ColaLife worked with global health agencies, including UNICEF, and the Ministry of Health in Zambia, to study Coca-Cola’s techniques. We also consulted parents and carers of children in Zambia and more widely – among local and international NGOs, academics and businesses – and applied our learning to the design, marketing and distribution of a new, life-saving diarrhoea treatment kit. Kit Yamoyo contains the established global recommendation: ORS and Zinc, and also a small soap bar for hand-washing. Most importantly, it co-packages ORS and Zinc: our research found this is vital to ensure that children receive both medicines, as recommended by WHO/UNICEF, whether via the public or private sector. Working for nearly two years with partners, we put this evidence to WHO. In 2019, WHO accepted our evidenced submission, requesting that they change the international Essential Medicines List to recommend co-packaged ORS and Zinc. This was successful, and led to the foundation of ORSZCA: the ORS and Zinc Co-pack Alliance, to advocate globally for co-packaging. This simple change could save many thousands of children’s lives. ColaLife’s main efforts are now through this new global alliance.

After the initial trial in Zambia, in 2014, Kit Yamoyo achieved approval for general sale in Zambia, through ZAMRA and the Ministry of Health. Internationally, the designs have won many awards, in health, packaging and design fields. A decade after the first trial ended, Kit Yamoyo is still available in Zambia in major supermarkets and small shops, bringing it closer to people across Zambia. The Ministry of Health has adopted the product for distribution to its Health Centres across the country, where is is available without charge. Kit Yamoyo, manufactured by Pharmanova in Zambia during the trial, was taken on by them as their own product in 2016 and is now made and distributed independently, with no input from ColaLife, and is profitable. We are in the process of passing on a no-fee licence to them, to manufacture in Zambia.

This has ensured long-term sustainability and local ownership – part of ColaLife’s ethos from the outset. Zambian customers across the country can now try Kit Yamoyo for their sick children – and tell us their experiences.

Our first trial (known as COTZ) showed  compelling results. Perhaps the most important finding was that in the 12 months of the trial, children who received the recommended treatment for diarrhoea increased from less than 1% to 45%. Following a successful trial, ColaLife worked with partners on 2 scale-up projects in Zambia, with improved, lower cost formats of the original Kit Yamoyo design.

We achieved sustainable success in Zambia through twin approaches:

• redesigning the presentation of the global recommendation to better meet the needs of customers (a process drawing on design thinking and ‘human centred design’) and
• the development of a value chain for the products, to benefit from existing distribution channels, which can even reach remote communities. These were already used for fast-moving consumer goods like Coca-Cola, sugar, salt, cooking oil. ORS and Zinc are ‘general sales’ items in Zambia and in most countries. So, we learned from other products to establish a viable ‘value chain’ for Kit Yamoyo. This proved more important than the original ColaLife concept, which was to ‘piggy-back’ product, nested within cola crates. But innovation is about failing and learning, as well as success: that original idea didn’t help distribution, but it unlocked other innovations – which worked. As with many innovations, pursuing the original concept accidentally revealed others, which worked better in real life.

1 The product

The two commercial formats of the Kit Yamoyo anti-diarrhoea kit incorporate all the learning from the robust, quasi-experimental 12-month trial (COTZ), which served two remote rural areas of Zambia. These two formats are now in sustainable production in Zambia. They are: the Screw-top and the Flexi-pack.

The contents of both formats are based on the WHO/UNICEF recommendations for a diarrhoea treatment kit: Oral Rehydration Salts and Zinc (ORSZ). Zinc also plays a preventative role. We originally included soap to encourage hand washing and to give us a device to promote prevention. This is now included in the premium pack only (the Screw-top) as the inclusion of soap attracts VAT on the whole pack, and we strived to keep the flexi-pack as low cost as possible. A key design breakthrough is providing packaging which can measure safe water for new, small format sachets of oral rehydration salts (ORS). The trial clearly demonstrated better mixing and ease of use, through supplying smaller sachets than the conventional 1L. This resulted in strong customer confidence. Co-packaging ORS and Zinc in one pack has also been a game-changer, that we have taken to international level.

1.1 The Screw-top

The Screw-top was tested during our scale-up projects and launched commercially in Zambia in 2017. It is mainly distributed now through supermarkets. The screw-top container is produced from a standard ‘pre-form’ already available in Zambia. It is heated and blown into our own Kit Yamoyo mould, so that the measuring function is clear.

The screw-top format contains:

• 4 x small format ORS Sachets (4g/200ml)
• 1 x blister pack of 10 Zinc tablets (20mg)
• 1 x 25g bar of soap
• 1 x instruction leaflet

It has the following features:

• It acts as the measuring device for the water needed to mix the 200mg ORS sachets correctly
• It acts as the mixing device for making the ORS solution
• It is a storage device for the mixed ORS
• It is a cup children can drink from
• The screw-top has indented sides (not evident in this image) which enable it to be held easily by a child
• It has a clear measuring mark for 200ml water
• The brand is embossed on the jar
• It can be re-used by buying a lower cost ‘flexi-pack’ as a refill.

For a better idea of how the mixing and cup features work please see the information leaflet shown below.

1.2 The Flexi-pack

The Flexi-pack, originally conceived as a refill for the Screw-top, has become the primary product due to its low cost, ease of transport, and adoption by the government of Zambia for health centres. It contains the same components as the screw-top but without the soap. It is cheaper, yet retains the key functionality of measuring as the Screw-top. Price is crucial in the markets that Kit Yamoyo is aimed at. Despite its apparent simplicity, the packaging is quite sophisticated: a gusseted bag with an easy-to-open laser cut, it stands up well when filled with water to measure what is required to accurately make up the ORS sachets provided. Instructions are printed on the bag and are also graphically displayed on the removable leaflet inside.

The Flexi-pack is also produced in a government-branded version. This is identical to the commercial version above except the leaflet carries the government branding. This version is given away free in government health centres in Zambia.  The see-through packaging is key to enable the manufacturer to easily run production of the commercial flexi-pack alongside large orders from the government, simply by changing the locally printed leaflet.

The video below shows the Flexi-pack in action.

2 The components

2.1 ORS

Focus group work and consultation with experts carried out before our trial began revealed that customers (mainly mothers and carers of children in remote/poor settings) had difficulty measuring the 1 litre of water needed to mix the standard-issue ORS sachet. A litre is not well understood, and measuring devices are uncommon in many poor African homes. In any case, a child will only drink an average of 400ml in a day; one is supposed to throw away any remaining solution after 24 hours. So, following the instructions on a conventional 1 litre pack, customers are expected to throw away more ORS than they use. This is seen as a waste of ORS and – just as crucial – a waste of water, usually brought from a long distance.

So, the Kit Yamoyo ORS sachets are designed to make up just 200ml of solution, with the packaging used as the measure for the water needed.

This simple innovation led to 93% of Kit Yamoyo users mixing the ORS correctly compared to less than 60% of users who are given that standard 1 litre sachet. It also extended the number of days that ORS was given as there was no waste.

2.2 Zinc

Following the trial, our pharmaceutical partner started production of their own Zinc product. This gave us the opportunity to influence the design of the packaging. We had great success, through design, in increasing the adherence to the correct mixing of ORS and through this blister pack design we increased adherence to the correct Zinc regime (10 days).

2.3 Information leaflet

The information leaflet for the Screw-top and the Flexi-pack are the same: a double-sided, single-fold format. We have gone away from a tri-lingual design, which we found that very few people actually read (as literate people in Zambia have often been taught to read English, not their local language, in school), to the use of minimal text in English only, and simple diagrams.

For more details on the background to the development of the Kit Yamoyo please see: colalife.org/aidpod

Further details of our work is available from our website: colalife.org