When ColaLife set out, in 2008, to improve distribution of simple medicines by ‘harnessing’ Coca-Cola’s world-renowned distribution of fizzy drinks, the logic seemed simple:
i) Cola gets everywhere in developing countries – especially Coca-Cola
ii) Simple life-saving medicines, like Oral Rehydration Salts and Zinc for diarrhoea, don’t
iii) Within most developing countries, Coca-Cola arrives – even in remote villages - in the world-famous red plastic crates.
So: design an anti-diarrhoea kit - or 'AidPod' - that fits into a Coca-Cola crate and it can ‘hitch a ride’. Simple. Clever. Sustainable.
But the real world is never that simple, as we were to find out.
Some things, we did right: we began by sharing our idea with as many people as possible, both professionals and people living and working in Africa, to see if it really was a good idea, if it could be improved, changed – or should simply be thrown out. We began our research in earnest in 2008. We took advice from experts in logistics, from specialist staff at Coca-Cola, and most importantly, from people on the front line, such as mothers, carers and - in Tanzania - small distribution businesses, called MDCs (Micro Distribution Centres). Our first ideas included removing a bottle from the cola crate, and putting a tube in its place, or putting a wedge-shaped pack in the space between the crated bottles. Generously, Coca-Cola itself made no objection. But what did the frontline think? Simon visited several MDCs in Tanzania to find out.
Removing even one bottle was our first fail, immediately seen by small retailers as a potential lost sale. But the ‘wedge’ idea fascinated people: “It’s a good idea,” Benito, an area sales manager, tells us in this video clip. “Coca-Cola gets everywhere but medicines don’t. It would be good if we could be doing something to help with people’s health.” We also spoke to mothers in Uganda and Zambia, as well as health professionals, Ministries of Health and even UNICEF and WHO. Emboldened by wide-ranging support, we went ahead to work on prototypes of an aspirational new anti-diarrhoea kit that fitted into cola crates. So far, so good.
Failure number two was a communications conundrum, which, despite our best efforts, persists to this day. This first raised its head as The Coca-Cola Distribution Myth. Many people imagine that this powerful global giant owns and controls its channels to market. People thought we were proposing international distribution: inserting anti-diarrhoea kits into crates in factories in America or Europe, and then shipping the entire crate into Africa. What a powerful myth that is!
In fact, Coca-Cola is manufactured locally, in over 200 countries in the world. Amazingly, they are one of the biggest employers in Africa. Lorries may carry crates between major towns, but Coca-Cola owns no mules, bicycles, oxcarts or buses, and this is how a myriad of products is carried into villages. Anywhere a lorry can go is fairly straightforward - we were interested in those carts and bicycles: the 'last mile'. On top of this myth, the fact that we ‘dared’ to work with Coca-Cola returned to haunt us again and again. We regularly receive heavy criticism for proposing distribution ‘dependent’ on a global giant that ‘peddles’ unhealthy sugar-water. But, in fact, people everywhere make their own choices on what to eat and drink, and what to buy – and this includes the poor in Africa. The ‘magic’ of Coca-Cola distribution is conjured by millions of humble, independent shopkeepers like Shadrick (pictured) who make their own decisions on purchases, and on Shadrick’s customers, who make choices on how to spend their money. The lesson here: understand the complexity, but keep your messaging simple, and keep repeating it, again and again. Be patient. The world has many pre-conceptions, and you cannot change those overnight. Were we wrong to work with and learn from producers of an unhealthy commodity? We think not. But choose your battles – you can’t fight them all.
In spite of these recurring challenges, the idea of the anti-diarrhoea kit in the crate took off. Journalists contacted us; awards rolled in. Almost without our realising it, the photo of the 'clever packaging' that fits snuggly between bottles of Coca-Cola went viral, and quickly came to represent our work: a classic case of the 'double edged sword'.
By early 2013, we knew that the ‘Kit Yamoyo’ (Kit of Life) and the distribution trial was a huge success. Before we began, less than 1% of children in our trial areas were getting the world-recommendation of ORS and Zinc for diarrhoea. Within 12 months, we had increased that to nearly half of all children in our trial areas: 45%. We had set up the trial to measure, observe and learn - and we soon found that, in spite of astounding successes, it contained at its very heart our biggest failure to date: only 4% of kits were actually carried back to the village in cola crates. Yes, retailers bought them, and carried them on bicycles, carts and buses; but in cartons and bags, not slotted into crates. Coca-Cola was losing out to cheaper sodas in rural areas; and in any case, demand for Kit Yamoyo was higher than could be accommodated in the crates going out to villages. Could we have found this out before design work started? Sometimes the only way to find something out is to try it in practice. Innovation is unpredictable. You end up in places you didn't expect.
So, we were back to managing the communications conundrum: even one of our kindest commentators, Peter Day of the BBC, asked if our award-winning design was ‘a bit of a con’.
Some of the criticism was a lot worse.
What to do? We had to face up to the fact that fitting the kit into cola crates wasn’t important after all. The easiest route would have been to keep that finding under wraps, to stick to our story, hang on to our now-famous photo of the kits in the crate, and defend our award-winning design. But how would that have helped our beneficiaries? Most of the 25,000 mothers and carers we had helped had no idea that the kit was designed to fit into a cola crate – but we had listened and learnt from them: we had introduced many benefits they really did want: smaller sachets for the Oral Rehydration Salts (200ml instead of the traditional 1 Litre); an easy way to measure the water needed; better tasting medicine; easy to understand instructions; and, as well as the vital Zinc tablets, a small bar of soap for hand-washing.
So, we publically announced we were ditching the award-winning packaging design – but were keeping all of the benefits that mothers, carers and retailers value. We’d learnt it was the space in the market, not the space in the crate, that was important. And the space in the market was a much more complex story, about how to design with the poor, for the poor – to better meet their needs. So we went back to the drawing board, to unpick what we had really learnt, and bring in cost reductions as well as more design improvements. We now have two designs: cheaper, better and more fit for purpose.
This change of direction could have been a huge embarrassment. But amazingly, by ‘coming clean’ straight away about the failure, we have won more praise, more friends, and more understanding. One of our award-givers even asked us back to the presitgious event we had won the year before, to hear more about our failure.
What the journey so far has shown us, is that it is OK to fail, as long as you are prepared to learn. Find the parts that do succeed and build on those. More than that: if at least some elements of your innovation don’t fail, perhaps you have not been brave enough. And unless you are equally proud of your failures as your successes, no-one will learn. But most important of all: listen to those you set out to help, what they want and need. If you stick to that, you can’t go far wrong.
During a busy summer break back in UK, Simon and I were delighted to hear from Rakesh, who is managing Kit Yamoyo manufacture in Zambia, that 50,000 Kit Yamoyos have been sold since we began the project, just 2 years ago, in September 2012. Just under half of these kits (21,823 to be precise!) were sold with the help of vouchers - and a BIG thank you to all our supporters for helping us to achieve this. As we move forward, towards a sustainable market, we are also delighted that over half of all sales have been for cash. And, as production is now all undertaken in Zambia by our local manufacturing partner, Pharmanova - where Rakesh is Marketing Director - all the profits are going into local pockets: from the factory to the shop.
Shortly afterwards, our fieldworker in remote Katete district, Elias Lungu, confirmed that 30 cartons had arrived at the local wholesaler. These contain just over 1,000 kits - and we know that will save at least 3 children's lives. As we come into the end of the dry season, good fresh water sources can become scarce and diarrhoea becomes a real issue. Elias told us that, in just 2 days, 7 of these cartons were sold to local shop-keepers like Christine, pictured, who can improve their livehood, as well as the health of their community, by bringing Kit Yamoyo to sell to local mothers.
Now that Kit Yamoyo is available for anyone to buy, in a free market situation, it's amazing to see what happens. Six of our newly trained retailers in remote Eastern Province are from villages that border Malawi: Muchenjeza and Sindamisale. And with Africa's porous borders, Malawians are coming across into Zambia to buy Kit Yamoyo, and taking it back into Malawi - where access to good, simple medicines is, if anything, worse than in Zambia. So, market forces are helping distribution to expand - all by itself. Our big hope for the end of this year, is to get another fully-funded project, so that we can boost this process - and get Kit Yamoyo established in two more countries.
Meanwhile, the same market expansion is happening on Zambia's border with Mozambique. At Mr Phiri's shop, in Mtandaza, he adeptly shows our fieldworkers, Albert and Elias, how he teaches Mozambican customers to use Kit Yamoyo. Donations from Global Giving are helping us to continue this simple but vital training of local retailers - often miles away from any clinic - so they can show customers how to treat potentially deadly dehydration from diarrhoea using Kit Yamoyo in the home; as well as the importance of using the soap provided for hand-washing; and how to make water safe to use. He tells us he now has equal numbers of customers from Mozambique and Zambia: "Those that are Zambian, and those who come from outside, they are same-same. They like this Kit Yamoyo." Even in this far flung remote rural area, Mr Phiri has successfully transitioned from sales using just vouchers distributed by the project, to cash sales.
We know though, that not every mother can afford the full retail price needed to make the product sustainable for every one in this 'value chain' (about $1), so we were also delighted, last month, to recieve our 350th donation via Global Giving! We are now working on a simplified voucher system to help the poorest in rural areas.
Please keep the support coming - and we hope to reporting more exciting news at the end of the year! Watch this space!
Well - it's been a really busy few months since our trial phase ended at the end of 2013! The ColaLife team in Zambia (well, mainly Jane) has been juggling report writing, with making new funding bids, audits and evaluations - and the launch of Kit Yamoyo as a product made in Zambia! Simon completed a mini-tour of the USA and Canada that included two film showings of The Cola Road and took in visits to PATH, The Gates Foundation, the Dupont Awards (as guest speaker and winner of last year's event), our great mentor Dr Prashant Yadav at the University of Michigan.
Meanwhile, our Zambian partners have been forging forward with the 'proper work': training new retailers as we expand out from our trial areas into new rural districts of Zambia and for the first time, into urban areas: the townships around the capital, Lusaka.
These reports are direct from Ezra and Elias - who work with our partner Keepers Zambia Foundation in Katete district, in Eastern Zambia. Katete district has a population of about 190,000 people, and in the rural areas beyond the town, there are about 60 people per square km. There are two tarmac roads – one goes down to the border with Mozambique, and the other stretches from the provincial capital, Chipata, on the Malawian border, to the national capital, Lusaka, 7-9 hours and over 500km away, to the west. Otherwise, dirt roads and footpaths provide the only transport links – and many become impassible in the wet season.
"First, we would like to introduce you to Sarah, from Chimosuko, on the road into Katete town. She has been running a grocery shop for the past 8 years now together with her husband. Apart from owning a small shop, she is also one of the trusted Health Community Workers attached to Chibolya Health Centre, which serves around 9,000 people. She came to know about Kit Yamoyo through the local radio programmes that are broadcast on Wednesdays of each week.
Sarah got the courage and came to the project office in Katete Town, to inquire how she could be one of the retailers to be included on the programme. It did not take long before Wave 4 training for the retailers was organized in the month of March 2014. Being among the 6 women that were trained, from a total of 26, Sarah has proved to the men that she is not ‘just a woman’! From the training, she bought a bag of 5 Kit Yamoyo and started selling right away. And within 4 days after training, she was already at the wholesaler ordering more Kit Yamoyo. As on the 3-Jun-14 she has sold 48 Kit Yamoyo in under 2 months and she is the highest in the group, selling around 20-24 kits a month.
When asked how she has managed to have good sales when most of her colleagues have sold between 10 to 18, here are some of the strategies she mentioned:
Sarah says she will expand her business by opening another retail shop in the nearby villages since the demand is good. Comparing with other groceries, which she is selling, she said she is happy with Kit Yamoyo as it fetches a good profit, more than sugar, soap, toothpaste and biscuits.
Secondly, meet Cosmas: a farmer and retailer who lives in Chundamila village, nearby Kafunkha Health Post - which is far from town. The area around Kafunkha Health Post is mainly supported by agriculture, and the population served by the health facility is around 7,600 people – who may live up to 10km walk away. Cosmas has been into trading for more than 20 years. He was trained by the project to sell Kit Yamoyo and be able to give basic advice on diarrhoea, in October 2014, in our third wave of training. Since last year, Cosmas has sold more than 175 Kit Yamoyo to the community around. That amounts to 30 to 35 a month – which in a low-population rural area represents good sales. His shop is well known and the most popular in the area.
Asked how he has managed to sell this quantity comparing to what his colleagues have done, he told us that his shop is well located and he is trusted by most of the customers. He is well stocked with nearly everything and takes advantage of high number of customers who frequent his shop to buy other groceries to inform them about Kit Yamoyo.
He also has been making follow-ups to his customers to find out how their patients have been recovering from diarrhoea, and uses what he learns to help advertise more. Cosmas is very happy with the performance of Kit Yamoyo both as a business as well as treatment for diarrhoea. He said all his customers have recommended Kit Yamoyo, once they have used it.
Introducing a new health product to people who are unfamiliar with it - especially in rural areas - is a tricky task, and we are delighted to have on board advocates like Sarah and Cosmas, who take their new role so seriously, and are also turning it into an opportunity to improve their business!
This month's report is straight from our field worker in Katete District - Elias Lungu - who is very impressed with one of our newly recruited retailers....
Mr Banda runs a tiny shop in Chipopela village, about 50 km north west of Katete town in eastern Zambia – and more than 8 hours from the capital, Lusaka. Born in 1967, he only went up to Grade 7 at primary school due to financial constraints. He is married with 6 children.
Mr Banda started his business in 2000 and has been in his current shop since 2010. Once or twice a month, he sets off to Katete town to buy the groceries that people in his remote village rely on: soap, sugar, exerices books, pens, biscuits and pain-killers. He heard about Kit Yamoyo on the radio last year and travelled the whole distance into town, just to inquire from our field office what Kit Yamoyo was all about and how he could be involved.
The team responded with plans to include his community in our scale-up phase. In September 2013, the district stakeholder meeting recommended seven new communities to work in – including his. He quickly got the good news through the radio, and again came to the office for confirmation: this one is keen, we thought!
Donations through Global Giving can help us support retailer training - and, together with 16 other retailers, Mr Banda came in October to learn about the Kit Yamoyo AidPod and how to avoid the dangers of dehydration. Immediately, he bought a whole boxful to take back to his shop. Within 3 weeks, he had sold over 20, and by early February he had sold 80. His nearby friend, had sold over 60. As the project has yet to launch the second phase of vouchers, these have all been cash sales, at 5 Kwacha (~$1). But Mr Banda says people appreciate having access to modern medicine so far from town, and many will buy when they need it, rather than make a long trip with a sick child.
He tells us: ‘When I just came from training, I started informing people at church, community and village meetings. I took advantage of those gatherings to advertise – even at funerals where many people gather. Secondary, I have been getting involved in clinic meetings for children in our village and I have also been informing the clinic staff to help refer all the diarrhoea patients to my shop, especially when the clinic is out of stock. I tell my customers to inform as many people as possible about this new product and how much they like it. And I make sure I have not less than 10 Kit Yamoyos in stock all the time.
Mr Banda assures us that Chipopela villagers are delighted someone has taken the trouble to understand their needs and the challenges in their lives, and has designed a medicine for the everyday problem of diarrhoea that is easy to understand and use, affordable, and now available within their own community. Mr Banda clearly knows a good business opportunity when he sees one!
In 4 days, our first trial in Zambia comes to an end - and it's the time of year to say 'Thanks' to everyone who has helped us, see what we have achieved and look ahead to what we can do next year.
Two years ago, as non-health professionals, Simon and I set out to see whether we could design an attractive, affordable, anti-diarrhoea kit, containing ORS and Zinc, to save children's lives. Those 2 years have transported our designs from our kitchen table to the United Nations, taken 25,000 'Kit Yamoyo' to some of the remotest communities in Zambia, and have now taken Simon to Uganda, India and South Africa to guage future interest (while I'm here writing the end of project reports!).
We could hardly have guessed when we began that in our first trial areas, we would:
There is still more work to do, and on December 1, we will be ready to start Phase 2. Two of our major funders have now confirmed support, and we will have the final piece in place in a week or so. Our ambition is to cover the whole of Zambia in 3 years - including communities in towns and the city of Lusaka.
ColaLife - Simon and I - plan to stay in Zambia for another year, helping our local frontline NGO partners to develop the market in their area, and our Zambian manufacturing partner, Pharmanova, to scale up production to serve the emerging market for Kit Yamoyo. And when Simon gets back from his travels, will we have another country to take on the challenge? Meanwhile, our brand new product now has its very own barcode: we hope that the big supermarket chains here will also buy Kit Yamoyo - creating the economies of scale we need to drive down the price. We now know that more that 2/3 of mothers and carers in our trial areas are willing to pay K5.00 (about a dollar) for the kit at their local shop, rather than carrying their sick child many kilometres to the health centre. And for those who can't afford it, we know that giving vouchers out will create demand and encourage shop-keepers to bring the kit to remote communities.
That's where YOU come in: as we start the holiday season, why not buy a pack of ten Kit Yamoyo AidPods on behalf of your friends and colleagues? Just $10 will buy ten vouchers for mothers in rural villages, and each voucher will put money into the hands of a local shop keeper and life-saving medicine into a mother's hands.
Send your greeting by email or print your gift card here.
Jane and Simon
A note on the data in this post
Cited data are interim results from the ColaLife Operational Trial in Zambia (COTZ) and do not reflect the final report which will be published as Ramchandani et al. Final calculations may vary.
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