Back in Mar-14 our trial partner UNICEF Zambia invited us to their office in Lusaka to meet visitors from the UNICEF Supply Division in Copenhagen. We described the work we were doing to Rudolf Schwenk who asked us to contact him once we were back in the UK so that we could present our work to his colleagues in Copenhagen. We followed through with this and Rudolf put us in contact with his colleagues involved in innovation, nutrition and essential medicines who invited me to meet with them today (4-Dec-14). I am very grateful to Kristoffer (Chief, Innovation), Heinrich, Loic and Katherine for giving me their time. I feel we have made contact with precisely the right people.
I learnt a lot about the workings of UNICEF’s Supply Division and their approach to doing rather than just talking about innovation. It is a shame that I was unable to finish my presentation with everyone still present. But I’m sure that communications will continue now that we’ve met face-to-face.
There was genuine interest in our trial results especially in the following areas:
- The difficulties carers have dealing with one litre ORS sachets in the home treatment of diarrhoea: not knowing what a litre is and/or not having a vessel big enough to mix a litre coupled with the fact that a child will only drink 400ml in 24 hours (on average) and you’re supposed to throw away mixed unused ORS after that period.
- The fact that if you provide ORS in smaller, 200ml sachets, as opposed to 1 litre sachets, carers use less ORS but treat their child for more days.
- The fact that we raised ORS/zinc treatment rates from <1% to 45% in 12 months by providing a well-designed, desirable anti-diarrhoea kit which carers, mostly women, could buy in their local shop.
A point that was made by UNICEF was that they receive little or no demand for anything other than one litre sachets of ORS. Perhaps this is because those doing the demanding are national governments and NGOs who are asking for what they think carers need not what we now know they want. There is also the possibility that those doing the demanding do not know the advantages of smaller sachets and this is something that needs to be actively promoted. In our trial we found the following advantages:
- Carers mix the ORS correctly 93% of the time compared with only 60% of the time with the larger one litre sachets;
- Carers used less ORS (800ml vs 2,000ml) but treated for more days (3.5 days vs 2.5 days);
- Providing two, one litre sachets only provides treatment for two days (if you follow the instructions) and most bouts of diarrhoea will last longer than this;
- There is no wastage of ORS (or water) with smaller sachets. Whereas, for every litre you make using one litre sachets, you throw away 600ml, based on average consumption of ORS by an under 5 child (400ml).
We believe that these findings are worth serious attention moving forward.
I was asked why mothers buy the kits when the medicine was available free of charge at the health centre. The answer is that the shops are closer to people’s homes than the health centres and shops have lower stock-out rates. The health centres regularly stock out of ORS and Zinc and even when they have both in stock they often don’t get prescribed together. In fact, we found that they get prescribed together in less than 1% of cases. And this, remember, is for an international standard treatment that is a decade old. If a decade-old treatment as simple and cheap as ORS and zinc is only getting to less than 1% of children, it indicates that current systems are not working.
Even if the public sector was working at 100% efficiency, a proportion of carers would still buy Kit Yamoyo because it’s cheaper than buying transport and food, and queuing for hours in the quest to access the free treatment. It also means you don’t need to delay treatment and even in the cases when you do need to go to the health centre, you can arrive with your child still hydrated. From the carer’s perspective, it’s all about choice and having options.
I learned that our name: ColaLife, is problematic for many people in UNICEF who assume, from our name, that we tied in with Coca-Cola in ways that we are not. This may prevent them from engaging ‘on principle’. This is perhaps something we need to address. I did point out that carers in Zambia know nothing of ColaLife. All they know is the brand ‘Kit Yamoyo’ and the name ColaLife does not appear anywhere on the product (and never will).
We will make our findings freely available to UNICEF and, given our ‘open source’/’open access’ approach, it will be a real win for us if they pick up on our learning and we influence their innovation pipeline.