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Medical Innovations – Kit Yamoyo and its value chain 11 th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15 #medinnov @colalife Simon Berry

Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

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Page 1: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

#medinnov@colalife

Simon Berry

Page 2: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain
Page 3: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

What is ColaLife and who are we?

ColaLife is a charity registered in the UKCharity number: 1142516

• Two founding executives• Five voluntary trustees• Focus on saving children’s lives• Independent• Our only project is in Zambia• Looking for global impact through

• Disruptive innovation• Generating robust evidence• Sharing findings and learning

• No personal commercial interest

Page 4: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Rohit Ramchandani

Jane Berry

The other members of the ColaLife team

Page 5: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Our starting point

What we did next

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Next moves

What we did What we learned

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Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

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Our starting point

What we did next

1

Next moves

What we did What we learned

Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

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Page 7: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

observation 1

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Diarrhoea

17%

Malaria

12%

AIDS

3%

Diarrhoea kills more children than Malaria and AIDS combined

Page 13: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

In Zambia 46% of children are stunted (up to 70% in some areas)

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observation 2

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Full shopsFull shops – empty clinics

Remote rural retail shop, Kalomo District, Zambia

Drug store room, Tiriri Health Centre, Katine, Uganda

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the idea

Page 18: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Why not put ORS & Zinc Kit in Coca-Cola crates?

Page 19: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Our starting point

What we did next Next moves

What we did What we learned

Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

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Jun 2010 | Gave up jobs to try and get a trial started

Page 21: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Jun 2010 | Gave up jobs to try and get a trial started

Our kitchen tableUK

Page 22: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Jun 2010 | Gave up jobs to try and get a trial started

Rohit on SkypeCanada

Our kitchen tableUK

Page 23: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Jun 2010 | Gave up jobs to try and get a trial started

Rohit on SkypeCanada

Harvard & UNICEF on speaker phoneUSA

Our kitchen tableUK

Page 24: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Sep 2010 | Cycle ride across France raised £6,000

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Oct 2010 | First of three consultation trips to Zambia

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Jun 2011 | Partnership and trial plan in place

Page 27: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

impactMothers in underserved rural communities increase use of ORS and Zinc in home treatment of diarrhoea

purposeTarget communities in two under-served rural districts have improved access to ORS and Zinc

outputs

Profit-driven supply chains improve availability of ADKs (anti-diarrhoea kits) in targeted communities in two underserved rural districts

Mothers/care-givers demonstrate awareness of ADKs and the benefits of the contents (ORS, Zinc and Soap)

access = ADK in the hand of an aware mother/care-giver

Availability = ADK in stock in retail outlets at community level

Generating robust evidence - the COTZ results framework

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Dec 2011

COTZ trial timeline | 24 months

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Our starting point

What we did next Next moves

What we did What we learned

Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

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Page 30: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Early 2012 | Pre-trial focus group work

What we learnt

Litre sachets are too big

Measuring water was an issue

Willingness to pay

Preferred branding

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Mar 2012 | Finalised the Kit Yamoyo design

Page 32: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Mar 2012 | Finalised the Kit Yamoyo design

Kit Yamoyo• Attractive

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Mar 2012 | Finalised the Kit Yamoyo design

Kit Yamoyo• Attractive

• ORS sachets are 200ml

Page 34: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Mar 2012 | Finalised the Kit Yamoyo design

Kit Yamoyo• Attractive

• ORS sachets are 200ml

• Packaging is also:

• A measuring device for

the water

Page 35: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Mar 2012 | Finalised the Kit Yamoyo design

Kit Yamoyo• Attractive

• ORS sachets are 200ml

• Packaging is also:

• A measuring device for

the water

• A mixing device

Page 36: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Mar 2012 | Finalised the Kit Yamoyo design

Kit Yamoyo• Attractive

• ORS sachets are 200ml

• Packaging is also:

• A measuring device for

the water

• A mixing device

• A storage device (the

soap tray is a lid)

• A cup

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Page 38: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Awards | The Kit Yamoyo has won many global awards

Page 39: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

0Nobody sold ORS or Zinc in the private sector.

Sep 2012

Before we started

Page 40: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

Sep 2012

Before we started

Page 41: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

Sep 2012

Before we started

Page 42: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

Sep 2012

Before we started

Page 43: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

Sep 2012

Before we started

Page 44: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

>26kkits sold into the two remote rural trial areas in 12 months.

Aug 2013

After 12 months

Sep 2012

Before we started

Page 45: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

>26kkits sold into the two remote rural trial areas in 12 months.

45%of children in trial areas received ORS/from Zinc. Up a baseline of <1%.

Aug 2013

After 12 months

Sep 2012

Before we started

Page 46: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

>26kkits sold into the two remote rural trial areas in 12 months.

45%of children in trial areas received ORS/from Zinc. Up a baseline of <1%.

2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.

Aug 2013

After 12 months

Sep 2012

Before we started

Page 47: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

>26kkits sold into the two remote rural trial areas in 12 months.

45%of children in trial areas received ORS/from Zinc. Up a baseline of <1%.

2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.

93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.

Aug 2013

After 12 months

Sep 2012

Before we started

Page 48: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

60%Only 60% of mothers mixed ORS correctly when given litre sachets.

0Nobody sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea

7.3kmWas the average distance to ORS.

>26kkits sold into the two remote rural trial areas in 12 months.

45%of children in trial areas received ORS/from Zinc. Up a baseline of <1%.

2.4kmThe distance to ORS/Zinc in the trial areas was reduced by two-thirds from 7.3km to 2.4km.

93%of Kit Yamoyo users mixed ORS correctly. Only 60% do when given 1 litre sachets.

Aug 2013

After 12 months

Sep 2012

Before we started

Page 49: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

4%Only 4% of kits went into Coca-Cola crates.

Aug 2013

After 12 months

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In Zambia, it’s the space in the market, not the space in the crates that is important.

This means we can revisit the packaging to make it cheaper.

Kit Yamoyo

Washing Powder

Eggs

Biscuits

Cola – but not Coca-Cola

Bread

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Manufacture

Assembly

Distribution

WholesaleK3.10

RetailK3.70

CustomerK5.00

Market development - the Value Chain

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Our starting point

What we did next Next moves

What we did What we learned

Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

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2014Incorporating the learning

into a national scale-up plan

Page 54: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Control

Trial – 2012-13

Transition – from 2013

Transition

Intervention

Progress towards national coverage

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ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Only include blister pack

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

Learning – product design

Page 56: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Only include blister pack

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

Learning – product design

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4Learning – 200ml ORS sachets

Page 58: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Only include blister pack

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Learning – reduce number of ORS sachets to 4

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ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Only include blister pack

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Learning – zinc

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Learning - designing for better zinc adherence

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ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Learning – zinc packaging design

Page 62: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Learning – soap

Page 63: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

Soap

Produce locally(still to be achieved)

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Learning – soap

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ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Design the blister pack to enhance adherence to the 10-day regime

lister pack needs no box

Soap

Produce locally

Leaflet Packaging

Removeconstraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

4Learning – leaflet

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4Learning – leaflet

Page 66: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

Soap

Produce locally

Leaflet

Simplify –single fold.Same leaflet for all formats

Packaging

4Learning – packaging

Page 67: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

ORS

Reduce number of sachets to 4

NOTE: This will also enhance adherence

Zinc

Produce locally

Design the blister pack to enhance adherence to the 10-day regime

Blister pack needs no box

Soap

Produce locally

Leaflet

Simplify –single fold.Same leaflet for all formats

Packaging

Removeconstraint of fitting in Coca-Cola crate. Only 4% of retailers used this option

Produce locally

Produce re-fill option

42014 | Incorporating the learning into the scale-up

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4Learning – packaging – the screw-top

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4Learning – packaging – the screw-top

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4Learning – packaging – the flexi-pack

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2015Implementing national

scale-up plans

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Scale-up – from 2015

Control

Trial – 2012-13

Transition – from 2013

Transition

Intervention

KYTS-ACE

Progress towards national coverage

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452,000

Product - new public sector format

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Promotion – aspirational product

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Promotion – frontline and face to face

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Para-skilling shop-keepers to advise customers

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Our starting point

What we did next Next moves

What we did What we learned

Medical Innovations – Kit Yamoyo and its value chain

11th Medical Innovations Summit 2015, Royal Society of Medicine 12-Sep-15

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Page 78: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Scale-up – from 2015

Control

KYTS-LUSAKA

Trial – 2012-13

Transition – from 2013

Transition

Intervention

KYTS-ACE

Progress towards national coverage

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Sharing the learning – our global impact strategy

colalife.org/openaccess

Page 80: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

Campaigning for…

1. 200ml ORS sachets for home use2. Co-packaging of ORS and Zinc3. ORS and Zinc as over the counter

medicines4. People to understand that all our

designs, learning and findings are theirs to take and use for FREE – we are NOT promoting a product – we promoting a game-changing new approach to diarrhoea treatment in the home

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Chimtende, Katete

Like us on Facebook (please):

facebook.com/colalife

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Thank you to the ColaLife funders

Isenberg Family Charitable Foundation

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To be continued…

colalife.org

[email protected]@[email protected]

Page 84: Royal Society of Medicine - Medical Innovations - Kit Yamoyo and its value chain

The data contained in this presentation are unpublished and based on preliminary analysis of data from the ColaLife Operational Trial in Zambia (COTZ). Final calculations may vary and will be published in peer reviewed literature in due course.

In the interim, the following citation may be used: Ramchandani, R. et al. (forthcoming). ColaLife Operational Trial Zambia (COTZ) Evaluation. Johns Hopkins Bloomberg School of Public Health, Baltimore.

Related correspondence should be sent to Rohit Ramchandani ([email protected]) and copied to Simon Berry ([email protected]).

A note on the data contained within this presentation

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