Project Lead(s): Rohit Ramchandani
Diarrhea accounts for 9% of all childhood deaths and is the second leading infectious cause of mortality in children under five years of age.
Oral rehydration salts (ORS) and zinc are recommended globally to treat diarrhea yet few children in developing countries can access them, due to weak supply chains, regular stock-outs, large distances to access points, lack of knowledge and cost.
ColaLife is a multi-award winning project focused on increasing utilization of ORS and Zinc in rural Zambia. The ColaLife model has involved the development of an innovative diarrhoea treatment kit, based on a human-centred design and the establishment of its end-to-end value chain.
The locally manufactured Kit Yamoyo® contains 200ml ORS sachets, pediatric-formulated zinc sulphate tablets (10-day treatment) and a small bar of soap for hand washing. Leveraging existing networks of private sector wholesalers and retailers (those used by Coca-Cola and other FMCGs), kits were distributed across the “last mile” to community-level shops, creating a complementary point of access to public sector health facilities, and providing caregivers with the “dignity of choice”.
A pre-test/post-test design with matched comparators study was used to evaluate this approach to community-level distribution.
A total of 26,230 kits were distributed through 80 retailers in four intervention districts. Kits were available through community-level retailers for cash or vouchers, which were provided through promoters and allowed caregivers to access kits at no cost.
Results from this study showed the value of this comprehensive health systems approach.
Of the 2,400 households surveyed at end-line, the project team found that 45% of children with diarrhea received the combination therapy of ORS and zinc, up from less than 1% at baseline.
The kit’s design also improved adherence to the recommended treatment, including improved preparation of ORS (measured by concentration) from 60% to 93%, demonstrating the advantages of using smaller sachets and a measuring vessel, over the standard 1L sachets available in most places around the world.
While 93% of Kit Yamoyo users did use the correct amount of water when preparing ORS at home, only 33% of users actually used the zinc tablets for the recommended time period (the full 10 days). The team is now applying human-centred design principles to improve zinc adherence.
The distance to access rehydration therapy was reduced from an average of 7.3 km (to a health centre) to 2.4 km (at a local retailer).
The work has been recognized globally and featured at several high-level summits, including the United Nations General Assembly (UNGA). It was also recently recognized with a Transformational Business Award in Health from the Financial Times & International Finance Corporation, the Diamond and Food Security Awards at the Dupont Packaging Awards, and a Product Design of the Year award from the London Design Museum. The knowledge has been widely disseminated through conference presentations, peer-reviewed journals, a popular blog, key publications, and featured in the award-winning documentary “The Cola Road” as well as a popular TEDx Toronto Talk.
The project has been scaled by others with $430,000 in funding received as follows: GlaxoSmithKline and Save the Children Healthcare Innovation Award ($191,000), J&J Foundation ($191,000) and private donors ($48,000).
A total of $1,673,232 was also received from: DFID Zambia ($1,207,165), Johnson & Johnson CCT ($280,438) and COMESA/TMSA ($185,629).