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New Incentives plans to provide treatment for childhood diarrhea during immunization sessions at the government clinics where we operate in northern Nigeria, thanks to a recommended grant of up to $4,759,596 from GiveWell. The treatment, oral rehydration solution and zinc supplementation (ORSZ), is a proven intervention that is very inexpensive and can mean the difference between life and death for a child with severe diarrhea.

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“We’ve developed a successful track record. We’ve scaled a cost-effective direct delivery program that saves lives with a high degree of program monitoring and quality. It’s exciting to now see the potential of the platform we’ve created. Donors have placed trust in us and placed confidence in New Incentives’ platform. By leveraging our existing framework, we can have an additional impact on childhood mortality, saving even more lives.”
- Svetha Janumpalli, New Incentives Founder and CEO

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Diarrheal disease is one of the leading causes of death for children under five in Nigeria, responsible for nearly 100,000 deaths in 2021 alone—compared to less than 100 related deaths in the United States. This stark disparity highlights how a treatable condition continues to claim young lives due to limited access to basic medical interventions. When a child develops severe diarrhea, they can lose dangerous amounts of water and electrolytes within hours, leading to severe dehydration that can be fatal if left untreated. Children under five are especially vulnerable, with those in their first two years of life at the highest risk.

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Please note that, although the graph above shows that the number of deaths from diarrheal diseases decreases after a peak in ~2008, diarrheal diseases are the fifth leading cause of death in this age group in Nigeria.

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Oral rehydration solution (ORS) works by replacing crucial fluids and electrolytes lost during diarrheal episodes. When combined with zinc supplementation, which reduces the severity and duration of diarrhea while strengthening the immune system, this simple intervention can reduce diarrhea-related child deaths by up to 93% (source). The World Health Organization has recognized ORSZ as one of the most impactful child survival interventions, crediting it as one of "the top interventions responsible for 5-11% of total deaths averted" in Niger, Nigeria, and Kenya.

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The new funding aims to significantly expand access to this life-saving treatment by offering it for free alongside our existing cash incentives program. It will enable New Incentives to distribute free ORSZ co-packs to caregivers bringing their children for immunizations across eight states in Nigeria over three years. Each caregiver will receive three ORSZ co-packs, enough to treat multiple episodes of diarrhea. Additionally, our program will provide vital education about proper ORSZ preparation, usage, storage, and early warning signs of dehydration that require immediate treatment.

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We are expanding our household coverage surveys to better understand ORSZ coverage, utilization rates, and diarrhea incidence among our target populations. This data will be used to help measure cost-effectiveness and inform decisions about program expansion. We will strategically scale the intervention only in areas where data demonstrates strong cost-effectiveness.

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“We think the program is cost-effective. Intuitively this is because New Incentives reaches a large number of young children through its existing immunization program, ORSZ distribution is relatively inexpensive, ORSZ is effective at treating dehydration from diarrhea, and we think providing ORSZ to caregivers of young children will avert deaths during a particularly vulnerable period.” 
- GiveWell (read more)

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GiveWell also highlighted that they expect monitoring and evaluation (M&E) implemented alongside the grant to generate evidence about how the program impacts uptake, and they have “a strong qualitative impression of New Incentives.”

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The first six months of 2025 will be dedicated to deploying ORSZ survey questions by adding them to the current coverage surveys to measure diarrhea incidence and ORSZ usage rates in areas where New Incentives currently works. We will also be testing educational materials and messaging for caregivers and piloting distribution in a few LGAs. Distribution of ORSZ is set to launch on a rolling basis as results from those surveys come in. 

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“This is just the start of complementary additions. The future is bright if we can successfully leverage New Incentives’ platform to address additional drivers of childhood mortality.”
- Svetha Janumpalli, New Incentives Founder and CEO