ColaLife presention to C2MTL | 28-May-2014
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Keynote presentation given at C2MTL on 28-May-2014. 20 mins, fully annotated. This gives the brief history of ColaLife, describes the ColaLife Trial in Zambia (COTZ), presents our key findings and describes our strategy for impact.
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ColaLife presention to C2MTL | 28-May-2014
- 1. #soddingbloodygenius ColaLife – can Coca-Cola save children’s lives? 28-May-14
- 2. Rohit Ramchandani Jane Berry The other members of the ColaLife team
- 3. Slash & Burn Agriculture | NE Zambia, 1985
- 4. Wherever I went I could get a Coca-Cola
- 10. Diarrhoea 17% Malaria 12% AIDS 3% Diarrhoea kills more children than Malaria and AIDS combined
- 11. In Zambia 46% of children are stunted (up to 70% in some areas)
- 12. Remote rural retail shop, Kalomo District, Zambia Drug store room, Tiriri Health Centre, Katine, Uganda Empty clinics – full shops
- 13. Why not put ORS & Zinc Kit in Coca-Cola crates?
- 14. The humble telex machine, 1985
- 15. May 2008 | Gordon Brown’s Business Call to Action
- 16. The mighty Facebook, May 2008
- 17. 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 2009 | WHO/UNICEF report on the problem of diarrhoea
- 18. Jun 2010 | Gave up jobs to try and get a trial started
- 19. Jun 2010 | Gave up jobs to try and get a trial started Our kitchen table UK
- 20. Jun 2010 | Gave up jobs to try and get a trial started Rohit on Skype Canada Our kitchen table UK
- 21. Jun 2010 | Gave up jobs to try and get a trial started Rohit on Skype Canada Our kitchen table UK Harvard & UNICEF on speaker phone USA
- 22. Sep 2010 | Cycle route - Boulogne to Biarritz
- 23. Sep 2010 | Cycle ride across France raised £6,000
- 24. Oct 2010 | First of three trips to Zambia
- 25. Jun 2011 | Partnership and trial plan in place
- 26. Nov 2011 | Funding partnership in place
- 27. Dec 2011 | Trial gets underway
- 29. impac t Mothers in underserved rural communities increase use of ORS and Zinc in home treatment of diarrhoea purpose Target communities in two under-served rural districts have improved access to ORS and Zinc outputs Profit-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 trial results framework
- 30. What we learnt Litre sachets are too big Measuring water was an issue Willingness to pay Preferred branding Early 2012 | Pre-trial focus group work
- 31. Kit Yamoyo • Attractive Mar 2012 | Finalised the Kit Yamoyo design
- 32. Kit Yamoyo • Attractive • ORS sachets are 200ml Mar 2012 | Finalised the Kit Yamoyo design
- 33. Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: • A measuring device for the water Mar 2012 | Finalised the Kit Yamoyo design
- 34. 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
- 35. 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 Mar 2012 | Finalised the Kit Yamoyo design
- 36. 0Nobody sold ORS or Zinc in the private sector. Stock-outs in the public sector were common. Sep 2012 Our starting point
- 37. 0Nobody sold ORS or Zinc in the private sector. Stock-outs in the public sector were common. <1%of children received the correct treatment for diarrhoea Sep 2012 Our starting point
- 38. 0Nobody sold ORS or Zinc in the private sector. Stock-outs in the public sector were common. <1%of children received the correct treatment for diarrhoea 7.3km Was the average distrance to ORS. Sep 2012 Our starting point
- 39. 60%Only 60% of mothers mixed ORS correctly when given 1 litre sachets. 0Nobody sold ORS or Zinc in the private sector. Stock-outs in the public sector were common. <1%of children received the correct treatment for diarrhoea 7.3km Was the average distrance to ORS. Sep 2012 Our starting point
- 40. 60%Only 60% of mothers mixed ORS correctly when given 1 litre sachets. 0Nobody sold ORS or Zinc in the private sector. Stock-outs in the public sector were common. <1%of children received the correct treatment for diarrhoea 7.3km Was the average distrance to ORS. Sep 2012 Our starting point
- 41. >26k kits sold into the two remote rural trial areas in 12 months. Aug 2013 After 12 months
- 42. >26k kits 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%. Aug 2013 After 12 months
- 43. >26k kits 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%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. Aug 2013 After 12 months
- 44. >26k kits 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%. 2.4km The 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. Aug 2013 After 12 months
- 45. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points. >26k kits 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%. 2.4km The 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. Aug 2013 After 12 months
- 46. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points. >26k kits 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%. 2.4km The 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. Aug 2013 After 12 months
- 47. Our award-winning idea…… this is what happened in practice
- 48. 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 @51m0n Simon Berry What we learnt from Coca-Cola – the value chain
- 49. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points. >26k kits 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%. 2.4km The 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. ...Request access to our findings colalife.org/openaccess Aug 2013 After 12 months
- 50. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points. >26k kits 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%. 2.4km The 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. ...Request access to our findings colalife.org/openaccess Aug 2013 After 12 months
- 51. The screw-top The flexi-pack
- 52. facebook.com/colalife Feb-14 | Chimtende, Katete
- 53. >26k kits 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%. 2.4km The 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.
- 55. A note on the data contained within this presentation 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).
Editor's Notes
- ColaLife | Can Coca-Cola save children’s lives? Keynote presentation C2MTL Montreal, 28-May-14 Hello! Before I start I’d like to draw attention to the uniqueness of this presentation. I am the first person in the World to get on a stage like this in front of an audience like you with diarrhoea on my shirt! If you are tweeting here are some hashtags for you. I apologise for the last one. It’s a bit long and rather crude. They came up with it not me!
- My name is Simon Berry and I am the co-founder of ColaLife and I work with these two lovely people. Jane works and lives with me full-time in Zambia – we are partners in life and ColaLife. Rohit works part-time and is our public health adviser and trial design genius. He was born in Montreal and lives here in Canada. We have 5 voluntary board members based in the UK. And that’s it. We are tiny but we are on a mission (and on course) to have a global impact on child health. This is our story (so far).
- The story begins nearly 30 years ago in remote rural Zambia. The area was so sparsely populated that it supported slash and burn agriculture like this.
- Despite the remoteness and sparsity of population I could get a Coca-Cola in most places I went.
- Against this backdrop, 1 in 5 children didn’t make it to their 5th birthday.
- These days it’s 1 in 8 – so it has improved but it is still unacceptably high
- – 25 times higher than here in Canada.
- ColaLife wants to make this picture for developing countries look like…
- … this one.
- Just as shocking as this level of mortality is the fact that diarrhoea, an easily treated condition, is the second biggest killer. It was back in 1985 and still now. Dehydration from diarrhoea kills more children than Malaria and HIV/AIDS combined.
- And it’s not just about children dying. Diarrhoea, which is often chronic, is a key contributor to the problem of stunting. In Zambia 46% of children are stunted on average and this rises to 70% in some areas. If a child is stunted at the age of two there is a permanent impact on both physical and mental development. This child is three.
- The public sector in developing countries struggles to maintain consistent supplies of essential medicines to its clinics. This picture is of a poorly stocked storeroom in a rural health centre in Uganda. But right next to these struggling clinics you will find fully stocked shops full of the things people want.
- And so our idea was born. Why don’t we put diarrhoea treatment kits in Coca-Cola crates? The logic was simple: Coke gets everywhere. So, if we put diarrhoea kits in the same crates, they would get there too
- But remember this was the 1980s and we had no telephone, no postal service, no fax or internet. The only communications device we had was this one – a humble telex machine – and take it from me, this is not a mass communication device. No good for spreading and sharing ideas. So I failed to get any traction around the idea. I returned to the UK, got immersed in my new job and the raising our 3 children.
- Then in May 2008, the ColaLife idea was rekindled by the launch of Gordon Brown’s Business Call To Action. The Business Call to Action challenged the big multi-nationals and asked them what they were doing to alleviate poverty in Africa. Coca-Cola were involved.
- I tried again as ‘Simon Berry’ to get Coca-Cola’s attention but again got nowhere. So I decided to start a Facebook Group to see if anyone else was interested in the idea of putting medicines in Coca-Cola crates. This got the BBC’s attention and they pulled in Coca-Cola and me to talk about the idea on UK national radio and that’s where the engagement with Coca-Cola started.
- While the support on Facebook grew, WHO/UNICEF published this report. ‘Diarrhoea: Why children are STILL dying and what can be done’ This was just what we needed at the time, as it provided a solid policy context for what we were trying to do. The report reminded us that we already know what to do – we know how to treat diarrhoea but children are not getting the treatment. It suggested that all new mothers should be given a diarrhoea treatment kit and be shown how to use it when their child gets diarrhoea. The report called for strengthened distribution systems and new delivery strategies And made the point that Market-based solutions are often the most effective way to deliver key diarrhoea control commodities Two years went by while my wife, Jane, and I carried on with our day jobs while the idea and support grew online. The hope was that an appropriate organisation would pick the idea up and run with it. But unfortunately, that didn’t happen and we came to the realisation that nothing would happen unless we did it ourselves. So we decided to give up our day jobs and gave ourselves a year to get something happening on the ground somewhere in Africa.
- It was a fun year with our kitchen table at the core of it. Despite our humble resources, the Facebook Group and blog had generated global interest and this was mustered to try and get a trial started. What you see in this picture was the sort of thing happened on a very regular basis. This particular event is a conference call between UNICEF and Harvard in the USA, Rohit in Canada and ourselves in the UK. Harvard had contacted us as they were advising UNICEF on how they might meet the MDG 4 on reducing child mortality. A goal that is going to be missed by the way.
- This is our kitchen table in the UK.
- A crucial activity during the trial set-up phase was consultation with mothers and carers of under-5 children. We sought to fully understand the problem, not so much from a technical/public health point of view but from the point of view of mothers in remote villages with a sick child. We did this by simply listening to mothers and carers of children. We ran 8 focus groups and we learnt so much: Firstly, they told us about the difficulties they had dealing with the standard issue 1 litre sachets of ORS. Many don’t know what a litre is and even if they do, they have no way of measuring it correctly. Once mixed, ORS should be discarded after 24 hours and a child will only drink 400ml in that time. So, if you follow the instructions on a litre sachet, you throw out more ORS than you use. This is waste of ORS and water. Bear in mind that the water will have been carried to the home and often over significant distances. We learnt about what they would be willing to pay for the sort of kit we were developing And we learnt about their branding preferences
- And this was the result – the Kit Yamoyo anti-diarrhoea kit. It’s attractive – something to aspire to – it’s not just a cardboard box with medicine in it.
- So we re-designed the ORS sachets, making them smaller
- the packaging became the measuring device for the water needed to mix the ORS,
- the mixing device
- and the cup.
- So let’s look at the situation before we started our trial. In the trial areas there was no ORS and Zinc available in the private sector and stock-out in the public health centres were common for both ORS and Zinc.
- Less than 1% of children received the correct treatment for diarrhoea – ORS and Zinc.
- The average distance to the health centre was 7.3km
- Only 60% of mothers mixed the ORS correctly when given a 1 litre ORS sachet.