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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
Mum and kids learn about Kit Yamoyo at the clinic
Mum and kids learn about Kit Yamoyo at the clinic

My field work promoting the new diarrhoea treatment, Kit Yamoyo, in the remote districts of Western Zambia can be both very challenging and very rewarding. Riding a motorbike over many miles of sandy, unmade roads is often dangerous and I have experienced punctures, break downs, accidents and even broken bones over the past 2 years.

But when we hear stories of our work, and see the progress, it makes it all worthwhile. Each life saved and each trip safely completed is a small miracle in our efforts to transform access to ORS and Zinc for children's diarrhoea.

I was recently talking to Mr. Mwezi Mwezi, the chairperson for the Nutrition Coordinating Committee (Ndoka Ward). Mr Mwezi is now a real advocate for Kit Yamoyo since his own daughter got sick: “She had lost her appetite and stopped breastfeeding. We were worried. We took her to the clinic and the staff gave her the ORS/Zinc Kit (Kit Yamoyo). Her diarrhoea stopped within two days and she soon started eating and getting strong."

He shared his story on how Kit Yamoyo, given out free in Health Centres and sold in small shops, has been helping to save children’s lives across the ward that his committee coordinates. The local nutrition committees are key in giving information and confidence to their communities, that ORS/Zinc is what their children need, advising mothers and caregivers not to delay taking children to the clinic when they have diarrhoea. The key change is that Kit Yamoyo now provides the Zinc needed, together with easy-to-use ORS.

Zinc is often missing from children's diets, leading to chronic diarrhoea and stunting. As Mr Mwezi confirmed: “Before the coming of Kit Yamoyo, children in my ward were suffering a lot whenever they were stricken by diarrhoea. This was because the Health Centre was only dispensing ORS which was not helping much as diarrhoea would re-occur. The coming of Kit Yamoyo has made life easy as most of the families with children having diarrhoea now get both ORS and Zinc for treatment of diarrhoea. The kit is very effective: children are cured within two to three days of treatment.”

Ndoka ward is one of the ten wards in Kalabo district that Keepers Zambia Foundation and ColaLife have been helping under the Scaling Up Nutrition (SUN) programme since 2015. Its two health centres, Namatindi and Ndoka, provide primary health care to about 11,000 people of which 18% are children under the age of five. Due to numerous challenges faced by the ward, ranging from inadequate access to safe water and poor hygiene practices, Namatindi has been recording one of the highest prevalence of diarrhoea in the district. This April alone, the low season for diarrhoea, the centre recorded 53 cases mostly among children under the age of five. As a result, it was one of the first to start receiving Kit Yamoyo. Since then, staff from KZF, ColaLife's partner, have trained staff and run sessions for the community.  

Mr Mwezi says that many children used to lose weight as a result of prolonged diarrhoea but now this is a thing of the past: "The combination of ORS/Zinc is so effective that it works small miracles."

ColaLife continues to provide support and funds to bolster free government supply in remote areas, whilst supporting the retail sector too, so that people can buy Kit Yamoyo in small shops and supermarkets. Every very small donation you make provides another small miracle - straight to the front line!

Nyambe's trusty motorbike
Nyambe's trusty motorbike
Oops another breakdown
Oops another breakdown
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Promotion filmed for MUVI TV, Katete, Zambia
Promotion filmed for MUVI TV, Katete, Zambia

As Simon and I make our way back to Zambia for our June visit, we're doing our best to follow the adage: Act local, think global. Can a tiny organisation like ColaLife 'think global'? Yes, we can.... but first: acting local.

With a hard-working local partner like Keepers Zambia Foundation (KZF) 'acting local' is the easy part. Promotion of Kit Yamoyo - our easy-to-use Oral Rehydration Salts and Zinc co-pack for childhood diarrhoea - continues apace in Zambia, with KZF running drama sessions and meetings across the capital, Lusaka, as well as in remote villages.

There was great excitement in April, when KZF staff were filmed promoting Kit Yamoyo in a village in Eastern Province, as part of a popular Zambian reality TV show. MUVI TV's programme, "Beads and Lipstick", follows young village women - 'Beads' - as they swap places with 'Lipsticks', their urban counterparts. Both the programme and the health-messaging has the support of forward-looking local Chieftainess Mkanda: "It will help the girls learn and share experiences in life."

And thinking global? Well, earlier this year, we launched our campaign to change the way WHO lists ORS and Zinc for childhood diarrhoea. Common sense tells us that if combination treatment is the global WHO recommendation - and it has been for 13 years now - then a co-packaged treatment should be on the all-powerful, international Essential Medicines List. But it isn't. 

Why is this important? Because WHO's Essential Medicines List drives governent buying policy in developing countries. It focusses limited budgets. It targets health education and training. Fewer than 1% of children with diarrhoea get the life-saving combination therapy provided by products such as our Kit Yamoyo, now made and sold across Zambia. It is clear from our work in Zambia and the work of others, that as long as ORS and Zinc are listed as separate items on the Essential Medicines List for Children (EMLc) they will continue to be bought separately, supplied separately and rarely dispensed together.

It is often the simplest things that get over-looked. So, in March this year, we put out a call to experts for their comments: Why doesn't WHO list co-packaged ORS and Zinc as a single treatment?  Bouyed by their response, we wrote to the Secretary of the Expert Committee on the Selection and Use of Essential Medicines, Doctor Magrini, in Geneva. The committee was about to embark on its 2-yearly review of the list. The deadline for submissions had just closed. With his help and advice, we attempted to obtain a last-minute official letter from Zambia's Ministry of Health - a plea to review the listing of ORS and Zinc, together, as a combined treatment.

Ultimately, we were too late for this round of decision-making - but we did manage to throw a few pebbles into the global 'pond', and the ripples are showing. In May, Simon addressed the Access to Medicines conference in Geneva, and while there, managed to meet with a potential supporter within WHO.  Simple things are never as simple as they seem. It may take another 2 years, but we hope to gather funding and peer-reviewed evidence to make sure co-packaged ORS and Zinc is listed by WHO for home treatment of childhood diarrhoea.

With your help, we can do it!

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Pharmanova's Mr Chintu, with Kit Yamoyo Screwtop
Pharmanova's Mr Chintu, with Kit Yamoyo Screwtop

Simon and I have just finished a busy trip to Zambia. It’s been great to see how much now moves on under its own steam - without us in the country.  This is our strategy: to embed the Kit Yamoyo (as the 'Aidpod' is now called) and everything that pertains to it, in Zambia, so when the current funded projects end in 2018, the world’s first children’s diarrhoea kit adapted for home use continues to be made, sold, bought and used by parents and carers.

Still, sometimes a little trouble-shooting is needed.

Here are three highlights from our recent trip:

1)    The Kit Yamoyo Screwtop to launch in Shoprite

Kit Yamoyo currently sells in two formats – the 'original', which, as well as ORS and Zinc, contains a small soap bar for hand-washing, and a new low-cost, no-VAT line, without soap.  So that customers can differentiate the two versions, we are going to re-package the ‘original’, and launch a new, locally produced jar, beautifully designed by our packaging partner, PI Global.  

Mohammed Umar, CEO of our local manufacturer, Pharmanova, went with Simon to negotiate this new line onto the shelves in Shoprite. This is not as simple as it sounds – supermarkets negotiate one of their most valuable assets – shelf space – very hard!  But the aptly named Lucky Ngandu (luckily for us!), head of Shoprite’s Buying Division, saw an opportunity to launch this new ‘premium line’ as part of Shoprite’s baby promotion in April.

So, we have left Pharmanova to get production of the new screwtop up and running - in 6 weeks!  Pharmanova have now taken over all aspects of Kit Yamoyo production: costing, pricing, sales and manufacturing decisions.  “Don’t worry,” says John Chintu, Quality Control Manager at Pharmanova. “It will be done.”  We're not worried!

2)    Mainstreaming public sector supply of life-saving ORS and Zinc

Meanwhile, in the public sector, Zambia’s Medical Stores Ltd (MSL), the government distributor, has finally agreed to ship out a box of 150 Kit Yamoyo (branded as a Ministry of Health product) with every box of Health Centre supplies delivered out to the district facilities. Again, this seems like a simple decision to take. But changing a process at a government agency is not plain sailing – it takes persistence, politeness and persuasion.

Each box of Health Centre supplies, sent out bi-monthly (one box per 1,000 population) contains 100 ORS sachets (sufficient for 50 children) but ONLY 100 Zinc tablets (enough for only 10 children).  Despite over a decade passing since WHO recommended Zinc with ORS (it makes a huge difference to recovery and immunity) today fewer than 1% of children in Africa get the combined treatment. The agreement with MSL is one step on the way to changing that.

Next step: lobby WHO at international level to get the Essential Medicines List changed, so that instead of two separate items, co-packaged ORS and Zinc is listed as one item for childhood diarrhoea. Again, a seemingly simple change: watch this space!

3)    Launching Phase 2 of our rural market development project

We are working in 14 rural districts that are key government targets to improve child nutrition in Zambia. Diarrhoea - and in particular low Zinc levels - exacerbates malnutrition. Typically, 45% of children in Zambia are stunted – up to 70% in some areas. If a child is stunted at age 2, he or she will never reach full potential - physically or mentally.

To cover all of these districts, new staff, employed by our partner KZF, will promote Kit Yamoyo in communities, ensure government health centres order the kit, and train and support small retailers. We arrived in Zambia in time to help KZF put together a full day of staff induction, bringing in the existing fieldworkers and setting them into groups to share lessons with their new colleagues. With presentations, brainstorming, role play and technical training on the use of tablet computers, we tried to make the day both fun and productive.

Our new field worker from Chinsali district enjoyed the day immensely: “I wondered if I could do the job – but now I know I can do it and I will enjoy it very much,” she told us, at the end of training.

Chinsali is where Simon worked in 1987, and where he was originally inspired by the coverage Coca-Cola could achieve to work on distributing a diarrhoea kit for children.

Thirty years later: we made it!

Two happy customers
Two happy customers
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Judith selling eggs, and Kit Yamoyo
Judith selling eggs, and Kit Yamoyo

Meet Judith.  Judith is one of the thousands of small grocery shop-keepers we have trained to sell Kit Yamoyo - the kit of life. That’s it on the counter there, surrounded by eggs. Her shop is in one of Lusaka’s slums, Kanyama West. Judith is one of our best retailers in Zambia's capital, Lusaka. When you ask what makes her successful, she’s very clear:

“Whenever a mother comes into my shop with her child, I tell her about Kit Yamoyo. I talk to her about her child’s health, and the dangers of diarrhoea. I keep a kit that I have opened, here, to show her what is inside and how to measure the clean water and medicine correctly. Then I ask her to buy one now. Why wait until your child has diarrhoea and it is late at night? Take one now, and keep it at home for when diarrhoea strikes.”  One of her customers recently did just that, and was able to treat her baby, Joshua, immediately - before diarrhoea weakened him. Joshua, pictured below, is every Zambian mother's dream. In a country where nearly half of all children are stunted, he's a healthy, stocky little chap who has grown well on exclusive breast-feeding and already looks far older and stronger than many 4 month old children. He wouldn't smile for the camera, but he's a Kit Yamoyo 'poster boy' just the same!

In rural Mumbwa, 140 kilometres out of Lusaka, the delightfully named Comely uses the same strategy: showing and telling every customer who visits his shop about Kit Yamoyo and its benefits. He always has an opened kit ready for demonstrations. Comely also takes advantage of community events and gatherings of women, men or farmers and sometimes goes out to surrounding villages. As a result, he’s one of our best-selling retailers in Mumbwa. He’s created so much demand that often his weekly stock sells out within two days, and he’ll top-up from fellow shop-keepers nearby, who haven’t developed the same selling skills. Across Zambia, our field worker teams and their project managers, Albert and Chibale, pass on these simple secrets of success.

Stopping children dying from diarrhoea isn’t rocket science. Sometimes small steps – just a nudge in the right direction - can bring about a huge change. So, ColaLife is not just working on the frontline in Zambia. We’re feeding many of these small steps into a global strategy for change.

And if you’d like to read more about that, and perhaps help us on our way, your next small step is right here!

Comely in his shop in rural Mumbwa
Comely in his shop in rural Mumbwa
Joshua: Kit Yamoyo poster boy at just 4 months old
Joshua: Kit Yamoyo poster boy at just 4 months old
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Woman & child with our ORSZ pack-Chinsali district
Woman & child with our ORSZ pack-Chinsali district

This is a tale of two health centres, way out in the African bush. It tells us a lot about the fine line between success and failure.

Let me take you to Chinsali - a small, dusty town, over 8 hours' drive from Zambia's capital, Lusaka. Chinsali is a significant place for ColaLife: it was here that the inspiration for our work was born, in the 1980s. It was while working here that it first struck me that in Chinsali and the surrounding villages, miles from anywhere, I could get a Coca-Cola. Yet there was nothing to treat a child with diarrhoea, which even today is still the third biggest killer of children under five years old.

I worked in Chinsali from 1985 to 1989 and last week, I returned - after 27 years. All my old haunts were still there but all around, progress is clear to see: where there were no two storey buildings, there are now multi-storey government offices. Where there were no fuel stations, now there are two. The old main street is now a bustling town centre with hundreds of shops including two pharmacies.

I was visiting with my counterpart, Albert S from Keepers Zambia Foundation, to check on the reach of our anti-diarrhoea kit, Kit Yamoyo. In Chinsali, the Zambian government is distributing its own ORS and Zinc co-pack, based on our ground-breaking design, for free, from health centres. 

Our first stop was Chinsali District Hospital where they had plenty of stock of the new co-pack. These are being delivered to them by Medical Stores: the public sector distributor. This distribution route is not always reliable, which is why we work hard to promote the private sector, to sit alongside what the government can do. But today: so far, so good.

We set off, with the District Pharmacist, driving 40km north of Chinsali Town to Mundu Rural Health Centre. This serves a population of around 8,000 people. We learnt that here, they see an average of 5 diarrhoea cases a day (150 a month). All the staff we met here knew about the new ORS and Zinc co-pack but there was no detailed knowledge of the product and they had no stock. The co-packs ran out about two weeks ago - but no-one had ordered any more. Not so good.

Apparently, the person we had trained in the new ORS/Zinc co-pack had moved on. Obviously, there had been no hand-over. Albert demonstrated the kit to the staff and they vowed to pick up some kits the next time they were in Chinsali. Unfortunately, we had to leave the health centre as we found it: with no stock of this simple, life-saving pack.

The next visit was to Lubwa Mission Rural Health Centre. Here we encountered a completely different situation. The District Pharmacist had travelled with us, taking advantage of the lift, and he'd brought the clinic's order: a box of 150 ORS and Zinc kits. Elvis S, the Clinical Officer in Charge, greeted us, as he signed for the delivery:

"Here in Lubwa, we take care with our ordering and our stock. All the children's cases of diarrhoea that we see are given this new ORS kit, this Kit Yamoyo. Even now, we have 50 kits in stock. This kit works - it is very effective. The mothers who bring their children appreciate it - very much. Every day, we treat 3 or even 5 cases of diarrhoea. It is the high season for this problem: the number of cases is increasing due to the season: we have higher temperatures, water sources drying up, and so the water is at greater risk of contamination."  

Mr S obviously runs a tight ship, and was very enthusiastic about the kit - which, interestingly, he calls Kit Yamoyo - its brand name - even though the government version doesn't carry the Kit Yamoyo name or branding. This extends to the way it is recorded in the dispensing register: Kit Yamoyo, the Kit of Life. Brand is vital: for trust, for reputation and for establishing the brand in Zambia.

ColaLIfe works closely with the public sector, but it is not our realm. Nevertheless, we went back to the district with some suggestions for the District Medical Officer: Why not send a box of the new kits every time a bulk order goes out - whether it's been ordered or not?  When Community Health Workers go out into villages, can they carry and dispense the new co-pack during their out-reach work? As well as getting more kits into the hands of mothers, this would also spread the knowledge of the co-pack across the teams at health centre level so that the system is less vulnerable to the transfer of staff. And if a vehicle is visiting, don't let it go empty: always send some stock!  

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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
$54,543 raised of $65,000 goal
 
746 donations
$10,457 to go
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