what we've learnt from coca-cola | taking colalife to scale in zambia

ColaLife | What we've learnt from Coca-Cola. Taking ColaLife to scale in Zambia. 11-Apr-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 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.

Although we used Coca-Cola wholesalers, only 4% of the retailers used this space in the crate to transport Kit Yamoyos. Many bought by the box full. Working capital was not an issue.The value chain is the key enabler. In Zambia, it’s the space in the market, not the space in the crates that is important.This means we can revisit the packaging to make it cheaper.

The vision The 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

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 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

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

NOTE: This will also enhance adherence

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

NOTE: This will also enhance adherence

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

NOTE: This will also enhance adherence

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

NOTE: This will also enhance adherence

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

Kit Yamoyo Screw-top• Attractive and functional

• A measuring device for the water• A mixing device• A storage device (screw-top)• A cup• And can be re-used

Kit Yamoyo Flexi-pack• A cost-saving, space-saving option• Plastic pouch that measures water• Refill option for the Screw-top• Currently being tested by CHAI

Kit Yamoyo designs for the scale-up

TARGET unsubsidised retail costs (Kwacha)

Screw-top Flexi with soap Flexi w/out soap

Components

ORS (4 sachets) 0.9000 0.9000 0.9000

Zinc (1 blister pack of 10 tablets) 1.0000 1.0000 1.0000

Soap (25g anti-bacterial) 0.4400 0.4400 0

Leaflet 0.2000 0.2000 0.2000

Packaging

Container 0.9100 0.2000 0.2000

Bags and carton (per kit) 0.1200 0.0240 0.0240

Assembly 0.5000 0.2500 0.2500

TOTAL 4.0700 3.0140 2.5740

MSRP 8.00 6.00 5.00

Assumed margins: Manufacturer/distributor 20%; Wholesaler 20%; Retailer 35%

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

ColaLife uses mobile phones to: provide an authentication system for the Kit Yamoyos; to deliver a Special Offer (50% off your next purchase); to allow promoters to activate vouchers before distribution and for voucher redemption by retailers.

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 demandTweetDeck

@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

To be continued…

colalife.org

simon@colalife.orgjane@colalife.orgrohit@colalife.org

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 (roramcha@jhsph.edu) and copied to Simon Berry (simon@colalife.org).

A note on the data contained within this presentation