche
A reality that we initially under-estimated, but that soon became abundantly clear, is that improving access to ORS & zinc treatment in countries with high child mortality from diarrhea (the 2nd largest killer of children under 5 globally) has received a lot of attention from NGOs & Governments in the last 20+ years. There are some notable successes, with eg. Bangladesh decreasing child mortality from diarrhea very significantly with wide rollout of ORS. However, it was also clear that the remaining high diarrheal mortality in countries like Nigeria and Ethiopia is not for lack of action by charitable/development organisations like USAID, CHAI, R4D, UNICEF, PATH and many others. In fact, their 2016 “Progress over a decade of ORS & zinc scale-up” report demonstrates an expansive set of interventions to build public+private sector systems to increase ORS usage at scale. That the big players have done so much and a huge problem remains, begged the question of what a small startup charity might realistically achieve.
We were lucky in Week 1 to meet with Leith Greenslade, Founder of JustActions and a veteran of the fight against child mortality from pneumonia and diarrhea. She kindly heard-out our aspirations, made it clear that this would not be straightforward, but introduced us to 10+ key people from her network, including the big aid agencies mentioned above. Those intros were invaluable in getting time with the people who had been fighting the diarrhea problem for years, substantially building our understanding of a complex landscape. One striking point was that efforts had largely wrapped-up ~2018; a sign of shifting trends in development funding, and perhaps a reaction to success in some countries and frustration at the lack of progress in others.
A big nod also goes to Simon & Jane Berry, founders of ColaLife, a charity of the 2010s that set out with similar goals & scope to our own, increasing ORS+zinc (ORSZ) usage in Zambia. They successfully catalysed improvements right along the value chain from product design and manufacture all the way to end customers’ needs (or vice versa), stimulating usage of their anti-diarrhea Kit Yamoyo, first by via the private sector, then with demand established also via public sector. They pioneered product improvements in co-packaged ORSZ – practical changes like smaller ORS sachet size to account for scarce clear drinking water & limited clear storage for prepared solution, and packaging that doubled as a measuring container: innovations that are yet to arrive in eg. Nigerian supplychains, Their playbook and open source materials gave us a lot of food for thought, and they kindly agreed to be regular advisors and sounding boards as we developed our ideas further.
Clear Solutions came about because of a research report by Charity Entrepreneurship into the potential impact of a charity modelled specifically around having Community Health Workers (CHWs) distribute ORS+zinc (ORSZ) free door-to-door to households with children under 5 years old, providing guidance on benefits & usage to caregivers/parents. Said report was informed in large part by a Uganda randomized controlled trial of that intervention; Wagner et al, 2019. We deliberately took a step back as we looked at the broader systemic challenges of increasing ORS+zinc usage, but after consulting with the veterans and the primary research, the community-level element seemed to be a relative gap in the work done previously. Perhaps CHWs are the key in addressing the remaining barriers to ORS+zinc usage. This is our working hypothesis and key to explore in our country visits.
Worthy of a sentence: we also created our website (courtesy of Ula at Charity Entrepreneurship), ran a design contest for our logo (which I’m very pleased with), and did all sorts of basic org setup tasks.
Weeks 5-8 coming-up in Part 2 of this post.
G2CE 