Improving Access to ORS and Zinc in Rural Zambia
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Presentation to PATH staff on 23-May-14. Delivered in Seattle with a video link to Washington and audio link to San Francisco. Download the presentation for the speech narrative that is contained in the notes to the slides.
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Improving Access to ORS and Zinc in Rural Zambia
- 1. The ColaLife Operational Trial in Zambia (COTZ) Prepared for PATH by Simon Berry 23-May-14
- 2. What is ColaLife and who am I? ColaLife is a charity registered in the UK Charity number: 1142516 • No paid employees • Five voluntary trustees • Focus on saving children’s lives • Independent • Our only project is in Zambia • Looking for global impact through • Disruptive innovation • Generating robust evidence • Sharing findings and learning • No commercial interest 2009 2010 2011 2012 20131985
- 3. The ColaLife team 2009 2010 2011 2012 20131985 Rohit Ramchandani Jane Berry
- 4. Our starting point Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines don't. Why?
- 5. impac t Mothers in underserved rural communities increase use of ORS and Zinc in home treatment of diarrhoea purpose Target communities in two under-served rural districts have improved access to ORS and Zinc outputs Profit-driven supply chains improve availability of ADKs (anti-diarrhoea kits) in targeted communities in two underserved rural districts Mothers/care-givers demonstrate awareness of ADKs and the benefits of the contents (ORS, Zinc and Soap) access = ADK in the hand of an aware mother/care-giver Availability = ADK in stock in retail outlets at community level Generating robust evidence - the COTZ results framework
- 6. Dec 2011 The COTZ trial timeline
- 7. Early 2012 | Pre-trial focus group work What we learnt Litre sachets are too big Measuring water was an issue Willingness to pay Preferred branding
- 8. The Kit Yamoyo benefits Kit Yamoyo • Attractive
- 9. The Kit Yamoyo benefits Kit Yamoyo • Attractive • ORS sachets are 200ml
- 10. The Kit Yamoyo benefits Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also:
- 11. The Kit Yamoyo benefits Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: • A measuring device for the water
- 12. The Kit Yamoyo benefits Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: • A measuring device for the water • A mixing device
- 13. The Kit Yamoyo benefits Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: • A measuring device for the water • A mixing device • A storage device (the soap tray is a lid)
- 14. The Kit Yamoyo benefits Kit Yamoyo • Attractive • ORS sachets are 200ml • Packaging is also: • A measuring device for the water • A mixing device • A storage device (the soap tray is a lid) • A cup
- 15. The COTZ trial Research Design & Methodology Quasi- experimental, pre-test, post test design baseline, midline and endline surveys Target groups: Care-givers of under-5 children and private community retailers Four Districts – two intervention districts and two matched comparator districts Sample sizes: 625 HH per district 40 retailers per district Vouchers used to launch the product
- 16. The COTZ trial Distribution infrastructure and value chain Pharmanova MSL Coca-Cola wholesalers • Standard Sales (2) • Isusya’s Approximately 85 retailers across Katete and Kalomo Manufacture & Assembly Lusaka to District District to Retailers Mothers & Care-givers
- 17. >26k kits sold into the two remote rural trial areas in 12 months.
- 18. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%.
- 19. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km.
- 20. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
- 21. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.
- 22. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets. 4%Only 4% of kits went into Coca- Cola crates. It was the space in the market not the space in the crates that was important.
- 24. Our award-winning idea…… what happened in practice
- 25. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets. 4%Only 4% of kits went into Coca- Cola crates. It was the space in the market not the space in the crates that was important. 6International awards for health and design innovation & 6 countries interested in replication.
- 26. Awards | The Kit Yamoyo has won many global awards In Sep-13 it was featured at the UN General Assembly as a breakthrough innovation in Child Health. In Mar-14 it was show-cased by PATH and PSI in their Best Buys for Global Health initiative.
- 27. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets. 4%Only 4% of kits went into Coca- Cola crates. It was the space in the market not the space in the crates that was important. 6International awards for health and design innovation & 6 countries interested in replication. ...Request access to our findings colalife.org/ openaccess
- 28. 14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%. >26k kits sold into the two remote rural trial areas in 12 months. 45%of children in trial areas received ORS/Zinc. Up from a baseline of <1%. Comparator sites stayed at <1%. 2.4km The distance to ORS/Zinc in the trial areas was reduced by two- thirds from 7.3km to 2.4km. 93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets. 4%Only 4% of kits went into Coca- Cola crates. It was the space in the market not the space in the crates that was important. 6International awards for health and design innovation & 6 countries interested in replication. ...Request access to our findings colalife.org/ openaccess
- 29. ORS Reduce number of sachets to 4 NOTE: This will also enhance adherence Zinc Produce locally Only include blister pack Soap Produce locally Leaflet Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option Oct 2013 | Incorporating the learning into the scale-up
- 30. Learning: number of Kit Yamoyo ORS sachets used
- 31. ORS Reduce number of sachets to 4 NOTE: This may also enhance adherence to the combined therapy Zinc Produce locally Only include blister pack Soap Produce locally Leaflet Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
- 32. Learning: Kit Yamoyo Zinc adherence – days Zinc taken
- 33. Designing for better Zinc adherence
- 34. ORS Reduce number of sachets to 4 This may also enhance adherence to the combined therapy Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
- 35. ORS Reduce number of sachets to 4 This may also enhance adherence to the combined therapy Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
- 36. ORS Reduce number of sachets to 4 This may also enhance adherence to the combined therapy Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime lister pack needs no box Soap Produce locally Leaflet Simplify – single fold. Same leaflet for all formats Packaging Remove constraint of fitting in Coca- Cola crate Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
- 37. 4Revised Kit Yamoyo leaflet
- 38. ORS Reduce number of sachets to 4 This may also enhance adherence to the combined therapy Zinc Produce locally Design the blister pack to enhance adherence to the 10-day regime Blister pack needs no box Soap Produce locally Leaflet Simplify – single fold. Same leaflet for all formats Packaging Remove constraint of fitting in Coca- Cola crate. Only 4% of retailers used this option Produce locally Produce re-fill option 4Oct 2013 | Incorporating the learning into the scale-up
- 39. The screw-top The flexi-pack
- 41. TARGET unsubsidised retail costs (Kwacha) Screw-top Flexi with soap Flexi w/out soap Components ORS (4 sachets) 0.9000 0.9000 0.9000 Zinc (1 blister pack of 10 tablets) 1.0000 1.0000 1.0000 Soap (25g anti-bacterial) 0.4400 0.4400 0 Leaflet 0.2000 0.2000 0.2000 Packaging Container 0.9100 0.2000 0.2000 Bags and carton (per kit) 0.1200 0.0240 0.0240 Assembly 0.5000 0.2500 0.2500 TOTAL 4.0700 3.0140 2.5740 MSRP 8.00 6.00 5.00 Assumed margins: Manufacturer/distributor 20%; Wholesaler 20%; Retailer 35%
- 42. Scale-up framework Community-based marketing (all markets) Not yet commercial markets Commercial markets KZF/iDEPharmanova Monitoring & Learning Not yet commercial markets Collaborators
- 43. colalife.org simon@colalife.org jane@colalife.org rohit@colalife.org The slides that follow this one may be of interest but are not essential reading
- 44. The data contained in this presentation are unpublished and based on preliminary 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 (roramcha@jhsph.edu) and copied to Simon Berry (simon@colalife.org). A note on the data contained within this presentation
Notas do Editor
- ColaLife & product innovation – a presentation for the Diarrhoea & Pneumonia Coordination Committee, Uganda.
- I have no commercial interest in the commercial product I will show you. But are strategy for impact is that others will find it of commercial interest – more of that later.
- The timeline
- This was our original award-winning idea. But this is what happened in practice. It was the space in the market not the space in the crates that was important.
- This was our original award-winning idea. But this is what happened in practice. It was the space in the market not the space in the crates that was important.
- The Kit Yamoyo has captured people’s imagination and won many global health, design and innovation awards. In Sep-13 it was featured at the UN General Assembly as a breakthrough innovation in Child Health. In Mar-14 it was show-cased by PATH and PSI in their Best Buys for Global Health initiative.
- We are now moving to a national scale-up where will hand over the product to the private sector. To do that we need to apply the learning from the trial and bring the cost of production down. We need to look at all components of the kit including the packaging. All components of the Kit Yamoyo were reviewed based on the findings of the trial.
- First we will reduce the number of ORS sachets to 4 (from 8) this will halve the cost of the ORS component while at the same time enhance adherence to the combined ORS and Zinc regime. 75% of care-givers used 4 ORS sachets or less. Reducing the number of sachets from 8 to 4 will improve adherence to the combined therapy and halve the cost of the ORS component.
- Our pharmaceutical partner in the trial as been inspired to produce Zinc locally. The first samples were put down for stability testing in Nov-13. This provides the opportunity to design are own Zinc packaging. We’ve improved adherence to the correct measuring of ORS through design, can we do the same for Zinc adherence and improve adherence to the 10-day regime.
- The locally produced Zinc will be cheaper and there will be no need for it to be in its own box which will also reduce costs.
- We have persuaded the only soap manufacturer in Zambia to produce a small 25g bar of soap. This will replace the soap imported from India. They will sell the soap themselves as a stand-alone product.
- We will simplify the leaflet and reduce costs by making a single fold format.
- We will simplify the leaflet and reduce costs by making a single fold format.
- Because the kit no longer needs to fit in the Coca-Cola crates we can move to locally produced option – a screw-top jar which is 40% cheaper than the current packaging. In the scale-up we will be using two new packaging formats: • a screw-top • a flexible pack The screw top will have all the functionality of the original packaging. The flexible pack can measure the water.
- So, in Zambia, we are no longer using the packaging that won the DuPont Diamond Award just last year. We’ve moved on and are using these formats instead. This Screw-top incorporates all the features of the original AidPod. In fact it’s a better measuring device, mixing device, storage device and cup AND it’s cheaper and it can be made in Zambia. And this humble, pop-open, Flexi-pack – developed for us by Amcor – is even cheaper. And it can also measure the water and is free standing when you pour water in it.