Designing for better Zinc adherence

Blister pack Zinc adherence v3 without dimensions and circles

Regular readers will know that Kit Yamoyo, which we designed and distributed through the ColaLife Operational Trial in Zambia (COTZ) did a great job of applying design thinking to make Oral Rehydration Salts easier for mothers to use in their home. We put a lot of effort into understanding the needs and circumstances of carers looking after young children – and it paid off. Our final survey showed that 94% mothers/carers who used Kit Yamoyo mixed the ORS correctly. On the other hand only 60% of people get the mixing right when given a 1 litre sachet. The reason for this is that the Kit Yamoyo packaging acts as a measure for the 200ml of water needed for the smaller ORS sachets the kit contains.

Although we did quite well with the vital micro-nutrient, Zinc, which goes along with ORS as the ‘gold standard’ diarrhoea treatment, we can do better. Yes, we did manage to get combined ORS and Zinc to 45% of children in our trial areas – up from a baseline of under 1% when we started. But our final survey showed that the adherence to the Zinc regime in the trial was not as high as it could be. Only 33% of care-givers actually continued to give their children Zinc pills for the recommended 10 days. The graph below shows that most care-givers gave Zinc for the duration of the diarrhoea and then stopped.  Actually, even a few days of Zinc will really help a child to get over diarrhoea and can protect them for up to 3 months. But 10 days is best.

ANALYSIS - Zinc tablets taken Overall

So, the question is, can we use good design to increase adherence to Zinc? This was a question Simon posed on the blog back in Sep-13. Many people dived in with suggestions and one company – Prime Decision – offered to look into this in detail on a pro bono basis.

Prime Decision applied their Seven Lenses methodology to the challenge to help explore current behaviour and identify new possibilities. Following this exploration of the problem, Prime Decision carried out a review of the literature on the labelling of medicines to encourage adherence. The key conclusions from this were:

  1. Putting instructions on the medicine itself is more effective than stand-alone instructions
  2. For tablets that need to be taken daily, having some sort of ‘calendar’ printed on the blister pack was more effective than transferring tablets to pill boxes
  3. Pulling out a clear message is helpful and having it in a box improves adherence

Prime Decision then produced a whole set of concepts which took this research and applied it to the Zinc adherence challenge. The final concept has now been worked-up by Simon to produce Version 1 of the artwork for the new Kit Yamoyo:

Blister pack Zinc adherence v3 without dimensions and circles

This artwork is now with our pharmaceutical partner – Pharmanova – for consideration. The next step will be to incorporate their feedback and get the design approved by the Zambia Medicines Regulation Authority.

Of course, none of this would be possible if Pharmanova hadn’t been inspired by its involvement in the trial to manufacture its own Zinc here in Zambia.

Related links

Zinc in Zambia: A case for behavioural design – Prime Decision’s report on the work they did for us


The data contained in this blog post:
Findings in this blog post are unpublished 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). ColaLife Operational Trial Zambia (COTZ) Evaluation. Johns Hopkins Bloomberg School of Public Health, Baltimore. Related correspondence should be sent to Rohit Ramchandani ( and copied to Simon Berry (


  1. I use adherence/compliance as one of the greatest achievements of ColaLife to date.

    We have worked on compliance in the pharma industry for 30 years as it is the final step in the process of delivering the product to the consumer and if it fails there, all steps in the process have been wasted. So I can’t understand why some organisations are still promoting 1 litre packs.