Product description:

‘Kit Yamoyo’ (Kit of Life) is a novel anti-diarrhoea kit, designed and tested in Zambia, based on UNICEF/WHO recommendations, to be affordable, desirable and easy-to-use by parents in African villages or townships. It co-packages Oral Rehydration Salts (ORS), 10 dissolvable tablets of pediatric Zinc Sulphate, plus a small bar of soap for hand-washing (and to connect the message of prevention). Vital customer benefits include: the orange-flavoured ORS sachets are small size (200ml, 4.2g), avoiding wasted water and ORS solution; the pack doubles as a measure (improving both taste and efficacy); clear, graphical instructions.

Where the product/service is being used:

In rural and urban communities in Zambia – typically in low-income homes, where water may have to be fetched, mothers/carers may be illiterate, and health services may be 5km-10km away, under-stocked and/or overcrowded.

List the countries/regions where the product is being marketed:

Zambia

The Problems it attempts to solve or address:

In developing countries, diarrhoea kills. It is the second leading cause of childhood mortality, accounting for 11% deaths in children under 5. Globally, 700,000 children died from diarrhoea-related causes in 2011. Diarrhoea is also a significant contributor to poor child development and stunting; related under-nutrition is responsible for 45% of deaths, underlying 3M deaths annually. WHO/UNICEF have been recommending ORS plus Zinc for childhood diarrhoea for a decade: it is low cost, safe and very effective. Yet uptake is very low, and the public sector typically struggles to deliver these essential medicines. Until now, market-based approaches to product design and distribution have been neglected. These include: identifying customer needs for home use; how to make the product more desirable and appealing; affordability via the private sector; and micro-retailers for distribution – ie modelling a simple health product on other successful fast moving consumer goods, which are easily found even in remote villages (such as cola).

Design Approach:

For many health interventions in developing countries, the starting point is a behaviour change or a recommended treatment desired by health experts, based on what they think people need, and then ‘pushing’ product through a distribution channel. We began by consulting these health experts, including government, but also strived to learn from corporates who understand FMCG (eg Coca-Cola, SABMiller) and, most importantly, from the customer. This led us to understand and design into Kit Yamoyo the benefits, functionality and attractiveness that a customer desires. If you can get this right, and if profits can be made at every step (including by local micro-entrepreneurs) then a market-based ‘pull’ system can get the product to where the public sector cannot reach. Vital insights were: traditional 1 Litre ORS sachets are too big for home use and wrongly mixed at least 60% of the time; 1L is poorly understood; safe water is precious, so making up 1L at a time is not appreciated; literal, pictorial branding is preferred; usage graphics need to be clear and high quality.

Technology Used:

We have moved from a specially designed pack – which actually fitted within the unused space in Coca-Cola crates – to two new, cheaper formats that retain key benefits:

–          a highly attractive screw-top cup, blow-molded locally in-country from an existing ‘blank’. This measures water for the 4 ORS sachets contained within; acts as a child’s drinking cup; can be re-sealed for safe storage or to carry ORS solution; can be re-used multiple times. Also contains 10 Zinc tablets, soap and graphical instructions.

–          a low-cost flexi-pack, designed by Amcor. Contents as above, but about 30%-40% cheaper. A specialized transparent bag that stands up (semi-rigid) to measure water. It has a laser cut opening that pops open easily; is low-cost and very low-volume for delivery in bulk. It can be a refill for the above, or a stand-alone product.

Business Model

We are moving from subsidised trial to sustainable business model, locally owned and run. ColaLife’s trial partners in Zambia included Ministry of Health, UNICEF, Medical Stores Ltd, the local Coca-Cola bottler SABMiller, local NGOs Keepers Zambia Foundation and iDE, packaging experts PI Global, and the local manufacturer, Pharmanova. Trial funders included DfID, Johnson and Johnson Corporate Citizenship Trust and Janssen EMEA, and COMESA. We are now transferring the learning and the product to Pharmanova in Zambia – and potentially to other manufacturers elsewhere. The model allows acceptable profit at each price point: with localized manufacturing; sales to district-based wholesalers/distributors and purchase from there by micro-retailers – who then carry the product to villages or into townships. ColaLife is currently seeking further funding to enable us to ‘para-skill’ micro-retailers in product benefits and wider health messaging around diarrhoea, to underpin wider, faster and more effective market development, with discount vouchers for customers in poorer areas.

Impact:

In the two rural/remote trial areas, 26,000 kits were sold in one year; use of ORSZ combination therapy increased from <1% (baseline) to 45% endline; the distance mothers had to walk to an access point was cut by 65% (from 7.3km to 2.4km); >90% of customers used all 3 components and measured ORS correctly; perception of ORS improved by 14 percentage points. We estimate that one child’s life was saved for every 330 kits sold. The next step is wide sharing of data and learning, scale-up across Zambia led by the local private sector (in collaboration with government and NGOs) and take up in at least one other country.

Lessons Learned

i) Bring together ‘unlikely’ collaborators (eg corporates with health agencies; global with local; experts with users/customers)

ii) Design for customers at ‘the bottom of the pyramid’: including benefits and functionality; quality and branding; cost.

iii) Strengthen what is there; design and build a ‘value chain’ for the product that works: the elements needed may exist yet need bringing together (eg manufacturers needing to be ‘plugged in’ to global recommendations and design expertise; small grocery outlets where staff/owner may need to be ‘para-skilled’ for the best outcomes);

iv) be flexible, responsive, prepared to leave behind one innovation to pursue another that emerges;

v) embrace ‘open source’ – share your ideas to improve them and share data/learning as soon as possible.

Contact details

jane@colalife.org   simon@colalife.org     www.colalife.org

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