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Presentation to the University of Michigan, 19-May-14, Ann Arbor, Michigan at the invitation of the William Davidson Institute. Download the presentation for the speech narrative that is contained in the notes to the slides.
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ColaLife | What we've learnt from Coca-Cola.
Taking ColaLife to scale in Zambia. 19-May-14
What is ColaLife and who am I?
ColaLife is a charity registered in the UKCharity number: 1142516
• No paid employees• Five voluntary trustees• Focus on saving children’s lives• Independent• Our only project is in Zambia• Looking for global impact through
• Disruptive innovation• Generating robust evidence• Sharing findings and learning
• No commercial interest
2009
2010
2011
2012
2013
1985
The other members of the ColaLife team
2009
2010
2011
2012
2013
1985
Rohit Ramchandani
Jane Berry
1985 | Our starting point
Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines don't. Why?
Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines don't. Why?
Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines don't. Why?
1985 | Our starting point
Child mortality in less developed countries is unacceptably high.
In 1985 1 in 5 children didn’t make it to their 5th birthday (now it’s 1 in 8).
1985 | The ColaLife idea was born
The public sector struggles to maintain reliable supplies of drugs to health facilities.
Child mortality in less developed countries is unacceptably high.
1 in 8 children don’t make it to their 5th birthday.
1985 | The ColaLife idea was born
The public sector struggles to maintain reliable supplies of drugs to health facilities.
Child mortality in less developed countries is unacceptably high.
1 in 8 children don’t make it to their 5th birthday.
Yet you can get a Coca-Cola in the most remote, rural villages.
1985 | The ColaLife idea was born
The public sector struggles to maintain reliable supplies of drugs to health facilities.
Child mortality in less developed countries is unacceptably high.
1 in 8 children don’t make it to their 5th birthday.
Yet you can a Coca-Cola in most remote, rural villages.
Why don’t we put medicines in Coca-Cola crates?
1985 | The ColaLife idea was born
1985 | The ColaLife idea was born
Why not put ORS & Zinc Kit in Coca-Cola crates?
1985 | No technology to enable sharing of the idea
May 2008 | Gordon Brown’s Business Call to Action
May 2008 | Set-up Facebook Group
… and with international good practice (WHO/UNICEF, 2009) also including Lancet 2013 series on nutrition/diarrhoea – Apr-13
Strengthened distribution systems and new delivery strategies
Diarrhoea treatment kits for all new mothers… combining ORS and Zinc
Market-based solutions are often the most effective way to deliver key diarrhoea control commodities
We know what to do… but access and availability are barriers“
”
Jun 2010 | Gave up jobs to try and get a trial started
Jun 2010 | Gave up jobs to try and get a trial started
Our kitchen tableUK
Jun 2010 | Gave up jobs to try and get a trial started
Rohit on SkypeCanada
Our kitchen tableUK
Jun 2010 | Gave up jobs to try and get a trial started
Rohit on SkypeCanada
Harvard & UNICEF on speaker phoneUSA
Our kitchen tableUK
Sep 2010 | Cycle route - Boulogne to Biarritz
Sep 2010 | Cycle ride across France raised £6,000
Oct 2010 | First of three trips to Zambia
Jun 2011 | Partnership and trial plan in place
Nov 2011 | COTZ Funders in place
Dec 2011 | COTZ gets underway
Dec 2011
The trial timeline
impact Mothers in underserved rural communities increase use of ORS and Zinc in home treatment of diarrhoea
purposeTarget communities in two under-served rural districts have improved access to ORS and Zinc
outputsProfit-driven supply chains improve availability of ADKs (anti-diarrhoea kits) in targeted communities in two underserved rural districts
Mothers/care-givers demonstrate awareness of ADKs and the benefits of the contents (ORS, Zinc and Soap)
access = ADK in the hand of an aware mother/care-giver
Availability = ADK in stock in retail outlets at community level
Generating robust evidence - the COTZ results framework
Early 2012 | Pre-trial focus group work
What we learnt
Litre sachets are too big
Measuring water was an issue
Willingness to pay
Preferred branding
Mar 2012 | Finalised the Kit Yamoyo design
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive• ORS sachets are 200ml
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:
• A measuring device for the water
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:
• A measuring device for the water
• A mixing device
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:
• A measuring device for the water
• A mixing device• A storage device (the
soap tray is a lid)
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:
• A measuring device for the water
• A mixing device• A storage device (the
soap tray is a lid)• A cup
The COTZ trialResearch Design & Methodology
Quasi-experimental, pre-test, post test designBaseline, midline and endline surveys
Target groups: Care-givers of under-5 children and private community retailers
Four Districts – two intervention districts and two comparator districts
Sample sizes:625 HH per district40 retailers per district
The COTZ trialDistribution infrastructure and value chain
Pharmanova MSL Coca-Cola wholesalers• Standard Sales (2)• Isusya’s
Approximately 85 retailers across Katete and Kalomo
Manufacture & Assembly
Lusaka to District
District to Retailers
Mothers & Care-givers
>26kkits sold into the two remote rural trial areas in 12 months.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
4%Only 4% of kits went into Coca-Cola crates. It was the space in the market not the space in the crates that was important.
Our award-winning idea……
Our award-winning idea……what happened in practice
14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
4%Only 4% of kits went into Coca-Cola crates. It was the space in the market not the space in the crates that was important.
6International awards for health and design innovation & 6 countries interested in replication.
Awards | The Kit Yamoyo has won many global awards
In Sep-13 it was featured at the UN General Assembly as a breakthrough innovation in Child Health.In Mar-14 it was show-cased by PATH and PSI in their Best Buys for Global Health initiative.
14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
4%Only 4% of kits went into Coca-Cola crates. It was the space in the market not the space in the crates that was important.
6International awards for health and design innovation & 6 countries interested in replication.
...Request access to our findingscolalife.org/ openaccess
14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
4%Only 4% of kits went into Coca-Cola crates. It was the space in the market not the space in the crates that was important.
6International awards for health and design innovation & 6 countries interested in replication.
...Request access to our findingscolalife.org/ openaccess
ORSReduce number of sachets to 4
NOTE: This will also enhance adherence
ZincProduce locally
Only include blister pack
SoapProduce locally
Leaflet PackagingRemove constraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
Oct 2013 | Incorporating the learning into the scale-up
Learning: number of Kit Yamoyo ORS sachets used
ORSReduce number of sachets to 4
NOTE: This may also enhance adherence to the combined therapy
ZincProduce locally
Only include blister pack
SoapProduce locally
Leaflet PackagingRemove constraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Oct 2013 | Incorporating the learning into the scale-up
Learning: Kit Yamoyo Zinc adherence – days Zinc taken
Designing for better Zinc adherence
ORSReduce number of sachets to 4
This may also enhance adherence to the combined therapy
ZincProduce locally
Design the blister pack to enhance adherence to the 10-day regime
Blister pack needs no box
SoapProduce locally
Leaflet PackagingRemove constraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Oct 2013 | Incorporating the learning into the scale-up
ORSReduce number of sachets to 4
This may also enhance adherence to the combined therapy
ZincProduce locally
Design the blister pack to enhance adherence to the 10-day regime
Blister pack needs no box
SoapProduce locally
Leaflet PackagingRemove constraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Oct 2013 | Incorporating the learning into the scale-up
ORSReduce number of sachets to 4
This may also enhance adherence to the combined therapy
ZincProduce locally
Design the blister pack to enhance adherence to the 10-day regime
lister pack needs no box
SoapProduce locally
LeafletSimplify – single fold.Same leaflet for all formats
PackagingRemove constraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Oct 2013 | Incorporating the learning into the scale-up
4Revised Kit Yamoyo leaflet
ORSReduce number of sachets to 4
This may also enhance adherence to the combined therapy
ZincProduce locally
Design the blister pack to enhance adherence to the 10-day regime
Blister pack needs no box
SoapProduce locally
LeafletSimplify – single fold.Same leaflet for all formats
PackagingRemove constraint of fitting in Coca-Cola crate. Only 4% of retailers used this option
Produce locally
Produce re-fill option
4Oct 2013 | Incorporating the learning into the scale-up
The screw-top The flexi-pack
Scale-up strategy - Zambia
Community-based marketing (all markets)
Not yet commercial
markets
Commercial markets
KZF/iDEPharmanova
Monitoring & Learning
Not yet commercial
markets
Collaborators
Scale-up strategy - Global
Open source – sharingcolalife.org/openaccess
So what did we learn from Coca-Cola?
The COTZ trialWhat we learnt from Coca-Cola – the value chain
Pharmanova MSL Coca-Cola wholesalers• Standard Sales (2)• Isusya’s
Approximately 85 retailers across Katete and Kalomo
Manufacture & Assembly
Lusaka to District
District to Retailers
Mothers & Care-givers
Value
Kit Yamoyo
The COTZ trialWhat we learnt from Coca-Cola – the value chain
14 Jan via
You can get any commodity/service to anywhere in the world by creating & sustaining demand & making it profitable to fulfill that demand
TweetDeck
@51m0nSimon Berry
The COTZ trialWhat we learnt from Coca-Cola – the last mile for consumer goods
Feb-14 | Chimtende, Katete
Like us on Facebook (please):
Facebook.com/colalife
The data contained in this presentation are unpublished and based on preliminary analysis of data from the ColaLife Operational Trial in Zambia (COTZ). Final calculations may vary and will be published in peer reviewed literature in due course.
In the interim, the following citation may be used: Ramchandani, R. et al. (2014). ColaLife Operational Trial Zambia (COTZ) Evaluation. Johns Hopkins Bloomberg School of Public Health, Baltimore.
Related correspondence should be sent to Rohit Ramchandani ([email protected]) and copied to Simon Berry ([email protected]).
A note on the data contained within this presentation
