The India Report

Arriving in India is a shock to the senses. All of them. I flew into Kochi from Uganda via Ethiopia and Mumbai and India hits you immediately. In Uganda, the driving was pretty scary but it has nothing on India. Here,there is no margin for error with motorbikes, cars and lorries gliding and lurching and missing each other by centimetres – just like a computer game, but nothing virtual about this reality! Then there is the copious use of the horn.

Virtually every lorry has the words ‘Sound Horn’ painted on the back and everyone does. Motorbikes come at you from all directions (like they do in Uganda), other vehicles approach each other at speed, head-on, in roads that only appear to be wide enough for one. Somehow, they make it through unscathed.

And then suddenly I enter the tranquility of Le Meridian Hotel and all is calm – and very much less crowded. I came here at the invitation of HLFPPT to the first ever global health conference on social marketing and franchising for health, to talk about ColaLife. It was a superbly organised event with around 350 delegates from around 20 different countries.

One of the first speakers was Dr Philip D Harvey, President of DKT International, who talked about piggybacking condoms on the value chains that got Brook Bond tea across the whole of India through its 600,000 outlets! Everything here is massive. He showed this slide of camels carrying Brook Bond tea across one of the Indian deserts and remarked that a box on condoms would not have broken the camel’s back!

I was rather embarrassed that I hadn’t come across Harvey’s work before. This sort of thing has been going on in India for 3 or 4 decades! So, what is considered as one of the innovative aspects of ColaLife in Zambia (and in most of Africa) – distribution through small retail outlets – is old hat in India.

So I knew I was in the right place immediately. I felt comfortable and excited and then immediately felt rather uneasy. What was I going to bring to this social marketing and franchising party that people hadn’t heard already? The answer was ‘product innovation’. In an earlier blog post I’ve talked about our innovation map and explained how we’ve moved from what we thought was a distribution innovation to a product innovation. The product is the Kit Yamoyo, an anti-diarrhoea kit which contains 200ml sachets of ORS (not 1 litre sachets) and packaging that acts as a measure for the water needed, a mixing device, storage device and cup.

There are huge ORS/Zinc programmes underway in India and the biggest new one is run by the Clinton Health Access Initiative (CHAI). They are rolling out a huge investment in marketing and promotion activities that are repeated over and over. Through this they are seeking to habitualise ORS and Zinc usage for the treatment of diarrhoea. I was able speak with three members of the CHAI team including Chandra Sharma, Senior Director, Essential Medicines Supply Chain and there was a lot of interest in the Kit Yamoyo. I also shared our simple cost calculator (XLS, 48KB) with CHAI and I hope they will put Indian costs in it and share back. Things are much cheaper in India so it will be interesting to see what a locally made Kit Yamoyo might retail for.

Another presentation that stood out for me, was given by Sheena Chhabra, Team Leader, Health Systems Division, USAID India. One of her slides was entitled ‘Dominant Myths’ around Social Marketing and one row read:

Sheena went on to say that to focus purely on price is a big mistake, which is view that we share.

The final presentation that stood out for me was by the academic Keith Joiner, Professor of Medicine and Economics, The University of Arizona on service-dominant logic, a term I’d not come across before. This is a whole new way to think about value creation, products and service delivery amongst other things. You can read more about it here: www.sdlogic.net

Professor Joiner made the following points (amongst others):

1. Products are appliances, or a means, for service delivery
2. A product is of no intrinsic value. Value is only generated when the product is used correctly and for the intended purpose
3. Value is always determined by the beneficiary – you cannot ‘impose’ value on a beneficiary: they will determine whether a product has value or not
4. Value is always co-created by the producer and the consumer

If all this is correct, then we would appear to be on a very firm foundation with the Kit Yamoyo:

1. Through design and product innovations we have made it easy for mothers to mix ORS correctly (94% of mothers mixed ORS correctly when using Kit Yamoyo, only about 60% did when they were given 1 litre ORS sachets)
2. We gave the mothers ‘the dignity of attention’ when designing the Kit Yamoyo and sought to understand the issues they faced when treating a child with diarrhoea in the home, which very few others seem to have done.
3. We co-created the value represented by a Kit Yamoyo with mothers themselves.

Despite all these positive things and this firm foundation in academic theory, we still have to work on improving adherence to the 10-day Zinc regime AND have a duty to get the price down to make the Kit Yamoyo affordable to the maximum number of people. However, we need to do this without destroying the value we have co-created in the product. Reducing Kit Yamoyo to 2 x 1 litre sachets of ORS and a blister pack of Zinc tablets in a cardboard box may minimise the cost but would destroy the value.

All of this brings us back, very neatly, to the discussion around price, value and aspiration following my Uganda Report.

It’s been a great 2 weeks ‘on the road’. I’ve learnt a lot. I wish to express my thanks to all those who invited me, hosted me and generally looked after me. I’ve made some good friends and ColaLife has some valuable new contacts.

A note on the data in this post
Cited data are interim results from the COTZ endline survey and may not reflect the final report.
Final calculations may vary.
Final results of the ColaLife trial (COTZ) will be published in due course by Ramchandani R, et al.