The ColaLife Operational Trial in Zambia (COTZ)Prepared for PATH by Simon Berry 23-May-

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What is ColaLife and who am I?

ColaLife is a charity registered in the UKCharity 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

2013

1985

The ColaLife team

2009

2010

2011

2012

2013

1985

Rohit Ramchandani

Jane Berry

Our starting point

Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines don't. Why?

impact Mothers in underserved rural communities increase use of ORS and Zinc in home treatment of diarrhoea

purposeTarget communities in two under-served rural districts have improved access to ORS and Zinc

outputsProfit-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

Dec 2011

The COTZ trial timeline

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

The Kit Yamoyo benefits

Kit Yamoyo• Attractive

The Kit Yamoyo benefits

Kit Yamoyo• Attractive• ORS sachets are 200ml

The Kit Yamoyo benefits

Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:

The Kit Yamoyo benefits

Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:

• A measuring device for the water

The Kit Yamoyo benefits

Kit Yamoyo• Attractive• ORS sachets are 200ml• Packaging is also:

• A measuring device for the water

• A mixing device

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)

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

The COTZ trialResearch 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 district40 retailers per district

Vouchers used to launch the product

The COTZ trialDistribution 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

>26kkits sold into the two remote rural trial areas in 12 months.

>26kkits 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%.

>26kkits 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%.

2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.

>26kkits 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%.

2.4kmThe 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.

14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%.

>26kkits 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%.

2.4kmThe 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.

14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%.

>26kkits 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%.

2.4kmThe 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.

Our award-winning idea……

Our award-winning idea……what happened in practice

14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%.

>26kkits 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%.

2.4kmThe 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.

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.

14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%.

>26kkits 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%.

2.4kmThe 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 findingscolalife.org/ openaccess

14The perception of ORS as an effective treatment for diarrhoea increased by 14 percentage points to 92%.

>26kkits 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%.

2.4kmThe 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 findingscolalife.org/ openaccess

ORSReduce number of sachets to 4

NOTE: This will also enhance adherence

ZincProduce locally

Only include blister pack

SoapProduce locally

Leaflet PackagingRemove constraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

Oct 2013 | Incorporating the learning into the scale-up

Learning: number of Kit Yamoyo ORS sachets used

ORSReduce number of sachets to 4

NOTE: This may also enhance adherence to the combined therapy

ZincProduce locally

Only include blister pack

SoapProduce locally

Leaflet PackagingRemove constraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Oct 2013 | Incorporating the learning into the scale-up

Learning: Kit Yamoyo Zinc adherence – days Zinc taken

Designing for better Zinc adherence

ORSReduce number of sachets to 4

This may also enhance adherence to the combined therapy

ZincProduce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

SoapProduce locally

Leaflet PackagingRemove constraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Oct 2013 | Incorporating the learning into the scale-up

ORSReduce number of sachets to 4

This may also enhance adherence to the combined therapy

ZincProduce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

SoapProduce locally

Leaflet PackagingRemove constraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Oct 2013 | Incorporating the learning into the scale-up

ORSReduce number of sachets to 4

This may also enhance adherence to the combined therapy

ZincProduce locally

Design the blister pack to enhance adherence to the 10-day regime

lister pack needs no box

SoapProduce locally

LeafletSimplify – single fold.Same leaflet for all formats

PackagingRemove constraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Oct 2013 | Incorporating the learning into the scale-up

4Revised Kit Yamoyo leaflet

ORSReduce number of sachets to 4

This may also enhance adherence to the combined therapy

ZincProduce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

SoapProduce locally

LeafletSimplify – single fold.Same leaflet for all formats

PackagingRemove 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

The screw-top The flexi-pack

Format comparison

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%

Scale-up framework

Community-based marketing (all markets)

Not yet commercial

markets

Commercial markets

KZF/iDEPharmanova

Monitoring & Learning

Not yet commercial

markets

Collaborators

colalife.org

simon@colalife.orgjane@colalife.orgrohit@colalife.org

The slides that follow this one may be of interest but are not essential reading

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