considerations in last mile delivery in access to medicines – the colalife story
TRANSCRIPT
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
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.
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
Kit Yamoyo brand, design & benefits.
Kit Yamoyo• Attractive
• ORS sachetsare 200ml
• Packaging is also:– A measuring device
for the water
Kit Yamoyo brand, design & benefits.
Kit Yamoyo• Attractive
• ORS sachetsare 200ml
• Packaging is also:– A measuring device
for the water
– A mixing device
Kit Yamoyo brand, design & benefits.
Kit Yamoyo• Attractive
• ORS sachetsare 200ml
• Packaging is also:– A measuring device
for the water
– A mixing device
– A storage device(the soap tray is a lid)
– A cup
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.
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.
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.
452,000 kits to 11 of the SUN Districts
v2
2010 2011 2012 2013 2014 2015 2016 201720091985
Government ORS/Zinc co-pack.
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
Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu
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
Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu
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%
Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu
Percentagewithstockandnumberinsample(numberinsampleequalsnumbercontacted)
TARGET
4
77%
39%
50% 50%
67%
47%
74%
45%50%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Mumbwa Chipata Eastern Chirundu Kafue Lusaka Chilanga Kalabo Mongu
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.
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.