Last updated: 12-Nov-16
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Latest changes in green.
ColaLife team deployment:
Simon Berry – full-time – in the UK – until mid-Jan-17 – remote support to the Kit Yamoyo scale-up (KYTS) and development of ColaLife’s Globalization strategy. Zambia from mid-Jan-17 – on-site support.
Jane Berry – full-time – in the UK – until mid-Jan-17 – remote support to the Kit Yamoyo scale-up (KYTS) and development of ColaLife’s Globalization strategy. Zambia from mid-Jan-17 – on-site support.
Rohit Ramchadani – part-time – Canada – remote support for the monitoring of KYTS-LUSAKA. Representing ColaLife at the Global Health Systems conference in Vancouver (11 to 14-Nov-16).
Ralf Siwiti – part-time – Zambia – distribution and marketing consultant (since Dec-15).
There are two threads to our activity:
Our aim over the next 4-5 years is to support our local partners in Zambia as they expand access to the Kit Yamoyo designs that emerged from our first trial. Together, we are applying what we learnt about market-based distribution, and learning about what works (and what doesn’t) in the ‘real world’. We want Kit Yamoyo to be commercially sustainable for manufacturers, wholesalers and retailers, but we are using donor funding to develop the market, capture lessons, measure impact and spread awareness among customers, retailers and policy makers. >> jump to the detail
Since mid-2016 we have been working on our Globalization Strategy as part of the Ashoka Globalizer programme on Light and Health sponsored by the Philips Foundation. Our strategy focuses on scaling our social impact beyond Zambia. It does not focus growing ColaLife. The first draft of our strategy was presented in Eindhoven on 19-Oct-16 and it is now under final revision. We expect to make it public in early 2017. In the meantime we are inviting people to contribute to our globalizer knowledgebase here.
- CAMPAIGNING AND DISSEMINATION
At the same time, ColaLife will be working to influence the big players in global health, as well as other manufacturers. We want others to adopt and adapt key lessons and design benefits, which we believe will help increase home use of ORS and Zinc for under-5 diarrhoea. Our three main messages are: smaller ORS sachets are better for home use; make packaging both attractive and functional, especially co-packaging ORS with Zinc and enabling easy measuring of water to make up ORS solution; desirable, affordable and profitable products will reach even remote communities. >>jump to the detail
A trial of the ColaLife Model in 2012/13 increased diarrhoea treatment rates with Oral Rehydration Salts (ORS) and Zinc, the WHO/UNICEF standard, from <1% to 45% in remote rural areas of Zambia in 12 months (see Headline Findings of the ColaLife Trial in Zambia). This compelled us to keep the supply of ORS and Zinc going when the trial ended in Sep-13. It would have been unethical to stop the supply at the end of the trial as carers, mostly mothers, had got used to being able to buy ORS and Zinc in the form of an anti-diarrhoea kit, called Kit Yamoyo, from their local shop. We refer to the scale-up as KYTS (Kit Yamoyo Transition to Scale) and there are now three threads of activity under KYTS:
- KYTS-ACE (Adapting to Challenging Environments)
- KYTS-FORMAL (Shoprite and other supermarkets, pharmacies)
KYTS-ACE got underway in Feb-15 and is focussed on the 14 most nutritionally challenged districts in Zambia. In 5 of these districts we are working with small retailers (like we did in the trial); 11 districts are being supplied with a public sector ORS/Zinc co-pack, based on the Kit Yamoyo design. This is being distributed through the public sector. In 4 districts, there is distribution through Shoprite stores. In some of the 14 districts more than one distribution channel is operating, so we can observe the effect of various combinations of channels. Both Kit Yamoyo (the commercial product) and the public sector ORS/Zinc co-pack are produced locally in Zambia, by Pharmanova. This work is supported by Zambia’s SUN Programme (Scaling Up Nutrition). Our partner KZF was invited to submit a proposal to extend this work until Dec-17. This was done with ColaLife’s support and an extension to Dec-17 has now been approved.
KYTS-LUSAKA launched in Oct-15 and is focussed on Lusaka Province: primarily on the townships (compounds) around the capital but also in 2-3 other, more rural districts. Again work with small grocery stores serving these densely populated areas but have also secured distribution through Shoprite stores, and some pharmacies. Shoprite started stocking Kit Yamoyo from Jan-16. This work is supported by UK Aid Direct (75%) and the balance of the funding comes from ColaLife’s own resources.
KYTS-FORMAL covers activities with up to 30 Shoprite stores nationwide; there is some overlap with KYTS-ACE (4 stores) and KYTS-LUSAKA (7 stores). This thread of activity gives us outlets in the Copperbelt (the second largest populated area in Zambia) for the first time. As well as being important retail outlets, Shoprite stores also act as wholesalers for small retailers. This is a common model in Zambia: retailers from the townships and rural areas buy in bulk from Shoprite and re-sell in their own communities at a profit. Shoprite recognise this and have put no limits on bulk buying of Kit Yamoyo. (They do have limits on bulk buying of other products). This work started in Jan-16 and is funded from ColaLife’s own resources.
The resources we have had, to move from successful trial to scale-up have varied enormously, as explained below, so the level of activity varied from district to district over time. In Nov-14 we had to shut down operations in Southern Province due to lack of funds. However, we plan to re-start marketing there during 2016. Activities in Southern Province will also take a boost through our agreement with Shoprite who have two stores in the province (Mazabuka and Livingstone).
What do we mean by scale-up?
Scale-up is a one-off investment by donors and philanthropists to establish Kit Yamoyo in the Zambian market. Once established in the market, Kit Yamoyo and the value chain that delivers it to communities, will be sustainable because the Kit Yamoyo product is intrinsically profitable for all those involved in getting it to carers. We know from the trial that once carers have used Kit Yamoyo they will 1) seek it out to use it again and 2) recommend it to their friends. We are learning from the market scale-up work in Zambia, so we can support other countries.
The key elements of the scale-up activity are:
- Training retailers and Community Health Workers in product benefits and issues around diarrhoea
- On-going support for newly trained retailers and Community Health Workers
- Awareness raising among carers
- Development of the distribution chain (recruitment of wholesalers and retailers)
- Community-based marketing
- Mass marketing
- Identifying and ironing out bottlenecks in distribution and other issues arising.
Our target is to have completed scale-up in Zambia by 2020 and for no further donor funding, and no further input from ColaLife, to be required beyond that point.
The scale-up story so far
Moving from the original trial to implement our scale-up plans was not easy. We were not successful in raising the funds for a national scale-up to follow on seamlessly from the trial (see Grand Challenges Canada say “no”). However, two of the trial funders – DfID and Johnson & Johnson/Janssen EMEA – provided transitional funding. This enabled modest expansion of the retailer network in the trial districts (Katete and Kalomo) and a move into the trial control districts (Petauke and Monze).
A second attempt to raise funding for a national scale-up through USAID-DIV made good progress but failed at the final hurdle. By this time (mid 2013) the transitional funding was coming to an end. We faced other significant challenges during this time. In Nov-13 the KZF Office in Kalomo (Southern Province) had to be closed and staff were laid off and there has been no further scale-up activity in Southern Province since this time. At this point ColaLife injected £15,000 of its own reserves to keep activity underway in Katete (Eastern Province) while we waited for news on our KYTS-ACE bid which was approved on the second attempt. KYTS-ACE got underway in Feb-15 and is funded under the Zambian SUN* programme targeting 14 of the most remote and sparsely populated districts in Zambia (see above). These are not areas one would choose to scale-up a private sector product such as Kit Yamoyo. However, KYTS-ACE also supports Zambia’s Ministry of Health in the procurement of 452,000 ORS/Zinc co-packs for distribution through the public sector. This gave a massive boost to our pharmaceutical partner, Pharmanova. These ORS/Zinc co-packs contain the same ORS and Zinc components as the commercial product (Kit Yamoyo) and are delivered in the same packaging but do not carry the Kit Yamoyo branding. The first private sector kits (Kit Yamoyo) arrived in Central Province (Mumbwa) and Western Province (Mongu and Kalabo) in the week beginning 2-Nov-15. Project field staff have been trained in the use of the Android tablets using the CommCare system to track progress.
In Sep-15 we signed a contract with DfID, under UKAID Direct, to scale-up in Lusaka Province: the most densely populated province in Zambia. This project is called KYTS-LUSAKA (see above) and got underway on 1-Oct-15. The data collection phase of the baseline survey is now complete. 1,513 household surveys were carried out. The data has been cleaned and analysis is underway.
Finally, in Dec-15 Shoprite agreed to carry Kit Yamoyo in their catalogue, nationwide. This is hugely significant and gives us outlets in the Copperbelt for the first time. Kit Yamoyo started appearing in stores in Jan-16. This thread of activity is referred to as a part of KYTS-FORMAL.
The scale-up so far – staffing
Keepers Zambia Foundation has the following staff in place:
- Headquarters (Lusaka):
- Project Manager – KYTS-ACE
- Project Manager – KYTS-LUSAKA (started on 11-Jan-16)
- Four Field Facilitators – KYTS-LUSAKA (started on 10-Feb-16)
- Central Province (Mumbwa)
- Field Facilitator – KYTS-ACE (resigned at the end of Oct-16, still be be replaced)
- Field Facilitator – KYTS-ACE (resigned at the end of Oct-16, still be be replaced)
- Eastern Province
- Project Officer – KYTS-ACE
- One Field Facilitator – KYTS-ACE
- Western Province
- Project Officer – KYTS-ACE
- Two Field Facilitators – KYTS-ACE
These staff are supported part-time by a KZF Programme Manager and the Accounts Team, as well as by ColaLife staff.
What impact do we expect to have?
We know from many studies that increased use of ORS and Zinc saves lives and reduces stunting in under-5 children. Academics used the Lives Saved Tool (LiST) developed by Johns Hopkins School of Public Health to estimate the lives saved during the ColaLife trial and concluded that 3 lives were saved per 1,000 kits used. We are working for a sustainable impact and our target is to halve diarrrhoea deaths in Zambia by 2020 (2,500 lives saved per year – on an ongoing basis). As an illustration, with current prevalence, this would mean 850,000 ORSZ kits are used per year.
Kits sold so far
Approxmately 70,000 Kit Yamoyos have been sold to date and 125,000 ORS/Zinc co-packs have been supplied to the Ministry of Health. A summary table of sales is being compiled and will be published here shortly.
- An anti-diarrhoea kit which carers WANT which is:
- Better product design, to meet users needs
- Effective marketing
Our approach is distinctive too:
- We involved carers in the design of Kit Yamoyo anti-diarrhoea kit so that we produced a product we knew they wanted not something that we thought they needed.
- We use a price minus costing approach rather than a cost plus pricing approach. That is to say, we start with what customers tell us they are willing to pay and work backwards from that, seeking to reduce costs to achieve the profit margins required for all those in the manufacturing and distribution chain while maintaining affordability for the customer.
- We applied subsidies sensibly so as to strengthen, not undermine, existing distribution channels and establish a viable value chain. We did this in two ways:
- When first launching the Kit Yamoyo product we gave vouchers which carers could exchange for a kit in their local shop. This kick-started the value chain and provided the initial incentive for retailers to seek out wholesale suppliers of the kit and bring it to their community.
- During the trial we were unable to get the costs down low enough to ensure affordability and provide adequate margins for those manufacturing and selling the kits. To overcome this we injected a subsidy at the top of the value chain so that the price points achieved along the value chain (the ex-factory price, the wholesale price and retail price) were those that we were aiming for in the long term (once costs had been reduced and the subsidy removed). Subsequently, this subsidy has been removed by reducing the cost of production of the kit. This has been achieved by applying the learning from the trial and re-designing the kit to be lower cost. See How the ColaLife trial findings have influenced the design of Kit Yamoy0.
- We are focussing on sustainability. For us, this means everything is done through local organisations. ColaLife’s role is catalytic and temporary. For this reason ColaLife is not constituted in Zambia. Carers who buy the product and all those along the distribution chain are not aware of ColaLife’s existence. ColaLife’s branding appears nowhere (not even on the Kit Yamoyo). To be sustainable, ColaLife cannot be a permanent part of the system that delivers an affordable and aspirational anti-diarrhoea kit to carers in Zambia.
We want to grow our impact beyond Zambia as quickly as possible and hope to publish our plans for others to contribute to and comment on in early 2017. We aim to save 5,000 lives and improve 2 million others by 2020 and then, every year from 2021, save 5,000 lives and improve 1 million lives. Our approach will be to support others to take on the learning and findings from the trial and scale-up in Zambia and apply this to their own circumstances. The following steps are envisaged in our globalization plan:
- Identify the 10 countries with the highest number of diarrhoea deaths
- Establish a “smart network”, or “national alliance” in at least 6 of these countries around the vision of: Saving lives and reducing stunting through better access to ORS and Zinc for the treatment of diarrhoea.
- Support this “smart network” to achieve this vision using local organisations and processes.
In parallel with the scale-up effort we are campaigning for:
- The increased global availability of 200ml ORS sachets for the home treatment of diarrhoea. See: The case for 200ml ORS sachets.
- The co-packaging of ORS and Zinc. See: The case for co-packaging ORS and Zinc.
- Over-the-counter status for ORS and Zinc so that it can be sold through ordinary retailer outlets. This is already the case in many countries but there is work to do in others.
- People to understand that all ColaLife’s designs, learning and findings are available for free for anyone with a responsibility for child health. See: ColaLife’s Open Access Initiative.
ColaLife could not grow quickly enough to have the impact we seek. In any case, the organisations are already in place globally and nationally with a mandate and responsibility for children’s health. So, our strategy for global impact is to influence the strategies of others so that they apply our designs, findings and learning to their own circumstances. We are helping this process through our Open Access Initiative.
As the scale-up gets underway we will be able to apply more resources and become more strategic and proactive in our campaigning and dissemination activities.
In Apr-16 we were accepted onto the Ashoka Globalizer programme and we are working with a external team of specialists with expertise in the scaling up of social impact beyond Zambia. Our plan will be presented in Oct-16.
We are immensely grateful to the majority funders of our current projects (SUN programme, including DfID, and DfID’s UK Aid Direct fund) and especially to funders who have come on board in the last year, to offer vital core funding that we can use freely in creative ways. This has put ‘match funds’ on the table to win our two current projects, and enabled us to devote ourselves full-time to all aspects of the ColaLife mission: A huge thank-you, then, to The Isenberg Family Trust, GSK/Save the Children Innovation Award, all of our Global Giving donors in UK/Europe, the USA and beyond, our sponsorship by Everly, and the Ashoka Network.
Form the outset ColaLife has depended on the support of hundreds of people who have put in time, expertise and other resources. We are very grateful to them all and have tried to list everyone here (if your name’s missing please let us know!).
* SUN = Scaling Up Nutrition
** In the ColaLife Operational Trial in Zambia (COTZ), over a 12 month period, ORS/Zinc treatment rates increased from <1% to 45% in children with diarrhoea in the last two weeks. See Seven of the headline findings from the ColaLife trial in Zambia.