ColaLife: Emulating Private Sector Value-Chains to Transform Access to ORS & Zinc for Childhood Diarrhoea
We identified key bottlenecks associated with the supply & demand of ORS & Zinc for childhood diarrhea. By emulating the value-chains of companies like Coca-Cola - leveraging the same distribution channels used to supply their products to remote communities, & creating an innovative, profitable, demand-driven product based on human-centred design - we've demonstrated that access & use of this combination therapy can be significantly improved, closer to home & more effectively
ColaLife is currently working with the MOH, Keepers Zambia Foundation (KZF), and our local pharmaceutical partner, Pharmanova, to scale-up our internationally acclaimed model, both within Zambia (i.e. nationally) and beyond. This has resulted in multiple Kit Yamoyo Transition to Scale (KYTS) streams including:
KYTS-Formal - Scaling through new private sector partners like Shoprite, Africa’s largest grocery chain with 359 franchise outlets in 15 countries across Africa (including the 20+ outlets we are working with in Zambia), as well as other retailers like SPAR, Choppies and the Live-Well social enterprise. In addition, we have initiated partnerships for community level distribution through various NGOs (e.g. Marie Stopes International).
KYTS-ACE (Adapting to Challenging Environments) - Funded by the Scaling-Up Nutrition (SUN) movement with match funding from ColaLife (through our GSK and Save the Children Healthcare Innovation Award), this stream focuses on achieving scale in the 14 most underserved, rural districts in Zambia. Central to this stream is a public (Government-branded) version of our kit, free at point of distribution (i.e. health centres). The kit is based on the same design configuration as the Kit Yamoyo, and makes Zambia one of the handful of countries in the world that is providing an ORSZ combination therapy product through the public sector.
KYTS-Lusaka – Funded by DFID’s UK Aid Direct with 25% match funding from ColaLife (through our GSK and Save the Children Healthcare Innovation Award and crowd-funding). This focuses on market shaping in Lusaka Province, with an emphasis on urban and peri-urban compounds. Public-private collaboration with health centres and community health workers compliment the private sector expansion that is taking place.
Monitoring and evaluation activities related to these streams of work continue, as we continue to shape the market and gain traction throughout Zambia, into 2018.
How does your innovation work?
Our Innovation has the following features:
Four "mini" 4.2g sachets of orange flavoured, low osmolarity ORS, which each make up 200ml of solution (more appropriate for home use)
10 dispersible, pediatric formulated zinc tablets in a blister pack designed to encourage improved adherence to the full 10-day course.
Bar of soap for handwashing, and to tie in the message of prevention (optional - version with and without)
Instructions/BCC materials which contain mostly pictoral directions for proper use of the kit. This leaflet also contains the branding for the Kit and can be easily changed to meet the specifications of different contexts.
Packaging that doubles as a measurement vessel (with 200ml mark) for preparing the enclosed ORS sachets in the correct concentration.
The screw-top format can also serve as a m ixing vessel and a drinking vessel.
Social marketing and more traditional forms of marketing are then used to increase awareness and demand for the product at the community level.
The Kit is then plugged into the same distribution channels as those of other fast-miving consumer goods. Every player in the value-chain makes a little bit of profit, from the manufacturer, to the district level wholesalers, to the community level retailers, while maintaining an affordabke cost for consumers at the end of the value-chain
What Evidence do you have that your Innovation works?
Findings from the ColaLife Operational Trial Zambia (COTZ) and beyond:
Increased coverage of ORS and Zinc combination therapy in our intervention districts from less than 1% at baseline to 47% at endline. No change was seen in the matched comparator districts.
While only 60% of standard one-litre sachet users prepared ORS in the correct concentration, 93% of Kit Yamoyo users did. Odds of correct ORS preparation were found to be 10.93 times greater (p<0.001; 95% CI: 5.74-20.78) in Kit Yamoyo users vs. those that used 1-liter sachets from the health center.
Preparation of ORS in the correct concentration was also found to be significantly associated with an increase in the odds of perceiving ORS as effective (OR: 1.84, 95% CI: 1.05-3.23, p<0.05)
At baseline, caregivers walked an average of 7.3km to get to an ORS and Zinc access point (i.e. rural health centres). At endline, they walked an average of 2.4km to get to an access point (i.e. community-level shops).
Over 26,000 kits were sold across 2 intervention districts during the one-year ColaLife Operational Trial in Zambia. We are now well into our national scale-up. In 2016, 379,974 Kit Yamoyo were distributed through public and private sector channels.
A Lives Saved Tool (LiST) analysis estimates that 83 lives were saved across the two intervention districts during the COTZ alone.
For more related studies, and more robust evidence, please visit:
Yes. 1000's of Kits are now being sold (via the private sector) or distributed through rural health centres (At no cost to the patient) throughout Zambia.
What is your strategy for expanding use of your innovation?
In addition to national scale-up activities in Zambia, we have also started working on a globalizer strategy. With a focus on some of the highest burden countries for childhood diarrhea (which include: India, Nigeria, Pakistan, Democratic Republic of Congo (DRC), Angola, Ethiopia, Indonesia, Chad, Afghanistan, Niger, China, Sudan, Bangladesh, Somalia, Tanzania, Uganda, and Kenya), we are now exploring opportunities and partnerships to adapt our model beyond Zambia, improving coverage and effective use of ORS and Zinc globally. We believe that adoption of our product designs and approaches can have a significant impact in these areas.