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.

1. ColaLife | What we've learnt from Coca-Cola.
Taking ColaLife to scale in Zambia. 19-May-14

2. 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

3. The other members of the ColaLife team
2009 2010 2011 2012 20131985
Rohit Ramchandani
Jane Berry

4. 1985 | Our starting point
Coca-Cola seems to get everywhere in
developing countries, yet life-saving
medicines don't. Why?

5. 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

6. 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

7. 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

8. 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

9. 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

10. 1985 | The ColaLife idea was born

11. Why not put ORS & Zinc Kit in Coca-Cola crates?

12. 1985 | No technology to enable sharing of the idea

13. May 2008 | Gordon Brown’s Business Call to Action

14. May 2008 | Set-up Facebook Group

15. … 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
“

16. Jun 2010 | Gave up jobs to try and get a trial started

17. Jun 2010 | Gave up jobs to try and get a trial started
Our kitchen table
UK

18. Jun 2010 | Gave up jobs to try and get a trial started
Rohit on Skype
Canada
Our kitchen table
UK

19. 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

20. Sep 2010 | Cycle route - Boulogne to
Biarritz

21. Sep 2010 | Cycle ride across France raised £6,000

22. Oct 2010 | First of three trips to Zambia

23. Jun 2011 | Partnership and trial plan in place

24. Nov 2011 | COTZ Funders in place

25. Dec 2011 | COTZ gets underway

26. Dec 2011
The trial timeline

27. 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

28. 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

29. Mar 2012 | Finalised the Kit Yamoyo design

30. Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo
• Attractive

31. Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo
• Attractive
• ORS sachets are 200ml

32. Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo
• Attractive
• ORS sachets are 200ml
• Packaging is also:

33. Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo
• Attractive
• ORS sachets are 200ml
• Packaging is also:
• A measuring device for
the water

34. 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

35. 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)

36. 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

37. 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

38. 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

39. >26k
kits sold into the
two remote rural
trial areas in
12 months.

40. >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%.

41. >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.

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%.
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.

43. 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.

44. 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.

45. Our award-winning idea……

46. Our award-winning idea…… what happened in practice

47. 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.

48. 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.

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.
6International
awards for health
and design
innovation &
6 countries
interested in
replication.
...Request access
to our findings
colalife.org/
openaccess

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.
6International
awards for health
and design
innovation &
6 countries
interested in
replication.
...Request access
to our findings
colalife.org/
openaccess

51. 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

52. Learning: number of Kit Yamoyo ORS sachets used

53. ORS
Reduce number
of sachets to 4
NOTE: This may
also enhance
adherence to
the combined
therapy
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

54. Learning: Kit Yamoyo Zinc adherence – days Zinc taken

55. Designing for better Zinc adherence

56. ORS
Reduce number
of sachets to 4
This may also
enhance
adherence to
the combined
therapy
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

57. ORS
Reduce number
of sachets to 4
This may also
enhance
adherence to
the combined
therapy
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

58. ORS
Reduce number
of sachets to 4
This may also
enhance
adherence to
the combined
therapy
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

59. 4Revised Kit Yamoyo leaflet

60. ORS
Reduce number
of sachets to 4
This may also
enhance
adherence to
the combined
therapy
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

61. The screw-top The flexi-pack

62. Scale-up strategy - Zambia
Community-based marketing (all markets)
Not yet
commercial
markets
Commercial
markets
KZF/iDEPharmanova
Monitoring & Learning
Not yet
commercial
markets
Collaborators

63. Scale-up strategy - Global
Open source – sharing
colalife.org/openaccess

64. So what did we learn from Coca-Cola?

65. 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

66. 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

67. The COTZ trial
What we learnt from Coca-Cola – the last mile for consumer goods

68. Feb-14 | Chimtende, Katete
Like us on
Facebook
(please):
Facebook.com/c
olalife

69. To be continued…
colalife.org
simon@colalife.org
jane@colalife.org
rohit@colalife.org

70. 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