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

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The final keynote presentation at the IHI/BMJ Quality & Safety in Healthcare Conference.

The final keynote presentation at the IHI/BMJ Quality & Safety in Healthcare Conference.
Paris, 11-Apr-14

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  • ColaLife | What we've learnt from Coca-Cola. Taking ColaLife to scale in Zambia.Plenary presentation to the International Forum on Quality and Safety in HealthcareParis, 11-Apr-14
  • I have no commercial interest in the commercial product I will show you.But are strategy for impact is that others will find it of commercial interest – more of that later.
  • This was our starting point way back in 1985.
  • And this is where we get our name from.Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines don't. Why?
  • Back in 1985, 1 in 5, or 20% of children didn’t make it to their 5th birthday.Now the figure is 1 in 8.The figure for the UK is 1 in 200 and in France it’s even better than that at 1 in 250.In the recent review of the Millennium Development Goals, more developed countries which already had low mortality rates have reduced their mortality rates more than less developed countries.
  • 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 telex machine – and this is not a mass communication device. No good for spreading and sharing ideas. So I failed to get any traction around the idea. After Zambia we went back home as our children needed to start school there and my wife Jane and I set up an NGO to support UK rural development. The years passed while we were engrossed in our work in the UK.
  • The ColaLife idea was rekindled by the launch of Gordon Brown’s Business Call To Action which Coca-Cola were involved in.
  • Simon Berry did online research to see if anyone else had had the idea in the 23 years since 1985. No one had so he set-up a Facebook Group to share the idea.
  • Despite their humble resources, the Facebook Group and blog had generated global interest in the idea and these were mustered to try and get a trial started.
  • Despite their humble resources, the Facebook Group and blog had generated global interest in the idea and these were mustered to try and get a trial started.
  • In September 2010 Simon Berry and two Facebook supporters – Nigel and Keifer – cycled across France to raise the money needed to travel to Africa to work on a trial plan with local stakeholders.
  • The cycle ride funded three trips to Zambia where Simon and Jane worked with local partners on a plan for a trial of the ColaLife idea.
  • Rohit Ramchandani – DrPH Candidate, Johns Hopkins University. Trial designer.
  • The timeline
  • The key learning has been about the value chain.
  • The Kit Yamoyo has captured people’s imagination and won many global health, design and innovation 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.
  • We are now moving to a national scale-up where will hand over the product to the private sector.To do that we need to apply the learning from the trial and bring the cost of production down.We need to look at all components of the kit including the packaging.All components of the Kit Yamoyo were reviewed based on the findings of the trial.
  • First we will reduce the number of ORS sachets to 4 (from 8) this will halve the cost of the ORS component while at the same time enhance adherence to the combined ORS and Zinc regime.75% of care-givers used 4 ORS sachets or less. Reducing the number of sachets from 8 to 4 will improve adherence to the combined therapy and halve the cost of the ORS component.
  • Our pharmaceutical partner in the trial as been inspired to produce Zinc locally. The first samples were put down for stability testing in Nov-13.This provides the opportunity to design are own Zinc packaging. We’ve improved adherence to the correct measuring of ORS through design, can we do the same for Zinc adherence and improve adherence to the 10-day regime.
  • The locally produced Zinc will be cheaper and there will be no need for it to be in its own box which will also reduce costs.
  • We have persuaded the only soap manufacturer in Zambia to produce a small 25g bar of soap.This will replace the soap imported from India.They will sell the soap themselves as a stand-alone product.
  • We will simplify the leaflet and reduce costs by making a single fold format.
  • We will simplify the leaflet and reduce costs by making a single fold format.
  • Because the kit no longer needs to fit in the Coca-Cola crates we can move to locally produced option – a screw-top jar which is 40% cheaper than the current packaging.In the scale-up we will be using two new packaging formats: • a screw-top • a flexible packThe screw top will have all the functionality of the original packaging.The flexible pack can measure the water.
  • In the trial only 4% of retailers put the kits in Coca-Cola crates.This provides an opportunity to re-visit the packaging design and make it cheaper WITHOUT losing any of the innovation features – measuring, mixing, storage device and cup.The jar is produced locally and is 40% CHEAPER than the specially made crate-shaped packaging.… we are also looking at a flexible plastic pouch.
  • ColaLife & product innovation – a presentation for the Diarrhoea & Pneumonia Coordination Committee, Uganda.

What we've learnt from Coca-Cola | Taking ColaLife to scale in Zambia What we've learnt from Coca-Cola | Taking ColaLife to scale in Zambia Presentation Transcript

  • 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 UK Charity 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 20131985
  • The other members of the ColaLife team 2009 2010 2011 2012 20131985 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 table UK
  • Jun 2010 | Gave up jobs to try and get a trial started Rohit on Skype Canada Our kitchen table UK
  • Jun 2010 | Gave up jobs to try and get a trial started Rohit on Skype Canada Harvard & UNICEF on speaker phone USA Our kitchen table UK
  • 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
  • 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 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 trial Research Design & Methodology Quasi-experimental, pre-test, post test design Baseline, 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 district 40 retailers per district
  • The COTZ trial Distribution 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
  • >26k kits sold into the two remote rural trial areas in 12 months.
  • >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%.
  • >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.
  • >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.
  • 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.
  • 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.
  • 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. >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. 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. >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. 6International awards for health and design innovation & 6 countries interested in replication. ...Request access to our findings colalife.org/ openaccess
  • 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. 6International awards for health and design innovation & 6 countries interested in replication. ...Request access to our findings colalife.org/ openaccess
  • ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Only include blister pack Soap Produce locally Leaflet Packaging Remove 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
  • ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Only include blister pack Soap Produce locally Leaflet Packaging Remove 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
  • ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
  • ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
  • ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime lister pack needs no box Soap Produce locally Leaflet Simplify – single fold. Same leaflet for all formats Packaging Remove 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
  • ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Simplify – single fold. Same leaflet for all formats Packaging Remove 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 – sharing colalife.org/openaccess
  • So what did we learn from Coca-Cola?
  • The COTZ trial What 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 trial What 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 @51m0n Simon Berry
  • The COTZ trial What we learnt from Coca-Cola – the last mile for consumer goods
  • Feb-14 | Chimtende, Katete Like us on Facebook (please): Facebook.com/c olalife
  • To be continued… colalife.org simon@colalife.org jane@colalife.org rohit@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