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Medical Innovations – Kit Yamoyo and its value chain 11 th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15 #medinnov @colalife Simon Berry
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Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
#medinnov@colalife
Simon Berry
What is ColaLife and who are we?
ColaLife is a charity registered in the UKCharity number: 1142516
• Two founding executives• 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 personal commercial interest
Rohit Ramchandani
Jane Berry
The other members of the ColaLife team
Our starting point
What we did next
1
Next moves
What we did What we learned
2 3
54
Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
Our starting point
What we did next
1
Next moves
What we did What we learned
Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
2 3
54
observation 1
Diarrhoea
17%
Malaria
12%
AIDS
3%
Diarrhoea kills more children than Malaria and AIDS combined
In Zambia 46% of children are stunted (up to 70% in some areas)
observation 2
Full shopsFull shops – empty clinics
Remote rural retail shop, Kalomo District, Zambia
Drug store room, Tiriri Health Centre, Katine, Uganda
the idea
Why not put ORS & Zinc Kit in Coca-Cola crates?
Our starting point
What we did next Next moves
What we did What we learned
Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
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1
Jun 2010 | Gave up jobs to try and get a trial started
Jun 2010 | Gave up jobs to try and get a trial started
Our kitchen tableUK
Jun 2010 | Gave up jobs to try and get a trial started
Rohit on SkypeCanada
Our kitchen tableUK
Jun 2010 | Gave up jobs to try and get a trial started
Rohit on SkypeCanada
Harvard & UNICEF on speaker phoneUSA
Our kitchen tableUK
Sep 2010 | Cycle ride across France raised £6,000
Oct 2010 | First of three consultation trips to Zambia
Jun 2011 | Partnership and trial plan in place
impactMothers 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
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
Dec 2011
COTZ trial timeline | 24 months
Our starting point
What we did next Next moves
What we did What we learned
Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
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1
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
Mar 2012 | Finalised the Kit Yamoyo design
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive
• ORS sachets are 200ml
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive
• ORS sachets are 200ml
• Packaging is also:
• A measuring device for
the water
Mar 2012 | Finalised the Kit Yamoyo design
Kit Yamoyo• Attractive
• ORS sachets are 200ml
• Packaging is also:
• A measuring device for
the water
• A mixing device
Mar 2012 | Finalised the Kit Yamoyo design
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
Awards | The Kit Yamoyo has won many global awards
0Nobody sold ORS or Zinc in the private sector.
Sep 2012
Before we started
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
Sep 2012
Before we started
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
>26kkits sold into the two remote rural trial areas in 12 months.
Aug 2013
After 12 months
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/from Zinc. Up a baseline of <1%.
Aug 2013
After 12 months
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/from Zinc. Up a baseline of <1%.
2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.
Aug 2013
After 12 months
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/from Zinc. Up a baseline of <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.
Aug 2013
After 12 months
Sep 2012
Before we started
60%Only 60% of mothers mixed ORS correctly when given litre sachets.
0Nobody sold ORS or Zinc in the private sector.
<1%of children received the correct treatment for diarrhoea
7.3kmWas the average distance to ORS.
>26kkits sold into the two remote rural trial areas in 12 months.
45%of children in trial areas received ORS/from Zinc. Up a baseline of <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.
Aug 2013
After 12 months
Sep 2012
Before we started
4%Only 4% of kits went into Coca-Cola crates.
Aug 2013
After 12 months
In Zambia, it’s the space in the market, not the space in the crates that is important.
This means we can revisit the packaging to make it cheaper.
Kit Yamoyo
Washing Powder
Eggs
Biscuits
Cola – but not Coca-Cola
Bread
Manufacture
Assembly
Distribution
WholesaleK3.10
RetailK3.70
CustomerK5.00
Market development - the Value Chain
Our starting point
What we did next Next moves
What we did What we learned
Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
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1
2014Incorporating the learning
into a national scale-up plan
Control
Trial – 2012-13
Transition – from 2013
Transition
Intervention
Progress towards national coverage
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
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
Learning – product design
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
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
Learning – product design
4Learning – 200ml ORS sachets
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
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Learning – reduce number of ORS sachets to 4
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
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Learning – zinc
Learning - designing for better zinc adherence
ORS
Reduce number of sachets to 4
NOTE: This will also enhance adherence
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
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Learning – zinc packaging design
ORS
Reduce number of sachets to 4
NOTE: This will also enhance adherence
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
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Learning – soap
ORS
Reduce number of sachets to 4
NOTE: This will also enhance adherence
Zinc
Produce locally
Design the blister pack to enhance adherence to the 10-day regime
Blister pack needs no box
Soap
Produce locally(still to be achieved)
Leaflet Packaging
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Learning – soap
ORS
Reduce number of sachets to 4
NOTE: This will also enhance adherence
Zinc
Produce locally
Design the blister pack to enhance adherence to the 10-day regime
lister pack needs no box
Soap
Produce locally
Leaflet Packaging
Removeconstraint of fitting in Coca-Cola crate
Produce locally
Produce re-fill option
4Learning – leaflet
4Learning – leaflet
ORS
Reduce number of sachets to 4
NOTE: This will also enhance adherence
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
4Learning – packaging
ORS
Reduce number of sachets to 4
NOTE: This will also enhance adherence
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
Removeconstraint of fitting in Coca-Cola crate. Only 4% of retailers used this option
Produce locally
Produce re-fill option
42014 | Incorporating the learning into the scale-up
4Learning – packaging – the screw-top
4Learning – packaging – the screw-top
4Learning – packaging – the flexi-pack
2015Implementing national
scale-up plans
Scale-up – from 2015
Control
Trial – 2012-13
Transition – from 2013
Transition
Intervention
KYTS-ACE
Progress towards national coverage
452,000
Product - new public sector format
Promotion – aspirational product
Promotion – frontline and face to face
Para-skilling shop-keepers to advise customers
Our starting point
What we did next Next moves
What we did What we learned
Medical Innovations – Kit Yamoyo and its value chain
11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15
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1
Scale-up – from 2015
Control
KYTS-LUSAKA
Trial – 2012-13
Transition – from 2013
Transition
Intervention
KYTS-ACE
Progress towards national coverage
Sharing the learning – our global impact strategy
colalife.org/openaccess
Campaigning for…
1. 200ml ORS sachets for home use2. Co-packaging of ORS and Zinc3. ORS and Zinc as over the counter
medicines4. People to understand that all our
designs, learning and findings are theirs to take and use for FREE – we are NOT promoting a product – we promoting a game-changing new approach to diarrhoea treatment in the home
Chimtende, Katete
Like us on Facebook (please):
facebook.com/colalife
Thank you to the ColaLife funders
Isenberg Family Charitable Foundation
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. (forthcoming). ColaLife Operational Trial Zambia (COTZ) Evaluation. Johns Hopkins Bloomberg School of Public Health, Baltimore.
Related correspondence should be sent to Rohit Ramchandani ([email protected]) and copied to Simon Berry ([email protected]).
A note on the data contained within this presentation
