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 Children  Zambia Project #12438

Lifesaving AidPods for 65,000 African children

by ColaLife
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Lifesaving AidPods for 65,000 African children
Our application for WHO to list co-packaged ORSZ
Our application for WHO to list co-packaged ORSZ

It was nearly 2 years ago in January 2017, when the penny dropped for me: "Why isn’t co-packaged ORS and Zinc on WHO’s Essential Medicines List for Children?"

That doesn't sound like a very exciting thought for most people, on a winter morning. So, what does it mean for me, for ColaLife, and for millions of children across the world whose lives are at risk from diarrhoea?

WHO's list of essential medicines influences what governments buy and what donors will pay for. Oral Rehydration Salts (ORS) co-packaged with Zinc (to ensure children get both), has been WHO policy for 15 years but the medicines are still listed separately. Only about 7% of diarrhoea cases receive both.

So, why not simply ask WHO to update their list? We think this would transform access to the recommended treatment, save thousands of children's lives and improve many more. Last March, we asked some contacts at WHO - and they agreed we could make a formal submission.

But ColaLife is a very small organisation. We have generated a lot of evidence, but we don't have much 'clout' on the big stages. Enter the splendidly-named global Diarrhea Innovations Group (DIG); I first presented our simple idea to them in Sep-17, and a few weeks later, our Public Health advisor, Rohit Ramchandani, followed up in person. Within 2 days, DIG confirmed they were on board: with a multi-organisation, expert submission, to be led by PATH. Fifteen people contributed to the application; 7 were PATH staff and 3 were from ColaLife.

20 months later, and this month I proudly submitted a formal application to WHO. This has now been accepted and will be considered by the 22nd Expert Committee on the Selection and Use of Essential Medicines, which will meet in Geneva from 1 to 5-Apr-19.

We could not have achieved this alone, but we played our part and we are pleased to have this acknowledgement at the start of the application:

"This collaboration was initiated by ColaLife under their Globaliser programme."

Our application went in with ten letters of support - including one from UNICEF - and we are very proud to see it published here. We're delighted that ColaLife has used its power as a catalyst to make this happen.

The timetable from now is:

7-Dec-18: Application deadline. Applications open for public comment.
1 to 5-Apr-19: Meeting of the 22nd WHO Expert Committee on the Selection and Use of Essential Medicines will consider applications.
Jun-19 The decisions of the Expert Committee will be published.

You can follow our progress and see the story unfold on our blog.

With our project funding in Zambia coming to an end, can a small charity like ColaLife have a global impact? With our partners and supporters, and with your help, we believe we can!

We've spent the summer gathering evidence from our projects, to move our findings on innovative design and distribution of the 'Kit Yamoyo' - kids' diarrhoea treatment - beyond the work in Zambia and into national and global policy.  Why? Because in 2018, diarrhoea is still the second or third biggest killer of young children in developing countries. At ColaLife, we have always believed that WHO's simple, low-cost recommendation (Oral Rehydration Salts and Zinc) can save more lives if it is designed better and distributed more effectively: more like a desirable, affordable commodity - for example Cola. Now we need to take that evidence to WHO - the World Health Organisation.

We asked key influencers and health experts in Zambia for their views:

Dr Kennedy Malama, Permanent Secretary to the Minister of Health, is chair of our Learning Group and supports 'main-streaming' of products like Kit Yamoyo in Zambia, based on the evidence our projects have produced:

““This [the evidence] is very critical and it has the highest weight as it also hinges on the quality of the product, putting beneficiaries at the centre. The research was very good and helpful. Kit Yamoyo content is superior. The game change with this product is that is contains Zinc which is adding high value as informed by evidence compared to ordinary ORS as a product. The look is excellent. We need to explore the possibility of having this commodity free of charge in the public sector and have room for selling in private outlets." 

From his team, Mr S, responsible for advising on buying decisions at the Ministry of Health is optimistic that change will happen:

“We can’t just sit and continue maintaining the status quo. We never thought we could improve with packaging of these life-saving commodities for diarrhoea, we never thought – but then there was the innovation from your project! It's good! In terms of procurement of medical supplies, it is an area that must become cost effective, and effective in terms of addressing the health delivery issues. One of the impacts [of this project], is that it has actually facilitated a policy change, which can involve re-packaging the two [ORS and Zinc]. When I am asked what type of ORS [to supply in future] then I will go for the one which has been modified to 200 mls. It’s better. And the one which is co-packaged with Zinc.” 

Dr Malama recognises that the move from project to policy won't happen unless everyone is behind the change:

"What is critical now is to ensure that the key stakeholders are fully engaged so that they play their roles very well in a catalytic manner to sustain the availability and utilisation of this high impact life-saving commodity. Government and its partners shall definitely play a key role."

So, next month, we're bringing supporters together in Zambia for a final meeting and review, hosted by USAID DISCOVER-Health and chaired by the Zambian Ministry of Health.

ColaLife is very small, but we are now working with an international consortium of large organisations, who can help us to influence WHO's Essential Medicines List for children globally (EMLc). PATH, the Clinton Health Access Initiative (CHAI), global manufacturers and academics are all helping us - through the UN's Diarrhoea Innovations Group (DIG). They have experience of asking for policy changes on Essential Medicines at WHO, which in turn influences what Ministries of Health will buy and distribute and what international charities and donors will support with their funds.

Our submission to WHO's HQ in Geneva will be ready by the end of 2018, and we will hear in spring 2019. We are presenting evidence on all we have learnt, with your help: providing ORS and Zinc together in one pack (co-packaging); an attractive, affordable consumer product; with better flavour and colour, better instructions, a measuring function and smaller, easier to use sachets of ORS. 

It's not often that you get a chance to change a small part of how the world works for the better - so, thank you for helping us move from project to policy!

By

Jane Berry

Business Research and Development

Jane, Chibale, Simon and the Chilanga Clinic team
Jane, Chibale, Simon and the Chilanga Clinic team

Over the last few months we have been gathering views from government health workers, who we have been supporting in Lusaka Province in Zambia for the past 30 months, with training on ORS and Zinc for diarrhoea, creating links between government clinics and local small shops.

Our market development project is coming to a close, and we wanted to know what difference it has made to government Health Centres - where medicines are given out for free - now that Kit Yamoyo can be bought in nearby shops.

Do health staff welcome, or resist this parallel supply of Oral Rehydration Salts and Zinc for childhood diarrhoea? Is it helping or hindering their work? What have health staff learnt from collaborating with our project fieldworkers? And, perhaps most important: - what would health staff like to see happen now, after the end of the project?

Our project manager, Chibale Phiri (pictured second from left) went to find out.

First up, is Sister Grace, the Sister-in-Charge at Kafue Mission Hospital:

"We became interested in the Kit Yamoyo project, because it helped our community. When they tried Kit Yamoyo and they saw that it really worked, they trusted that information, and the reputation for Kafue Mission improved.

Say the child becomes sick in the night, instead of coming to the facility, they just go nearby. They buy the Kit Yamoyo. They use it and then they maybe come to the facility in the morning. So, it reduced the burden, it reduced the flow of clients to the facility. And when you look at the way that the children are coming to the facility, they are not coming dehydrated. So, it has reduced that burden of us putting up IV fluids, running up and down and referring children. The children are coming with diarrhoea, but not so dehydrated. Because it was flavoured, the child was eager to take, because it was tasting like a drink. So they were so happy about this, compared to the other [unflavoured] one we have..

"A friend of mine, I referred her to a shop where these kits are found. The child had severe diarrhoea....we didn’t have ORS at the [health] facility. When she bought this, the child was able to drink eagerly.. the child took the ORS and the Zinc tablets, the diarrhoea stopped.

"I hope that the Ministry of Health has taken it up. They should continue the packaging of the Kit Yamoyo, for us to distribute, that will be very helpful to the community.”

Sister Priscilla, Sister-in-charge at Chilanga Health Centre, told Chibale a similar story:

"Kit Yamoyo - this product - it is full bouquet: it is hygienically packed, and also it has a flavour that can be tolerated by babies - orange flavour. You have also included zinc, this will reduce and stop diarrhoea. And also, how it's packed, you can make the ORS, because you have the instructions, which a mother will be able to follow. It is user-friendly actually.

"I don’t think there is any member of staff here [now] who can say 'I don’t know about this. I don’t know how, I don’t know why we combine ORS and Zinc together.' They are more knowledgeable now, that the best is, to combine ORS and Zinc.

"As a facility we have had less diarrhoea cases. Those that we receive – the babies - previously, they could be dehydrated, lethargic, unconscious, but we have not experienced that [lately], because the mothers, they now know how to make the ORS at home, and the combination of the ORS and the Zinc, it made it easier for us to manage, when they do come.

"After the project, what will continue is the mothers’ knowledge. Because it is implanted in them. And the supply in the shops...  For those who can buy, they will buy, but for those who cannot, it is a problem, although the suggestion of giving vouchers to them - that is the best. Because people are used to it, so now when it is done, if they cannot have it, it will be difficult. 

"So, I would suggest, to include the Kit Yamoyo in the [replenishment] drug kits that are being distributed from the Medical Stores, under Ministry of Health. Those who have used this Kit Yamoyo, they have seen it is very effective. So I think it is supposed to be - it must be – available."

Encouragingly, the District Co-ordinator, Dr James Zulu has been supporting their request:

"In my supervisory role, I work with the facilities and during my monitoring visits and through their reports from health staff I have heard of the benefits of the promotions, because the mothers start to give fluids at home. So yes, it is important to have this kit in the Health Centres - as well as shops. The combination that it is, is very easy for a prescriber to give. We always have a tendency to rush to ORS and forget the zinc, which is a very important component. In the pack that they are, it is easy for someone to administer and for someone to prescribe as well."

It's exciting that the Ministry of Health has taken note, and this month published their first ever procurement for 250,000 ORS/Zinc co-packs, based on Kit Yamoyo, to be distributed free in government health centres.

To fill the gap until the tender has gone through, we have added YOUR funds, collected via GlobalGiving, to a donation from the Isenberg Family Charitable Foundation, who visited our projects in Zambia in March. This has helped us to fund 20,000 kits per month in Health Centres from April to September, to sit alongside the continuing supply in shops and supermarkets.

Thanks to you, and all our donors, Sister Grace and Sister Priscilla will see their hopes fulfilled this month!

Dr Chilufya,  Zambia
Dr Chilufya, Zambia's new Health Minister

As we study the impact of our two big projects in Zambia - developing the market for Oral Rehydration Salts and Zinc for childhood diarrhoea - uppermost in our mind is one word: 'self-sustainability'.

OK, maybe that's two words. Put it another way: Have we done enough in Zambia to establish the award-winning Kit Yamoyo (or 'aidpod' as we originally called it, seven years ago) in the market, permanently, as a self-sustaining product?

Kit Yamoyo is now locally and profitably manufactured, by our partner Pharmanova. It's sold across the country in Shoprite supermarkets, pharmacies and small shops. Community shop-keepers we have trained now match health workers, in their knowledge of diarrhoea prevention, danger signs and how Kit Yamoyo is used. What more can we do?

Last week, we went to see the new Minister of Health in Zambia, Dr Chitalu Chilufya. Dr Chilufya hails from one of the very poor areas of the capital, Lusaka, where we work: Kaunda Square. We've trained over 750 small shop keepers in Lusaka's slums, including Happy Mwenge, whose small shop is in Kaunda Square, near the heatlh centre. He was delighted to report he'd sold five kits in the week of our last visit, in January.

We hope we've done enough to encourage small retailers like Happy to keep selling Kit Yamoyo. But we've also been busy interviewing health professionals in remote rural areas, where health centres have been distributing a free, government-funded version of the kit. Time and again we heard the same message.

Felicitus Simpasa, Provincial Nutrition Support Coordinator in Eastern Province, sums it up perfectly: "We've seen reductions in the cases of diarrhoea from the time that this kit started going to the health facilities… reduction in the severity of the diarrhoea itself and also the period that the child has that diarrhoea. We are praying that the supply continues; if this one is withdrawn, it would create that gap amongst the users at community level. We need to strengthen the partnership with the Ministry of Health so that they actually help or facilitate the movement of this pack - Kit Yamoyo - from the pharmacist at district level to the facilities."

Mr Simpasa also wants to see the kit for sale locally in shops: "I've seen it in Shoprite. It's a good idea. It's better it's also available in the shops so that people can easily access it, in case in the health facilities it is not available." He adds: "In fact, it really helped me: I was able to use it: it was in the night and I had it in the house and by morning I was feeling better."

In the short term, ColaLife can help fill the gap in public sector supply through two corporate donors: Everly and Norr, as well as the all-important donations from you, our Global Giving supporters.

But for the longer term, the Health Ministry has to step up. So, we're taking the message from the field to Dr Chilufya. Will he make a small but very significant policy change in Zambia: to include co-packaged ORS and Zinc on Zambia's Essential Medicines List? This is the list that guides Health Ministry procurement, that donors buy from and that influences charities working in health. A 'model list' at international level also guides countries globally, so we have also convened an international team to lobby the World Health Organisation - WHO. We've been told they welcome requests and evidence from individual countries.

The Minister's response so far: "Zambia should lead, not follow. Give me the evidence and you will have my support."

Thanks to people like the nutritionist, Mr Simpasa, shop-keeper Happy and your help with donations - we have the evidence!

The Evaluation Team hits the road
The Evaluation Team hits the road

ColaLife’s public health advisor and lead researcher, Rohit Ramchandani, is out in Zambia at the moment, assessing the impact we have had in the far-flung areas of Eastern Province and Western Province in Zambia.

We first started working in Eastern Province almost exactly 5 years ago – when we trialled the original ‘AidPod’ format of the kit of life, Kit Yamoyo. We were supporting the sale of the newly designed diarrhoea treatment kit through village retailers, who travelled into town to pick up Coca-Cola, and could carry back diarrhoea kits in the spaces between the bottles in cola crates. What a long way we’ve come since then, with Kit Yamoyo now an established product, made in Zambia, known and understood in many parts of the country, and sold through supermarkets, pharmacies and village shops as well as directly to the government for free distribution through clinics. And all with no reliance on cola distribution at all (although they did teach us all they know!).

ColaLife is nearing the end of the formal work, scaling-up our model of distribution across Zambia. In the next 6 months, we are looking forward to discovering what we've achieved. So, Rohit is in Zambia now, and again in February, to help us to find out. First stop Chipata, Eastern Province – and this report features some snaps from Rohit’s photo diary.

Rohit’s first job was meeting our independent evaluation partner, RuralNet Associates, reviewing and approving the research tools and briefing and training the team of enumerators. He explains: "Quality control is an important part of what we do, as the evidence we collect must be accurate and robust. The team will be going out daily, to hundreds of households in many far-flung villages to see how far Kit Yamoyo has penetrated, to ask people if they have tried it, what they think of it and what difference it has made to families and their children, to have an affordable, world-class diarrhoea kit in their local shop or clinic. The enumerators will all be asking the same set of questions, using digital tablets, and we make sure that they listen well and capture and code answers carefully for analysis."

It's a seven hour trip from Lusaka to Eastern Province, and then off-road to small villages, randomly selected so our research isn't biased.

"Being on the road is hard and distances are enormous – so it’s best to take your mattresses and your food with you! But there are some home comforts - I missed Thanksgiving back home, so was delighted to be hosted by some of our team. We enjoyed a wonderful meal of village chicken and nsheema prepared specially for us in the village of Kantemeni. 

Some of the offerings at the roadside were less welcome though: rats on a stick, delivered to your window. Or perhaps a bowl of caterpillars – welcome extra protein, when in season.

“It’s a great priviledge to be here, to remind yourself of the beauty and complexity of the world, such a long way from home. And even more, to hear first-hand what people think of Kit Yamoyo and our work. We've had some great opportunities to verify what we think we know with a local community member – and weve had some great conversations – in homes, offices and even at the roadside.

Within a few days, and a whirlwind tour, Rohit was assured that the Eastern Province research team was ‘in their groove’. It was time to criss-cross Zambia from East to West, with a 14 hour trip across the country to Mongu, Western Province! The results will start coming out soon after Christmas, with the next phase due March-June. Have we done enough to establish Kit Yamoyo as a self-sustaining product in Zambia? We’ll soon know…

You can read more here.

Thanksgiving
Thanksgiving
Fast food on the road: rats on a stick!
Fast food on the road: rats on a stick!
Slower food: caterpillars
Slower food: caterpillars
Interview by the roadside
Interview by the roadside
Baobab, known as The Story Tree -with lots to tell
Baobab, known as The Story Tree -with lots to tell
Albert Saka, project manager, with Rohit
Albert Saka, project manager, with Rohit
 

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Organization Information

ColaLife

Location: London, Greater London - United Kingdom
Website:
Facebook: Facebook Page
Twitter: @colalife
Project Leader:
Simon Berry
Lusaka, Lusaka Province Zambia
$54,038 raised of $65,000 goal
 
720 donations
$10,962 to go
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