Considerations in Last Mile Delivery in Access to Medicines – the ColaLife Story

Considerations in Last Mile Delivery in Access to MedicinesOut of the box thinking and partnership – the ColaLife Story

Simon Berry Co-founder & CEO, ColaLife [email protected]

What is ColaLife?

ColaLife is a charity registered in the UKCharity number: 1142516

– Two full-time workers and one part-time

– Five voluntary trustees

– Focus on saving children’s lives

– Independent

– Most of our work to date has been in Zambia

– We are not looking to grow but

– We are looking to have a global impact through

• Disruptive innovation

• Establishing national smart partnerships

• Freely sharing findings and learning

We have no commercial interest in the products described in this presentation

Rohit Ramchandani

Jane Berry

Simon Berry

The Team.

Focus of

our work –

Zambia.

the problem

Diarrhoea

19% of infectious disease deaths

Malaria

15% of infectious disease

deaths

AIDS

4%

Source: Liu et al (2015) Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an

updated systematic analysis. The Lancet.

2nd biggest killer is diarrhoea.

40% of

children

are

stunted.

The decades old standard

treatment that 99% children don’t

get.

ORS and Zinc

the innovation(#1)

Coke gets

everywhere.

Remote rural retail shop,Kalomo District, Zambia

Drug store room, Tiriri Health Centre, Katine, Uganda

Medicines don’t

Finding out what people want.(not what you think they need)

What we learnt

Litre ORS sachets are too big

Measuring water was an issue

Willingness to pay

Preferred branding

2010 2011 2012 2013 2014 2015 2016 201720091985

The product: Kit Yamoyo.

Kit Yamoyo brand, design & benefits.

Kit Yamoyo• Attractive



• ORS sachetsare 200ml




• Packaging is also:– A measuring device

for the water





for the water

– A mixing device





for the water

– A mixing device

– A storage device(the soap tray is a lid)

– A cup

our approach(smart partnerships)

Everything we do must be self-sustaining…

We cannot become a permanent part of the solution

Everything is done through local organisations/processes

We choose to work through partnerships

WARNING!

These must be *smart* partnerships

Our approach.

Smart partnerships.

Smart partnerships (we are the strings).

the trial(establishing the evidence base)

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

0Suppliers sold ORS or Zinc in the private sector.

<1%of children received the correct treatment for diarrhoea – ORS & Zinc

7.3kmAverage distance to ORS at clinics (1 L sachet only, no Zinc).

>26kKit Yamoyos sold into 2 remote rural areas in 1 year via existing market channels.

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

2.4kmDistance 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, due to appropriate 200ml sachets and the kit’s measuring function.

August 2013

After 12 months’ trial of new Kit

Yamoyo design & distribution

through existing private sector

channels.

September 2012

Before Kit Yamoyo. Rural, remote

areas.

Before

After

2010 2011 2012 2013 2014 2015 2016 201720091985

Trial results.

The vision.

Kit Yamoyo

v2 2010 2011 2012 2013 2014 2015 2016 201720091985

The reality.

Manufacture

Assembly

Distribution

WholesaleK3.10

RetailK3.70

CustomerK5.00

The Value Chain.

The awards: trophies not millstones; kudos not baggage.

“The main thing is to keep the main thing the main thing”

Stephen Covey

the re-think(#1)

ORS

Reduce number of sachets to 4

This may also enhance adherence to the combined therapy

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

Remove constraint of fitting in Coca-Cola crate

Produce locally

Produce re-fill option

v2 2010 2011 2012 2013 2014 2015 2016 201720091985

Incorporating the learning into the scale-up.

The flexi-pack

The screw-top

v22010 2011 2012 2013 2014 2015 2016 201720091985

The Kit Yamoyo

bag can be

used to

measure the

correct amount

of water.

v2 2010 2011 2012 2013 2014 2015 2016 201720091985

Simple in-country campaign messages.

452,000 kits to 11 of the SUN Districts

v2

2010 2011 2012 2013 2014 2015 2016 201720091985

Government ORS/Zinc co-pack.

Kit Yamoyo production line.

v2 2010 2011 2012 2013 2014 2015 2016 201720091985

the re-think(#2)

The VAT issue response: Kit Yamoyo ESSENTIAL.

-19%$0.75 $0.93

the re-think(#3)

v22010 2011 2012 2013 2014 2015 2016 201720091985

The screw-top finally hit supermarket shelves.

2016 sales

2,602 18,195 7,227 351,950

Total 379,974

1,400 per working day in 2016

Discontinued from Oct-16

Introduced from Oct-15 Introduced from Oct-16 Supplied to MoH from Sep-15 to Dec-16

68,629 22,386 7,227 452,050

Total 550,292

Since Aug-12

2016 ex-factory sales.

Today'sdate: 01/12/16

Datasetdate: 30/11/16 Release7.1

Contactprogress Iftheredsegmentsinthesepiechartsmatchtheredsectionofthelargepiecharttotheleftthenweareontargettocontactallretailersinthecurrentmonth.

Theorangesegmentrepresentsthepercentageofsuccessfulcontacts(thegreensectorabove)thatwerefacetoface(ratherthanbyphone).Thetargetis50%facetofaceinLusaka,100%inotherdistricts.

Numberoftrainedretailers:1,302

Mumbwa:83,Chipata:161,Eastern:138

Chirundu:80,Kafue:108,Lusaka:528,Chilanga:32

Kalabo:63,Mongu:109

Pointofsalematerials

PercentageofretailerscontactedwithaPoster(P),

DisplayTray(D),WallPainting(W)andnoPOS

materials(N).

Target:P=80%,D=80%,W=40%(Lusakaonly),N=0%

Wholesale&retailpricesbydistrict/provinceProvince Wholesale Retail

Central-Mumbwa 9.81 13.50Eastern-Chipata 9.44 14.33Eastern-Other 10.03 14.82

Lusaka-Chirundu 9.69 14.99Lusaka-Kafue 8.79 14.59Lusaka-Lusaka 9.36 15.20

Lusaka-Chilanga 8.86 14.63Western-Kalabo 5.56 12.00Western-Mongu 7.15 14.72

KYTSManagementDashboard

100%

Percentageofcurrentmonthelapsed

Elapsed

Remaining

TARGET

TARGET

29%

Western-Mongu

Numbercontacted

NumberaXempted

NoaXempt

47%

Central-Mumbwa

47%

Eastern-Chipata

16%

Eastern-Other

100%

Lusaka-Chirundu

56%

Lusaka-Kafue

34%

Lusaka-Lusaka

59%

Lusaka-Chilanga

18%

Western-Kalabo

100%

62%

18%

100%

100%

98%

100%

91%

100%

Visit

Phone

2.31

0.64

1.230.91 0.97

2.56

1.050.82

1.44

0

2

4

Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu

Averagekitssold(includingzerosales)inthelast7daysandnumberinsample(numberinsampleequalsnumbercontacted)

TARGET

1

13.50 14.33 14.82 14.99 14.59 15.20 14.63

12.00

14.72

02468101214161820


Averagewholesaleandretailpricesbyprovinceandnumberinsample(numberinsampleequalsnumberwithretailsales)

Avgretailprice

Avgwholesaleprice

2

3.08

2.33

3.183.67

1.38

2.46

1.531.00

3.03

0

1

2

3

4

5

6


Averagestocklevel(includingzerostocks)andnumberinsample(numberinsampleexcludesretailersac_ngaswholesalers)

TARGET

3

84%

62%

52%

67% 67% 64%

74%

40%

55%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Percentagewithstockandnumberinsample(numberinsampleequalsnumbercontacted)

TARGET

4

77%

39%

50% 50%

67%

47%

74%

45%50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Percentageofretailerscontactedthismonthwithsalesinthelast7days

TARGET

5

82

0 518

P D W N

8468

1 8

P D W N

94 89

0 6

P D W N

82 90

0 2

P D W N

99 94

24

1

P D W N

95 95

0 5

P D W N

100100

0 0

P D W N

100100

0 0

P D W N

97 90

3 0

P D W N

Scale-up dashboards – colalife.org/dashboards.

key lessons

Foster innovation

Prioritise innovation around access to medicines

Fail fast, learn and move on

Focus on want not need

Make your partnerships smart

Key Lessons.

Isenberg Family Charitable Foundation

Thank you to the ColaLife funders past and present.

Considerations in Last Mile Delivery in Access to Medicines – the ColaLife Story

Health & Medicine