ColaLife to close down at the end of 2023

It has always been the view of our board of trustees and the ColaLife co-founders that ColaLife should not outlive its usefulness. We’ve achieved far more than we ever anticipated. And the changes we’ve brought about now sit with mainstream organisations much more powerful than we could ever be. So, ColaLife will close down gracefully at the end of 2023. Or to be more precise, it will cease operations on 31-Dec-2023 and close on 31-Mar-24.

This blog post outlines what we need to do to ensure a graceful shut down. It reflects on why ColaLife was set up in the first place, why it’s kept going for 12 years, the legacy it leaves and why it’s right to close it down at the end of this year.

Animation credit: Sam Berry (view video on YouTube)

When we started to globalise the idea of co-distributing simple medicines with Coca-Cola in May-2008 we had no intention of setting up an organisation. As a couple of volunteers, we thought that if we could get enough support behind the idea and get The Coca-Cola Company engaged, we’d be able to handover to a large existing international NGO (non-government organisation). We wondered if Save the Children or UNICEF might work in a distribution partnership. This was naive. In 2008/9 no NGO concerned with the health and wellbeing of children was going to partner with The Coca-Cola Company – even if Coca-Cola knew how do things they desperately needed to do better. So, Jane and I faced a dilemma. We would have to take things forward ourselves or risk being seen as the couple who generated massive support for an exciting idea and then did nothing about it.

It was over a weekend breakfast in Mar-2010 that we decided that it would fall to us to take things forward. We agreed that we would give up our jobs in Jun-2010 and give ourselves a year to get a trial of the idea underway somewhere in Africa. ColaLife was later incorporated and was granted charitable status in 2011.

Headline findings (MOO)But still, our focus was on handover. At this point we believed that if we could generate robust evidence that the co-distribution/co-packaging idea worked we would have an attractive proposition for an appropriate NGO to adopt and take forward. We were also advised by a DfID-funded consultant reviewing the ColaLife trial not to proceed to scale-up ourselves. “Running a trial is one thing, scaling up is quite another”, he said.

But again, there was no one in the right place at the required time to whom we might hand over. If scale-up was going to happen, ColaLife was going to have to catalyse it.

Our involvement in the scale-up in Zambia was intense initially as we worked to get funding in place for our existing partnership. In spite of our evidence, this wasn’t easy – or totally successful. With some funded activity in place, we left Zambia in Jun-2014 returning one month per quarter and supporting the local effort remotely until Sep-2018.

Kit Yamoyo - Proudly Zambian Mother and child with GRZ ORS/Zinc co-pack

The two most significant developments during the scale-up were that the national supermarket chain in Zambia (Shoprite) began stocking Kit Yamoyo and the government adopted the ORS/Zinc co-pack as the preferred treatment for diarrhoea – both providing significant customers for our manufacturing partner, Pharmanova. The government in particular had a huge impact on ORS/Zinc coverage in the country: our baseline surveys in 2012 showed ORS/Zinc coverage rates of <1%. After our scale-up efforts, the 2019 DHS survey found a coverage rate of 34%.

We are very proud of the legacy of the work in Zambia. By the end of 2023, 2.5 million co-packs will have left the local manufacturer’s factory. What’s more, the majority of these (1.7 million) will have left since donor support ceased in Sep-2018. Legacies like this are rare in the international development sector and others are keen to understand how this was achieved. This is our analysis: So how was the Kit Yamoyo Legacy achieved?

With this national impact we saw an opportunity for global impact and started to plan for an application to WHO. We thought that if we could change their Model Essential Medicines List (EML) to recommend co-packaged of ORS and Zinc this would move the co-packaging innovation into the mainstream. Our application was successful. The 2019 edition of the EML was changed to include the co-packaging recommendation.

The new WHO Essential Medicines List listing for diarrhoea

At this point it was tempting to call it a day even though we realised there was still a job to be done to advocate for this new recommendation, to accelerate its uptake by national governments. However, at what we imagined would be a final, sign-off meeting, in Aug-2019, with our most loyal strategic funder – the Isenberg Family Charitable Foundation – we were encouraged to continue to try and catalyse a global advocacy effort.

With the help of handful of key players, most notably Leith Greenslade (JustActions) and Elena Pantjushenko (PATH), and the support of two co-chairs – Dr Morseda Chowdhury (BRAC) and Samy Ahmar (Save the Children UK) – the ORS/Zinc Co-pack Alliance (ORSZCA) was launched in Jan-2022.

Since mid-2019, most of ColaLife’s resources have been focussed on the launch and establishment of ORSZCA. ORSZCA has already achieved a lot but now we believe that, to achieve its full impact, the administration of the ORSZCA network needs to be taken over by a large NGO with a track record in advocating for child health. We are working to try and make this happen. We are determined that this final handover attempt will be successful – ORSZCA has the potential to be a vibrant and influential network of key players who can promote a simple change, in their own countries and states, to save children’s lives: increasing coverage of co-packaging ORS and Zinc together.

After the closure of ColaLife, this website and blog will remain in place as a reference resource but with no further updates. We will continue to maintain the ColaLife Playbook, now remodelled and renamed as The Co-packaged ORS/Zinc Playbook, on a voluntary basis, and answer questions and requests for case studies of how we worked – which still continue to come in.

We wish to thank the thousands of people that have made this effort possible over the last fifteen years. Special mentions go to the 8,000 members of the Facebook Group in Mar-2010, which made turning back impossible, to all of our partners and supporters, past and present, and to the Isenberg Family Charitable Foundation. We thank them for seeking us out and trusting us with their money. Their funding has tied everything else together and allowed the effort to be continuous and relentless.

And so to the proverbial question. How many lives have we saved? This is very difficult to say although we do know from the evidence that there is a direct link between coverage of ORS and Zinc and child mortality. Increased coverage reduces mortality. But let’s not dodge the question. The case fatality rate from childhood diarrhoea ranges from one per 10,000 infections to more than 20 per 10,000 infections. If we assume that one co-pack treats one case and that the child survives, then we might say we have saved between 250 (2.5m/10000) and 5,000 (2.5m/10000 x 20) lives. This relates to our work in Zambia. It is impossible to say how many more lives will be saved by the global adoption of the co-packaging recommendation.

Also, it’s not just about saving lives. We’ve helped 2.5 million children get better and reduced the morbidity associated with childhood diarrhoea.

Onwards and upwards.