Coca-Cola gets everywhere, yet essential medicines (EMs) are hard to get in rural developing world communities; African public sectors struggle. Diarrhoea kills 1.5 million children/yr: more than AIDS, malaria and measles combined. Over 70% in Africa go without Oral Rehydration Salts (ORS)/zinc. WHO recommend integrated ‘kits’, and ‘market forces’, ‘innovative delivery strategies’ and educational materials, to reach rural communities. Yet transport costs are prohibitive: 40% of prices. Mothers may walk 30 km to a Health Post, to find essential medicines out-of-stock. ColaLife forms partnerships to trial new distribution partnerships and delivery models for EMs, and has designed an 'AidPod' to fit unused space in drinks crates - adaptable/adoptable in a range of countries, for local needs.

Problem

Coca-Cola gets everywhere, yet essential medicines (EMs) are hard to get in rural developing world communities; African public sectors struggle. Diarrhoea kills 1.5 million children/yr: more than AIDS, malaria and measles combined. Over 70% in Africa go without Oral Rehydration Salts (ORS)/zinc. WHO recommend integrated ‘kits’, and ‘market forces’, ‘innovative delivery strategies’ and educational materials, to reach rural communities. Yet transport costs are prohibitive: 40% of prices. Mothers may walk 30 km to a Health Post, to find essential medicines out-of-stock. ColaLife forms partnerships to trial new distribution partnerships and delivery models for EMs, and has designed an 'AidPod' to fit unused space in drinks crates - adaptable/adoptable in a range of countries, for local needs.

Solution

Harnessing the secondary Coca-Cola distribution chain for EMs is much discussed, but no fully evaluated trial has given metrics, learning and models for adoption/adaptation/scale-up. (Coca-Cola now advises Gov of Tanzania on logistics; some ad-hoc local co-transport initiatives have been seen). Design of the ‘AidPod’ is unique - 5 large or 10 small AidPods fit in each crate, separating the products physically/ psychologically from beverages. AidPods can be waterproof, trackable and tamper-evident, with potential to explore in future a variety of packaging options including: re-usable; recyclable; bio-degradable; SODIS-enabled (ie PET plastic); returnable; brandable; locally manufactured; cross-subsidised through parallel products sold in wealthier markets (including emerging African middle classes). Using retail/market incentives to improve distribution/access in remote areas to essential medicines is novel: using subsidies to drive demand/improve access. There are parallels/lessons from trials of distributing ant-malarials in Zambia and elsewhere (eg Global Fund), which we draw on. Use of SMS for tracking/authentication, e-vouchers. We draw on NORAD experience in Zambia in the agriculture sector; health product tracking using SMS is new for Zambia. Innovative text-based health messaging may be included. Trialling an ADK for home use by mothers/carers, along guidelines from UNICEF/WHO and including soap/hand-washing: new to Zambia; builds on PSI's work in Cambodia (Orasel: ORS+Zinc only). Evaluation and learning is a key outcome; there is already replication interest.

Example

ColaLife brings together unlikely alliances to create 'shared value' and work in new ways - eg in Zambia, the Cola bottler (SABMiller), UNICEF, Min of Health and local NGOs, to trial a new distribution model, slotting ‘AidPods’ in unused space in the drinks crates that micro-retailers carry. This brings simple lifesaving medicines like ORS/zinc closer to rural communities with no additional transport cost, and helps micro-retailers earn a margin on every AidPod they distribute. AidPods contain EMs and awareness materials, supported by social marketing and retailer para-skilling in simple health advice in areas where drug stores are absent. A first operational trial starting this autumn in Zambia will test the value chain for a locally-determined ‘Anti-Diarrhoea Kit' (ADK), will use vouchers to ensure affordability and mobile phones for tracking and authentication. It will establish key metrics and provide learning and models for roll-out, scale up and possible adaptation or transfer to other commodities/supplies and countries. Trial activities will be: • ADKs designed and produced to meet needs at all levels in value chain (est 10,000 units) • Novel leverage of Coca-Cola supply chain to meet demand for ADKs in underserved areas • 30+ Retailers and wholesalers trained in benefits of ADKs, across 2 trial districts • An IEC/Social marketing programme for mothers/carers on benefits of ADKs (reaching an estimated 7,500 mothers/carers and 15,000 children under5, in 30 rural communities across 2 districts).

Marketplace

In Zambia, rural health posts may serve communities 30 km away, with walking often the only access option, and queuing for ORS, which, although free, may not be in stock. ORS is well known, but zinc is not. Huge distances and distribution bottlenecks at district level stop EMs reaching rural people, and costs of bridging 'the last mile' are prohibitive; so the government is active in pursuing innovative public/private partnerships. Zambia's private health sector is one of the smallest in the world with only 70 registered retail pharmacies (2009) most in major towns; health-seeking behaviour via private sector retailers in rural areas is low. There are 2.3M children under 5 in Zambia; 74,000 die per year (Under-5 mortality rank is in bottom 20); 15% of childhood deaths are diarrhoea-related. Only 56% of Zambian under-5s with diarrhoea received oral rehydration and continuous feeding (World Bank, 2010). Nearly 20% are underweight (UNICEF). Rural mothers/carers ages are 15 to 80 with a median age 37 (eg USAID/SCOPE OVC programme, 2002), 70% are female. Average births is 6/mother and household size typically 6-7. UN estimates 570,000 Zambian children are AIDS orphans, many in extended families. Of $1-2 dollars/day income, 75% may go on food. The latest Demographics and Health Survey (DHS) for Zambia notes that 6 in 10 children with diarrhoea were taken to a health provider (DHS, 2007). Only 60% were treated with an ORS sachet; 10% were given recommended home fluids (RHF) prepared at home; 34% were given increased fluids 16% of children with diarrhoea received no treatment. Handwashing practice is poor in rural areas; UNICEF policy is to improve it. Over 2009/10 we completed 3 fieldtrips and 3 co-design workshops for a first trial of ColaLife localized to Zambian priorities, meeting 50+ professionals (16 NGOs), government and SABMiller and local women/retailers.