Children
 Zambia
Project #12438

Lifesaving AidPods for 65,000 African children

by ColaLife
Pharmanova
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
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
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!  

Pharmaceutical Society of Zambia back Kit Yamoyo
Pharmaceutical Society of Zambia back Kit Yamoyo

Our work is all about saving children's lives, one at a time. Until now, we've concentrated on Zambia. But this year, 2016, is the start of something big. I hope you’ll come along with us!

Influencing key organisations and networks is now right at the heart of our aims. Last month, in Zambia, Kit Yamoyo was presented at the Pharmaceutical Society of Zambia’s Annual Conference. There was a very enthusiastic response, and we’ll now be contacting similar associations across Sub-Saharan Africa.

What's more, ColaLife is being supported by Ashoka to work on a globalisation strategy. It will focus on countries where:

  • we can convene a network of existing players around a market-based effort
  • we can have the best chance of a big impact (number crunching mapped against ease-of-access)
  • we can get a manufacturer, government and NGOs willing to take up our Open Source offer, as well as a guide to commercialising Kit Yamoyo (our next big job) and support from ColaLife, if they need it.

Our work on better design and distribution has also featured strongly in an international publication:

These are the key messages we’re aiming to promote globally:

  • We are here to support local manufacture, existing systems, complementary programmes
  • Listen to your customers! They know what will help them.
  • Make it easy! Design is key: small sachets, co-packaged ORS and Zinc
  • Affordability and desirability go hand-in-hand
  • Education and awareness are key to drive demand

Meanwhile, in Zambia the work goes on. A Global Giving field-visitor, Aleia Bucci came to see our project recently. She says:

“Shop owners throughout the compound [slum area] all expressed the positive impact Kit Yamoyo has had in their community. The introduction of Kit Yamoyo has not only saved lives, but has increased the level of education surrounding prevention of diarrhoea in the future as well.”

We now have:

  • 1,220 trained small retailers, selling to communities all over Zambia
  • 70% - 90% of retailers with stock in 6 of our 9 provinces – we’re aiming for 80% across the board
  • Most small shops are selling between 1 and 4 kits a week to their community – our target is 1 to 2 kits
  • 28 stores in Zambia’s biggest supermarket chain selling Kit Yamoyo

Our fieldworkers update progress every week, and you can see a weekly snapshot here.

The next couple of years will be an interesting ride – stay with us!

Trained supermarket cashiers promote Kit Yamoyo
Trained supermarket cashiers promote Kit Yamoyo
Jude is delighted with the
Jude is delighted with the 'Miracle Medicine'.

Sometimes the simplest, low-cost solutions make a huge difference.

The world's health experts have known for over a decade how to treat the world's second biggest killer of young children: diarrhoea. Oral Rehydration Salts and Zinc are cheap, easy to distribute, and simple to use in the home - in theory. Hardly a 'miracle' breakthrough'.

But this is how ColaLife's 'Kit Yamoyo' is now being welcomed in African villages.  

Jude and her baby girl, Mushala, live in Namushakende Village, on the edge of the Zambezi river floodplain. It's a day's drive from the capital, and 25 kilometres from the Provincial town, Mongu. In the wet season, the whole area can be inundated: great for cattle farming on the newly green plains, but not so good for a clean water supply for families. A careful mother, Jude tells us she always treats the family's drinking water to make it safe and she takes care with hygiene. But Mushala is 16 months old - just at the age when children everywhere begin to explore their world, and as Jude says: 'With children, you can’t always see what they put in their mouth.'  

Jude had never heard of Kit Yamoyo until Mushala became seriously ill with diarrhoea: "I thought it was just an episode of a bad tummy and it would soon clear up," she told our Project Officer, Akufuna Ngenda. "But the diarrhoea did not stop. Instead it worsened. Rapidly the baby became very weak. As she deteriorated, I rushed to the Health Centre, which fortunately is very near the village."

But as often happens, government distribution systems can struggle and the Health Centre didn't have the medicine that Mushala needed in stock.

She continues her story: "They scolded me for delaying to come to the Health Centre. But they told me to go and get a new pack that had come to the village shop: Kit Yamoyo.

"I went to the shop immediately and bought the kit. I was in a hurry to give my baby the medicine because she had become very weak. But the shop-keeper, Mr. Liwena, has been trained in how to use this kit and he stopped me for a while to explain to me how the kit works.

"I followed his instructions and started the treatment. It was easy to understand and mix up the Oral Rehydration Salts at home. I also started the Zinc tablets immediately. The diarrhoea stopped on the second day and I thought it was a miracle!"

Indeed, Mushala now looks strong and healthy - it's difficult to imagine how quickly she became so ill and how suddenly her life was in danger.

Jude went back to Mr. Liwena and told him how good the kit was. He reminded her to continue with Zinc for the full 10 days, as it helps strengthen children's immunity. Jude followed his advice - and the diarrhoea hasn't returned.  Now Jude has become a local advocate for Kit Yamoyo, and tells her friends and neighbours in the market about it, whenever she gets the chance.

Mushala is now one among thousands: when ColaLife began developing a new design for a rehydration pack to stop children dying from diarrhoea, we never imagined what a difference it could make to so many lives.

This great story brings together many of the simple solutions that your donations support: wider distribution of a better designed anti-diarrhoea kit, easy to use, easily sourced in the village from well trained shop-keepers - and backed by supportive government Health Centres.

Even the simplest solutions can bring a small miracle.

 

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Organization Information

ColaLife

Location: London, Greater London - United Kingdom
Website: http:/​/​www.colalife.org
Project Leader:
Simon Berry
Lusaka, Lusaka Province Zambia
$45,259 raised of $65,000 goal
 
637 donations
$19,741 to go
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