In a recent post I tried to quantify the Kit Yamoyo Legacy and indicated that I’d follow-up with a post on how we think this legacy was achieved.
We think it boils down to eight principles and furthermore we think that if ‘foreign bodies’ (international NGOs and aid agencies) followed these principles, we would see more self-sustaining development ie development that lasts beyond iNGO/donor involvement:
- Plan for a legacy from the outset
- Ensure co-creation and learning are iterative throughout
- Engage intended beneficiaries from the start and throughout
- Work as part of a ‘smart’ partnership (gathered around a vision not another partner or funding opportunity)
- Act as a catalyst: never a permanent part of the solution
- Do everything through local systems and structures
- Ensure you are invisible
- Leverage policy to align, embed and institutionalise at every opportunity
1. Plan for a legacy from the outset
This is self-explanatory. You should not start thinking of an exit strategy a year before a project is due to end.
2. Ensure co-creation and learning are iterative throughout
Co-creation has become something of a buzz word in recent years.
It’s fair to say we were ahead of the curve. We used participatory techniques to run 3 co-design workshops with the participation of over 20 interested organisations from 2010 to 2011. This was all before we wrote the first trial plan and donor bid. Ideas were co-developed and rigorously critiqued. Partners self-selected based on alignment with their own work programmes, expertise and aspirations.
3. Engage intended beneficiaries from the start and throughout
The same participatory and learning processes carried on into our quarterly Learning and Steering Group, hosted by any interested body (here, setting up at USAID Discover Health), chaired by the Ministry of Health. It ran from the trial launch until September 2018 and engaged at least 25 organisations from fields beyond public health – any interested organisation could attend and comment on emerging data, learning, progress, problems and failures.
We engaged our intended beneficiaries from the very outset. This sounds obvious but is often overlooked. It is essential to listen – and operate on the basis of what you know people want, rather than on what you think they need.
A very strong message from the eight focus groups we ran was that 1 Litre sachets are too big for home use. Yet it is standard practice to distribute 1 Litre ORS sachets to treat diarrhoea in the home. This would indicate that no one before us consulted with caregivers or if they did, they didn’t take note of what they said.
This finding nearly derailed us. Having received this message, we couldn’t proceed to put litre sachets in Kit Yamoyo.
So, we worked with the manufacturing partner to produce a 200 mL sachet and the design-thinking process brought in the packaging as a measure for water. This is the focus of our second recently published academic paper in the BMJ.
4. Work as part of a ‘smart’ partnership
The co-creation process and the resulting partnership focussed NOT around ColaLife or any other organisation, not around a funding opportunity, nor a single project. It formed around a shared vision. 
This encourages institutionalisation from the outset, promotes engagement, ensures shared ownership of the vision and helps ensure that the partnership will survive the departure of any single member. We call partnerships formed around a vision ‘smart partnerships’.
5. Act as a catalyst: never a permanent part of the solution
Foreign bodies should take care not to make themselves a permanent part of a solution. If they do when projects close and donors or iNGOs leave, part of the solution is lost. In the worst case scenario, when donors or iNGOs do become solution implementors they set up parallel systems and this can weaken pre-existing local systems which have the long term responsibility for providing the solution.
6. Do everything through local systems and structures
Before we first arrived in Zambia on a two-week exploratory trip, in October 2010, all the components required for the transformation we wanted to see were already here.
The policies were there (set by government); a regulatory system was in place; there was a pharmaceutical manufacturer who shared the vision; distributors were there, wholesalers and retailers too. There were Community Health Workers, nurses and doctors. Many local NGOs offered experience and networks across the country. No new institutions needed to be created. We all just had to gather around the vision: saving lives through better access to co-packaged ORS and Zinc.
7. Ensure you are invisible
Our project tee shirts said ‘Kit Yamoyo’, not ColaLife. The wall paintings credited Pharmanova. Posters, billboards, jingles – even the product itself had no reference to ColaLife or the name of the project or the donor. We had to fight for the latter, and we did fail once.
The urge, on the part of donors and development agencies, to brand everything they fund or support, is overwhelming. However, this completely changes how the intervention is perceived. For example, This was the original artwork for the billboard for the promotion of the diarrhoea treatment kit – Kit Yamoyo – at the start of the scale-up in Zambia:
In a second phase of marketing, a USAID project agreed to fund additional billboards but insisted on having their logos on the billboards. You’ll note that this destroys the integrity of the group effort and makes it look like it is from outside the country when in fact it was home grown.
This was a mistake.
We are very pleased to say we persuaded DfID (FCDO) to suppress their brand on the product – but we credited in training materials. Wholesalers, retailers and caregivers never knew of ColaLife. In the field, they knew of KZF, the frontline NGO partner. They knew of the evaluation partner: Ruralnet Associates. They knew of the Ministry of Health backing and support. This meant that the effort was seen for what it was: a Zambian effort catalysed by temporary donor assistance and technical support.
8. Leverage policy to align, embed and institutionalise at every opportunity
In November 2017, we went into Shoprite. When we saw this, we knew that Kit Yamoyo was on its way to self-sustainability.
This label was not put there, or even suggested by us. It was part of a Shoprite ‘local products’ campaign.
The co-creation process was founded on Ministry of Health (MoH) participation and support. The Ministry chaired our Learning and Steering Group. We continually aligned and re-aligned plans, materials, the products and activities with existing or emerging government policy.
This sometimes created issues and barriers: for example, we had to separate the hand washing soap from medicine to meet ZAMRA’s approval in the first kit design; we later had to remove the soap entirely as ZRA ruled the product would otherwise attract VAT.
But aligning to the MoH plans enabled us to harness Community Health Workers, explore the use of small retailers as pharma-outlets, explore a private sector role for Medical Stores Limited, and localise manufacture.
Our efforts culminated in the Ministry’s agreement to order its own branded kit through its Essential Medicines List process. Zambian evidence and lessons were then key in our subsequent successful application to change the WHO EML in 2019 – particularly that co-packaging improves dispensing practice. WHO now recommends *co-packaged* ORS and ZINC – the ultimate step in global institutionalisation. In 2021 we co-founded a network called ORSZCA (the ORS/Zinc Co-pack Alliance) to help accelerate the uptake of this new recommendation; we know of 2 countries that have amended their own EML already: Madagascar and Ethiopia.
We’d be particularly interested in comments on this blog post.
