In the lakeside county of Kisumu, western Kenya, community health volunteers—known as CHVs—walk door to door each morning, notebook in hand. They ask mothers about the previous 24 hours: Has the child had loose stools? How many times? Is there blood? The answers go into a ledger, then into a digital platform called DHIS2, Kenya’s health information system. The data show a clear pattern: diarrheal cases spike every rainy season, and young children are the most affected. But when a CHV finds a child with moderate dehydration, the simple treatment—a sachet of oral rehydration salts—is often missing from the local dispensary. The stock has been out for weeks.

The Two-Way Tracker: CHVs Record Diarrhea While ORS Shelves Empty

In the informal settlements around Kisumu city, each CHV is responsible for roughly 100 to 200 households. Alice Odhiambo, a volunteer in the Obunga area, starts her rounds at 7 a.m. “I see about five to ten diarrhea cases per week during the rainy season,” she says. She records each case on a paper form and later enters the data into a smartphone app. The information travels upward: sub-county health teams can see trends in near real-time.

Yet the same system that collects data does not guarantee that treatment is available. At the Nyamasaria dispensary, a facility serving several thousand people, the ORS shelf has been bare for three weeks. “We submitted a requisition to the sub-county store, but nothing came,” says the nurse in charge, who asked not to be named because she is not authorised to speak to the press. Parents are told to mix sugar and salt at home—a practice that can be dangerous if proportions are wrong.

The paradox is stark: the county health department knows exactly where cases are rising, but the supply chain cannot respond. “We have the data, but we don’t have a feedback loop that triggers resupply,” explains Dr. James Ochieng, a public health officer in Kisumu County. “The CHV reports go into a database, but procurement works on a quarterly cycle that doesn’t align with disease patterns.”

County health officials attribute the stockouts to procurement delays at the Kenya Medical Supplies Authority (KEMSA). Orders are placed every three months, and emergency requests can take two to four weeks to process. Meanwhile, children continue to fall ill. A 2024 assessment by the county health team found that ORS stockouts occurred in roughly 40% of facilities in Kisumu during the long rains.

Why ORS Stockouts Persist Despite Global Supply Glut

Oral rehydration salts are among the cheapest and most effective interventions in global health. A WHO-prequalified sachet costs under US$0.10 to produce. There is no global shortage—manufacturers in India and Kenya produce millions of sachets each year. Yet stockouts persist in many parts of sub-Saharan Africa, including Kenya.

The bottleneck is not supply but logistics and financing. Kenya’s devolved health system gives county governments responsibility for primary care, including the procurement of essential medicines. Each of the 47 counties manages its own supply chain, and forecasting is often inaccurate. “Sub-county pharmacists estimate needs based on past consumption, but they don’t have access to real-time surveillance data,” says Mary Wanjiku, a supply chain specialist who has worked with the Ministry of Health. “So they order a fixed quantity every quarter, regardless of seasonal surges.”

Donor-funded ORS arrives irregularly. UNICEF, for example, supplies sachets through its Essential Medicines program, but shipments are often earmarked for specific regions or time-bound projects. In 2024, a shipment of 500,000 sachets destined for Kisumu was delayed by three months due to a port clearance issue in Mombasa. When donor supplies run out, counties are expected to purchase their own—but many allocate less than 2% of their health budget to ORS. In the private sector, a sachet can cost US$0.30 to US$0.50, which is prohibitive for families living on less than US$2 per day.

KEMSA’s own order cycles compound the problem. The national medical store requires counties to submit orders at least eight weeks in advance. If a county underestimates demand during a flood-related outbreak, it cannot quickly adjust. “By the time the order arrives, the outbreak may have peaked, or the stock may expire unused,” Wanjiku adds.

Diarrheal Disease Burden in Western Kenya: A Preventable Resurgence

Diarrheal disease remains a leading cause of death among children under five in Kenya, despite significant progress. According to the Demographic and Health Survey, under-five mortality from diarrhea dropped by roughly 50% between 2000 and 2020, thanks to improved water, sanitation, and the introduction of the rotavirus vaccine in 2014. But recent trends are worrying.

In 2024 and 2025, heavy floods in the Nyanza region—which includes Kisumu—contaminated water sources and displaced families, leading to a sharp increase in diarrheal cases. The county health department recorded a 30% rise in under-five diarrhea admissions compared to the previous year. Rotavirus vaccine coverage stands at about 83% nationally, but in some remote areas of Kisumu it is lower, and non-vaccine serotypes are filling the gap.

“The rotavirus vaccine covers the most common strains, but other pathogens—like Shigella, Cryptosporidium, and enterotoxigenic E. coli—still cause severe diarrhea,” says Dr. Grace Mwangi, a pediatrician at Kisumu County Referral Hospital. “These cases require ORS and sometimes antibiotics, but we see a lot of antibiotic misuse. Parents buy over-the-counter drugs for bloody diarrhea without proper diagnosis.”

Antimicrobial resistance is a growing concern. A 2025 study in western Kenya found that roughly 40% of Shigella isolates were resistant to ciprofloxacin, a commonly used antibiotic. Without access to ORS, children with diarrhea are more likely to become dehydrated, and the temptation to use antibiotics—even when not indicated—increases.

The burden falls disproportionately on the poorest households. In the fishing villages along Lake Victoria, families rely on untreated lake water for drinking. A 2023 survey by the Kenya Medical Research Institute found that 60% of households in these communities had no access to a latrine. Diarrhea is a constant threat, and when ORS is unavailable, the consequences can be fatal.

Eyes on the Ground, Hands Tied: The CHV Network and Stockout Cycle

Kenya’s community health volunteer program is one of the largest in Africa, with roughly 100,000 volunteers covering millions of households. These volunteers are the backbone of primary care, providing health education, family planning, and disease surveillance. In Kisumu, they are the first point of contact for a child with diarrhea. Each CHV is trained to assess dehydration and administer ORS. They carry a simple color-coded chart: green for no dehydration, yellow for some, red for severe. In theory, they should have a supply of ORS sachets to give to families immediately. In practice, their stocks are often depleted.

“I used to carry ten sachets in my bag, but now I have none,” says Odhiambo. “I tell mothers to boil water, add salt and sugar, but I worry they will get the ratio wrong.” The CHVs file monthly reports to their supervising facility, but the reports rarely trigger a resupply. “We send the data to the sub-county, but we don’t hear back,” says John Otieno, a CHV coordinator in Kisumu East. “The facility nurse says there are no orders coming in.” The disconnect is partly bureaucratic: CHVs are not integrated into the supply chain system. They are volunteers, not employees, and their resupply depends on the facility’s stock, not the community’s need.

Motivation stipends are another challenge. CHVs are supposed to receive a monthly allowance of about US$20, but payments are often delayed by six months or more. “I have not been paid since January,” says Odhiambo, speaking in June. “I still do the work because I care about the children, but many volunteers have quit.” High turnover means loss of trained personnel, and new recruits must be trained again, further straining the system.

Budget Lines and Bureaucracy: Where the Money Gets Stuck

The Kenyan government has committed to universal health coverage, and the Ministry of Health’s Essential Medicines List includes ORS as a core item. But budget allocations at the county level tell a different story. A 2025 audit by the International Budget Partnership, titled “Health Budget Accountability in Kenya’s Devolved System: A Case Study of Kisumu County,” found that counties spend, on average, less than 2% of their health budget on oral rehydration salts and other diarrhea treatments. Most of the money goes to salaries and curative care.

Procurement is further complicated by devolution. Since 2013, Kenya’s 47 counties have had their own health budgets and supply chains. While this was intended to bring decision-making closer to the people, it has created fragmentation. Each county negotiates its own contracts with suppliers, and smaller counties lack the bargaining power to get low prices. “The county has to go through a tendering process that can take months,” explains a county procurement officer who spoke on condition of anonymity. “Emergency procurement is possible, but it requires approval from the county executive, which adds time.”

The World Bank financed a US$150 million health system strengthening project in Kenya, part of which supports supply chain improvements. But the project’s impact has been uneven. In some counties, new warehouses and logistics software have reduced stockouts; in others, the money has been slow to reach the front line. “The funds are there, but the bureaucratic processes are slow,” says Dr. Ochieng. “We need to give county health teams the authority to spend money quickly when an outbreak hits.”

A Practical Fix: Resupply Triggers and Buffer Stocks

Solutions exist, and some have been tested in small pilots. In Siaya County, neighboring Kisumu, a pilot program introduced an automated resupply trigger: when a facility’s ORS stock drops below a two-week threshold, an order is automatically generated and sent to the sub-county store. The pilot, run by the nonprofit organisation PATH, reduced stockouts by roughly 80% over 18 months.

Another approach is to create buffer stock depots at the sub-county level. Instead of relying on a central county store that may be hours away, each sub-county holds a reserve of ORS and other essential medicines. When a facility runs out, it can draw from the depot immediately, and the depot is replenished from the county store. This shortens the last-mile delay from weeks to days.

CHV-led distribution could also help. In the pilot, CHVs were given a small supply of ORS sachets to carry on their rounds, and they were allowed to restock directly from the facility rather than waiting for a formal order. The cost per child treated was less than US$0.50, including the sachet and the volunteer’s time. “It’s incredibly cheap,” says Dr. Mwangi. “The problem is not the cost; it’s the system.”

However, these fixes face significant barriers to scale. The automated resupply system requires reliable internet connectivity and a functional electronic inventory system—both of which are patchy in rural Kenya. Buffer stock depots require additional storage space and staff, which counties may be reluctant to fund. CHV-led distribution raises concerns about accountability: if sachets are lost or misused, who is responsible? Moreover, the political economy of health supply chains in Kenya is complex. County governments may resist changes that reduce their control over procurement, and KEMSA has historically been slow to adopt new technologies. “The pilot in Siaya worked because it had dedicated donor funding and a strong local champion,” says Wanjiku. “Scaling it to all 47 counties would require a level of political will that we haven’t seen yet.”

Kenya’s own Essential Medicines List already includes ORS, and the country has a national supply chain policy that emphasizes last-mile delivery. But implementation lags. “We have the policies, we have the data, we have the volunteers,” says Wanjiku. “What we need is the political will to connect them.”

From Surveillance to Supply: Closing the Loop

The digital platform DHIS2 already collects data from thousands of health facilities and CHVs across Kenya. In Kisumu, the data shows exactly where diarrhea cases are rising and which facilities are running low on ORS. The missing piece is a link between the surveillance system and the procurement system. “If a facility reports a stockout of ORS, the system should automatically flag it and trigger a resupply,” says Dr. Ochieng. “That is technically feasible today.”

Similar approaches have worked in other countries. In Rwanda, a national electronic supply chain system reduced stockouts of essential medicines by more than 50% within two years. In Malawi, community health workers use a mobile app to report stock levels, and the data feeds directly into district procurement. Kenya has the infrastructure—DHIS2 is already used nationwide—but the integration has not been made a priority.

In Kisumu, there is no documented example of a facility that has successfully used DHIS2 data to trigger a resupply of ORS. “We’ve talked about it for years, but it hasn’t happened,” says Dr. Ochieng. “The data flows one way—from the community to the county—but the supply chain flows separately. They are two parallel systems that never meet.” A 2024 evaluation by the county health department found that only 12% of facilities had integrated their stock management with DHIS2, and none had automated resupply triggers.

County health teams also need more spending authority. Currently, if a sub-county medical officer wants to buy ORS from a local pharmacy during an emergency, they must get approval from the county headquarters, a process that can take weeks. Giving them a small emergency budget—say, US$500 per quarter—could allow them to respond immediately. “We don’t need a massive new program,” says Odhiambo. “We just need the ORS to be there when a child needs it.”

National scale-up of these fixes would require political will and a modest investment. The World Bank project and other donor funds could be redirected from technology to simple supply chain integration. But the clock is ticking: every rainy season brings new cases, and every stockout is a missed opportunity to save a life.