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Mother and child leave the shop of a Kit Yamoyo retailer in rural Kalomo.  Image credit: Claire Ward

1. Completed the ColaLife Operational Trial in Zambia (COTZ)

When we started the ColaLife trial in Sep-12, no child in our trial areas was receiving the decade-old recommended treatment for diarrhoea: ORS and Zinc combined. Just 12 months later, 45% of children were and virtually all of them got it from Kit Yamoyo. When we started, the perception of ORS was already good with 78% of women agreeing that it was an effective treatment for diarrhoea. But 12 months later, 92% of mothers in our trial areas thought it was effective: a significant 14 percentage point rise. In 12 months, 90 registered retailers across the two trial districts bought 25,000 Kit Yamoyos and took them back to their remote villages to sell. That helped to reduce the distance mothers had to travel to access ORS and Zinc from 6.3km (to their nearest health centre) to 2.4km (their nearest Kit Yamoyo retailer). And so the list goes on. We will be announcing plans to release the trial findings in January 2014.

Findings in this blog post are no yet published and based on initial 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). Unpublished data. ColaLife Operational Trial Zambia (COTZ) Evaluation. Johns Hopkins Bloomberg School of Public Health, Baltimore. Related correspondence to Rohit Ramchandani (e-mail: roramcha@jhsph.edu).

2. Kit Yamoyo featured at UN General Assembly

The painstaking work designing the Kit Yamoyo – through consultation with mothers – has really paid off. Mothers love it and it has received global recognition as an effective, innovative, well-designed health product. In September 2013 it was chosen by PATH to feature at the UN General Assembly as one of the Top 10 ‘breakthrough innovations’ in mother and child health that if scaled-up could save lives now.

Regular readers will know that as well a delivering the medicine needed to treat a child with diarrhoea in the home, the packaging also acts as:

• • • • • 1. A measure for the ORS solution
          2. A mixing device
          3. A storage device and
          4. A cup

>> The full details on ColaLife’s Kit Yamoyo

 

3. Moving to a national scale-up

As indicated above, at the end of the trial there was a high level of use of the Kit Yamoyo in the treatment of diarrhoea (45%). However, even at the six-month point (the Midline survey) it was apparent that there was a high level of use of the kit. We asked mothers if their child had had diarrhoea in the last 2 weeks and if they answered ‘Yes’ we asked them how they had treated it; 43% said they’d used Kit Yamoyo. Given this, we started work on a national scale-up plan immediately, with the objective of having no gap between the end of the trial and the scale-up. What would women do if the flow of kits stopped?

We drew up a scale-up plan called KYTS – Kit Yamoyo Transition to Scale – and presented it to our three primary donors: DfID, Johnson & Johnson Corporate Citizenship Trust (J&JCCT) and Grand Challenges Canada (GCC). DfID said yes straight away to their contribution to Jun-14 and J&JCCT have agreed to the total amount we asked of them. We were hoping that GCC would have approved the amount we’d asked of them at this point. However, they have further questions they want answering before agreeing their contribution. We are hoping for a decision in Feb-14.

 

4. Peter Day, BBC’s Global Business Correspondent visits us

Simon first experienced Peter Day’s quick-fire interview technique at the Design Awards ceremony on 16-Apr-13 where our Kit Yamoyo won Product Design of the Year 2013 (see below). Peter’s Producer, Michael Wendling, indicated that they may visit Zambia on a Global Business Assignment in Jun-13. So, we invited them to visit the COTZ frontline. We met them on the main road south from Lusaka to the Victoria Falls and took them off-road for 50km to Kanchele, one of the villages in the COTZ trial area.

What resulted has been fantastic for us in terms of awareness and donations. First, an essay by Peter was broadcast on From Our Own Correspondent on 18-Jul-13. This was followed by a full 30-minute feature on ColaLife broadcast in the UK on 29-Aug-13, later repeated on the World Service. There was also an article in the BBC Magazine.

Peter was one of the first to break the news to the world that it was the space in the market that was the important thing, not the space in the crates. There is more on this here.

The reach of Peter’s broadcasts is amazing. We’ve had diplomats, big businessmen, academics, a taxi driver and a community development worker in Zambia all say they heard about ColaLife through Peter on the BBC. 

 

5. More innovation!

Despite all the awards (see below), every component of the Kit Yamoyo, including the packaging, is being reassessed, based on the findings of the COTZ trial. Our objective is to reduce the costs without reducing the innovative functionality. This root and branch review is summarised in the slide below.

Once again, packaging design is a key part of the evolution of the Kit Yamoyo. In 2013, we worked with our packaging partner PI Global to develop a Screw-top format; the mould for this is currently under manufacture in China for a local plastics company: Polymer Containers. We are at the advanced prototype phase with a cheaper, flexible pack which will be used as a refill for the Screw-top but can also be stand-alone, with the functionality to enable the measuring of the correct amount of water for mixing the ORS. We would like to thank Amcor for their tireless work in the UK on the various versions of the flexible pack. We will be announcing the details of this in the New Year.

 

6. Localisation: Zinc and small hand soap bars in Zambia

We contacted the few pharmaceutical manufacturers we could find in Zambia at the outset of COTZ – but only Pharmanova seemed ready to take up the challenge of making the small ORS sachets we needed for Kit Yamoyo. What’s more, inspired by their key role in the trial, they started the development of their own formulation of paediatric 20mg Zinc tablets. These will be the first Zinc tablets to be manufactured in Zambia. Samples of the new tablets were put down for stability testing in Nov-13. Assuming a successful outcome of these tests, the Kit Yamoyos produced in the second half of 2014 will incorporate these locally produced tablets.

In 2013 we also established a link with the only soap manufacturer in Zambia: Trade Kings. Trade Kings have agreed to manufacture a 25g bar of anti-bacterial soap, starting early 2014. This soap will replace the imported soap currently in the kits.

These two developments together with the new Screw-top packaging will make the Kit Yamoyo a 100% Zambian product.

 

7. Globalisation: Angola, Liberia, The Gambia, Uganda, Kenya and India

Angola | Liberia | Uganda | Kenya | India (approximately to scale)

We want our work to have a global impact. Our strategy for achieving this is not to grow ColaLife as an agent for global roll-out but to generate robust evidence of what works. Then, we do all we can to get existing players – national Ministries of Health; global NGOs and donors – to incorporate the learning we generate from our work into their own programmes. This is why we continue to put a lot of effort into building and maintaining alliances with key players in all sectors. This year, we have followed up on interest from Angola, Liberia, The Gambia (not shown above), Uganda, Kenya and India. In 2013 we hosted a visit from two representatives from the Angolan Human Development Fund. Simon visited Uganda (hosted by CHAI) and India (hosted by HLFPPT). In Jan-14 Simon will be visiting Kenya (hosted by TechnoServe).

 

8. Signed a partnership with the drinks start-up Everly

We were very pleased when the co-founders of the US drinks start-up Everly contacted us this year to explore a win-win partnership. The synergies between Everly and ColaLife are really quite striking. One of the founders – Chris Cole – spent time working in a clinic in Bangladesh – the birthplace of ORS – and their powdered drinks are not unlike ORS in concept. The partnership is now formalised: with each sale, Everly provides funds to ColaLife for the production of ORS packets, produced in Zambia, by Zambians.
>> Read more about our partnership on Everly’s website

 

9. More awards!

In 2013, ColaLife won five more awards to add to the cabinet! We were particularly pleased to break into the mainstream with the Product Design of the Year Award 2013. It was particularly pleasing to get this award for something as humble as an anti-diarrhoea kit – designed for the poor with the poor. Other contenders for this award were Bang & Olufsen and the Olympic Cauldron. The other equally prestigious awards were:

1. Innovation By Design Awards, Social Good category – 2 October 2013
2. 2013 Observer Ethical Awards – 13 June 2013
3. Overall winner, 25th DuPont Packaging Innovation Awards 2013 – 16 May 2013
4. Winner – Food Security, 25th DuPont Packaging Innovation Awards 2013 – 16 May 2013

>> Read more about our awards

 

10. The Cola Road Premiere: London, New York, Siachitema

The premier of The Cola Road documentary in Siachitema, one of the filming locations

Last year we listed the filming of The Cola Road as an achievement by Claire Ward, Guy Godfree and Tracey Levy. We are pleased to say that all this effort was followed through, with lots of work to produce the documentary itself. It was premiered in New York, London and Siachitema. In Aug-13, Claire Ward won Best Director (Documentary) at AOF Festival 2013, Monrovia, California for The Cola Road.
>> Click here for information on how to request a screening

 

… and we stimulated some more debate

One mechanism we use to make progress is to dare to ask provocative questions (like: Why are we giving litre sachets of ORS to mothers to treat diarrhoea in the home?) and challenge the status quo. We’ve done this in several areas this year including:

• Is it right to sell ORS to poor people when they could make their own?
• Could the private sector supply remote rural health posts in Zambia?
• How should we consider price vs value for poor people?

 

Finally, as we say every year . . . a big thank you to everyone who has supported ColaLife throughout 2013. We are making great progress. We couldn’t do it without our supporters. You are the foundation of everything!

Onwards and upwards.

Citing of the data contained in this blog post:
Unpublished raw data from the ColaLife Operational Trial in Zambia (COTZ) which may not reflect the final report which will be published as: Ramchandani, R. et al. (2014). ColaLife Operational Trial Zambia (COTZ) Evaluation. Johns Hopkins Bloomberg School of Public Health, Baltimore.
Final calculations may vary.