In our last blog post we outlined our aspiration to move seamlessly from the ColaLife Operational Trial in Zambia (COTZ) to a national scale-up which we are calling the KYTS Project (Kit Yamoyo Transition to Scale Project) and we explained how we intended to achieve this.
This blog post describes the overall approach we intend to take to the scale-up itself.
We having been working closely with the Zambian Ministry of Health since the outset, but all partners favoured a private sector approach, to complement what the public health infrastructure of Zambia can achieve. To achieve sustainability, we want to support a phased move away from donor dependency and into the private sector. And we believe that all the learning – including the Kit Yamoyo product itself, its value chain and all the resources we have developed (eg training materials and techniques) – should be fully embedded in the local organisations that have the long term responsibility for public health in Zambia. This means we have to let go. This won’t be too difficult as this has been our philosophy all along and our local partners are already undertaking all the day to day tasks associated with COTZ.
Producing Kit Yamoyos for the market not for an NGO or donor
What this means in practice is that our private sector partner, Pharmanova, who have invested so much already in development and know-how, will take on Kit Yamoyo as one of their new product lines. A common model is for local pharmaceutical companies to supply an NGO – which holds onto a brand for itself. But for scale-up of Kit Yamoyo, we don’t want ColaLife to be seen as the customer for Kit Yamoyo: Pharmanova will be producing Kit Yamoyo for the market. The market will always be here in Zambia, ColaLife will not. Pharmanova will decide on which markets to go for and when, based on the decades of experience they have in the manufacture and distribution of pharmaceuticals. We believe that this approach is absolutely essential for us to have a sustainable impact on child survival beyond the trial.
Dealing with market failure and equity
We believe that Kit Yamoyo will be a commercially viable product and will be both attractive and affordable for the majority of those households which operate in an all-year-round cash economy: urban areas, peri-urban areas and provincial and district towns. However, in rural and remote areas – where we have been doing our trial – there will be people who will not be able to afford the full commercial price of Kit Yamoyo, at least not all year round. In addition, these geographical areas are hard to reach and have low-density populations which make them non-viable markets from a commercial perspective – at least at the present time. To address these barriers and to ensure we achieve a level of equity of access to Kit Yamoyo, our scale-up plan will fund local, NGO-driven activities, running in parallel with the purely commercial activity of Pharmanova. This will require donor support until these markets do become commercially viable, which will happen with time.
Donor support that underpins the value chain
There is an emerging movement that believes that giving away free products to poor people undermines local markets and can actually discourage development. But there are other ways to support those who have less money in their pockets. A key instrument we will use for the KYTS NGO-led market development is the voucher or coupon. During face-to-face demonstrations of Kit Yamoyo where drama and other well-tested health promotion techniques are used with care-givers, vouchers will be distributed. These will be exchanged at trained, registered retailers and give 50% off the retail price of the Kit Yamoyo. A key aspect of this approach is that the Kit Yamoyo is made available in poor communities at a price mothers can afford BUT it is done in a way that strengthens and develops existing distribution systems and does not undermine them. This approach encourages local micro-retailers to become involved, it doesn’t by-pass them or undermine them in a way that giving the kit away free would do. We have gained a lot of experience with vouchers in COTZ and through sharing lessons with others.
The private sector/NGO interface
There will need to be close liaison between the commercial activity on the one hand and the donor-supported, NGO activity on the other. But importantly, one won’t be controlling the other. The way this will play out is that the NGO activity will be felt by the private sector as an increase in demand from the wholesaler supplying the retailers serving the areas where the NGO-led, equity and market development activity is being undertaken. We know that in Zambia – and many other developing countries, wholesalers don’t deliver to retailers – this isn’t how the system works. Retailers in these remote communities come in to the wholesalers to buy supplies to take back to the communities they serve.
Monitoring and learning
We are breaking new ground here and there is a lot of interest in our work. Furthermore, our strategy for global impact is to generate robust, credible evidence that others will use to modify their public health strategies to make them more effective. The generation of this evidence needs a higher level of monitoring than can be justified from a purely commercial perspective and this will be donor-funded. Donors are generally interested in supporting this type of activity as it helps them make the programmes they support in the future more effective.
In the next blog post we will describe the framework we have used to design the scale-up plan itself.
The other blog posts in this series:
- Moving from trial to scale-up – the transition from COTZ to KYTS
- An overview of our scale-up plan – KYTS – our approach (this post)
- The framework of our scale-up plan – KYTS