ColaLife Operational Trial Zambia (COTZ)
The innovation addresses poor availability and access to ORS/Zinc, particularly at the ‘last mile’ in rural areas, creating and trialling an ‘end-to-end’ value chain for a new commodity: an anti-diarrhoea kit.
Simon Berry, ColaLife
Challenges in distribution of ORS/Zinc
Globally, diarrhoea is responsible for approximately 15% of childhood deaths; the second leading cause after pneumonia. Similar figures are seen in Zambia; despite 'Oral Rehydration Salts' (ORS) being a known solution to this issue, there have been bottlenecks in its distribution to the population. Whilst Zambian health centres serving rural populations distribute ORS free, stock-outs have forced mothers/carers to walk long distances and then queue. Furthermore, the use of Zinc in a combined therapy for diarrhoea is less well known. Similar problems are typical in Sub Saharan Africa and elsewhere.
The project builds on WHO/UNICEF recommendations of user needs, adapted for Zambia. It aims to develop and distribute a ‘diarrhoea treatment kit’ for all new mothers, combining ORS, Zinc and promotion of hand-washing. It follows WHO/UNICEF guidance on using ‘market forces’ and ‘innovative delivery strategies’ to widen access. Following user insights, that 1 litre sachets are not ideal for home-use (a child on average drinks 400ml; the rest must be discarded) and issues mixing and measuring ORS solution in the home, the project designed the package as a 200ml measure with replaceable lid and reduced an existing ORS sachet to 200ml.
Strategically, we aim to provide metrics and learning on a range of innovative ideas, with adaptations/adoption available to other countries, for example, learning from the Coca-Cola distribution model. In Zambia, public sector distribution bottlenecks exist at district level. Zambia’s existing private health sector is one of the smallest in the world (<70 registered pharmacy retail outlets, most in towns). However, in rural communities, bottled soft drinks are readily available – suggesting potential to ‘piggy-back’ on those distribution chains – physically and intellectually.
The COTZ project builds on 3 years of innovative concept development and design involving local and international stakeholders, including 8 months' co-design with implementation partners in Zambia.
UK charity ColaLife pioneered the concept, with an 'AidPod' package, designed to fit into the unused space between crated bottles, with permission from The Coca-Cola Company and its Zambian bottler SABMiller to test this and similar delivery routes in order to explore the following hypothesis:
Piggy-backing essential medicines such as oral rehydration salts ORS and zinc on private sector supply chains, like that of Coca-Cola’s (which makes their product readily available in rural areas), can play a crucial role in improving availability, awareness, access, and utilization of simple medicines which may not be readily available (i.e. due to stock outs, distances to access points, opportunity costs, etc.), either in the public or private sector.
The new commodity ‘Kit Yamoyo’ (Life-giving Kit) is sold by existing rural micro-retailers, trained and registered by the project. The project's 'end-to-end' value chain enables profit to be made at every step. A voucher system supports tracking and acts as a marketing incentive ( 60-70% of customers may try the product for free during the trial).
The project purpose is to improve access, putting an anti-diarrhoea kit in the hands of an aware mother/care-giver.
- Harnessing a profit driven supply chain to improve availability of an anti-diarrhoea kit to rural mothers/carers of under fives
- Improved awareness of the anti-diarrhoea kit and its benefits, amongst mothers/care-givers (including benefits of contents: ORS, Zinc and Soap)
Amongst impacts, we will look at:
- Distances walked by mothers to access ORS/Zinc
- Reported use of ORS/Zinc
- Reported treatment delay
- Reported knowledge/awareness of the pack (and ORS/Zinc)
- Small rural shops/livelihoods
- Stock levels
Latest Project Updates
HEADLINE FINDINGS FROM THE COLALIFE OPERATIONAL TRIAL IN ZAMBIA
Here are seven of the headlines from the ColaLife trial.
You can apply for access to all our findings and learnings here.
The data contained in this blog post: Findings in this blog post are unpublished and based on initial 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 (email@example.com) and copied to Simon Berry (firstname.lastname@example.org).
Two projects are now supporting scale-up in distribution of Kit Yamoyo across Zambia, with local manufacture of cost-effective versions of the original trial kit creating local jobs, and profit supporting local livelihoods. Current projects are:
i) KYTS-ACE, funded under the Scaling Up Nutrition (SUN) Programme, distributing an ORS/Zinc co-pack via retail outlets (supermarkets, small general stores in villages and town 'compounds') as well as public sector channels, in 14 underserved, remote districts. Soap for hand-washing is included in the private sector version.
ii) KYTS-LUSAKA, funded by DfID and ColaLife's Health Innovation Award from GSK/Save the Children, is developing distribution via small general stores in Lusaka Province, focussing on slum areas ('compounds'). Supermarket and public sector distribution is expected to develop.
Updates and more detail can be read here: www.colalife.org/status
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