Brenda Mudenda looked down desperately at her dying seven-month-old baby, Nchimunya, rocking her slowly in her arms as she stood outside the deserted, rural health centre.
The long walk through Zambia’s sun-parched countryside to save her baby from chronic diarrhoea had been fruitless, the faint glimmer of hope ebbed out on to the doorstep of the empty clinic.
With her baby now refusing to take even breast milk, Brenda, 25, mustered all her strength to begin the trek to the next nearest clinic, some 40km away.
On her arrival at the health centre, the exhausted mother watched as her baby was treated using an odd wedge-shaped kit containing anti-diarrhoea medicine. Admitted to the centre and given the medicine over several days, Nchimunya was discharged five days later, giggling and back to health.
The strange-shaped pack was, in fact, the region’s first all-in-one anti-diarrhoea pack, called Kit Yamoyo or Kit of Life – designed specifically to fit inside Coca-Cola’s crates to be distributed to the far-flung reaches of Africa. The kits are the brainchild of Simon Berry, a British social entrepreneur.
Simon’s landline from Zambia crackles and breaks intermittently, almost making audible the many miles that separate Lusaka from Dubai. He chuckles, joking that holding a handset is no longer the norm, it’s Skype they use in Nkhata House, the offices that house his charity initiative ColaLife.
It’s no surprise that this social entrepreneur sees using an everyday phone as a thing of the past. The 57-year-old has been a leader in innovation for most of his life, and his latest creation is no exception.
Like most ingenious ideas, ColaLife and its Kit Yamoyo, appeared in a light bulb moment of clarity: If Coca-Cola can get to the most remote parts of Sub-Saharan Africa, why can’t medicine? However, as is so often the case with the brightest concepts, his plan to tackle the country’s critically high infant mortality rate didn’t get off the ground for several years.
“I was aware that wherever I went I could get a Coke, then I became aware that in these same areas one in four children was dying before their fifth birthday,” Simon says.
“So I put two and two together and got really excited about it, but we didn’t have telephones in those days, certainly not in the 1980s in North East Zambia anyway – there wasn’t even a postal system, just a telex machine – so the idea didn’t get off the ground.”
Time to revisit the concept
By 2008 burgeoning multinationals were being hauled over the coals to help alleviate world poverty, and Simon and his wife Jane, 56, then back in the UK, decided the time was right to revisit their ColaLife concept.
Firm believers in the power of social media, the couple launched a campaign to rally support on Facebook. They introduced the idea for the Kit Yamoyo, a plastic container that could carry anti-diarrhoea treatments (oral hydration salts, zinc and soap), coupled with Jane’s idea to design it so it could fit between and above bottles of Coca-Cola in crates.
The concept proposed filling unused spaces to carry their medicinal products to remote areas and in order to be sustainable, they proposed a model that would allow local wholesalers who already profit from distributing and selling Coca-Cola to also make money by delivering Kit Yamoyos. The plan was that the anti-diarrhoea packs would travel across Zambia, piggybacking on the Coca-Cola distribution network paved since 1929.
People loved the idea, and after lobbying from thousands of Facebook and Twitter users and promotion by the BBC, Coca-Cola wrote to the broadcaster’s Radio 4 programme confirming it was keen to be on board.
“It was a bit like walking into a vacuum,” Simon recalls. “This work needed to be done and everyone was suddenly thinking ‘why didn’t we do this before?’”
That year, Coca-Cola gave the Berrys permission to distribute the Kit Yamoyo using its distribution chain without any extra cost.
Zambia was a natural starting point for The Berrys. They had thought of the idea there when they worked for the British Aid Programme in the country years before, and the steep infant-mortality rate for under fives at 145 per 1,000* illustrated the need for it.
A killer illness
In Zambia, 40 children die every day from diarrhoea. It’s the country’s third biggest killer behind malaria and pneumonia. On top of that, Zambia has some of the highest rates for food insecurity in the region, with Unicef noting that 45 per cent of children under five are stunted due to malnutrition.
In many areas of this vast land, access to healthcare is almost non-existent, with devastating consequences for even the simplest of illnesses. Diarrhoea to a western parent is rarely cause for concern, easily treatable with a visit to a local GP.
In Africa, however, it’s an entirely different story, with mothers often faced with no alternative to watching their defenceless children die. Even when mothers like Brenda walk long distances in the sun to their nearest medical outposts, there is often little that can be done there.
The country’s small, sporadic health clinics are frequently run single-handedly by a clinical officer, who serves as many as 8,000 villagers – common practice in a country where research suggests that shockingly, there is only one doctor for every 10,000 people.
With just one treatment room, these clinics often have no water connection and no means of communication other than the officer’s personal mobile phone. Even more disturbing, they frequently have no medical supplies.
The vast distances between medical posts and the village communities they serve make them an impractical option for many rural patients, and the Berrys knew access to affordable medicine needed to be improved.
The plan to blanket communities with the Kit Yamoyo was rolled out across one-third of two of Zambia’s 80 districts initially.
ColaLife aimed to convince rural shopkeepers that the kit was as valuable to them as a can of Coca-Cola. If shops agreed to stock it, mothers could cut their travel time for life-saving medicine in half.
“Before we started, in one of our districts women had to travel on average 9km to their local health centre, and that may not have had stock when they got there. Now those women have to travel on average only 4km to get to a shop that stocks our Kit Yamoyo,” says Simon.
Although originally packaged with the intention of being fitted into crates of Coca-Cola, over the past few months the Kit Yamoyo has come into a life of its own and is moving away from the crates as a means of transportation. ColaLife has recently discovered that retailers are keen to pick up the kits from wholesalers at the same time they are collecting other stock for their shops.
Now only 8 per cent of its retailers use the Coca-Cola transport method. As Simon is keen to point out, rather than the actual distribution, the most valuable lesson they have learnt from Coca-Cola is the importance of a product’s value chain. In other words, if you make it valuable and desirable, it will work.
Simon is also realistic that in order for the Kit Yamoyo to catch on, it has to be affordable at community level. It retails at just less than Dh4 a pack – the price of five bananas – but that could decrease when its contents become locally sourced. At the moment the zinc comes from Tanzania and the soap from India, but already Zambia’s only local soap manufacturer is producing a small bar of soap for the kits.
There is also the possibility of a 35 per cent saving on costs by moving away from packaging that fits into Coca-Cola crates.
“We started with the space in the crate,” says Simon. “But much more important for
the long term is the space in the market.”
Hitting the mark
It would seem the affordable and medically effective design strategy was right on the mark, because rural Zambian families – 80 per cent of who live in poverty, according to The United States Agency for International Development (Usaid) – are willing to make the purchase.
Recent surveys conducted in Kalomo and Katete districts show 100 per cent positive feedback from communities.
Talise, a 25-year-old mother of three says, “The advice I can give to my fellow mothers is to use Kit Yamoyo straight away when you notice diarrhoea symptoms. Your child heals very fast and you will not risk the situation escalating.”
The success of the Kit Yamoyo can be attributed to many things, but it’s important to note that the people who inspired the idea are those who are using the product.
It was the mothers, grandmothers and carers of sick children who put forward their requirements and shaped the design before it was even on paper.
During the research stages, the ColaLife team discovered something as simple as measuring the correct amount of oral rehydration salts (ORS) to water was preventing mothers from treating their sick children.
The problem they faced was that ORS is produced for use in hospitals and is therefore packaged in one-litre sachets. However, a sick child requires just 400ml of ORS, meaning mothers should, if following instructions on the pack, throw away the remaining 600ml after 24 hours – something Simon says is unrealistic.
“Of course they don’t do that because they are poor, so what happens is they take a random amount of water and sprinkle in a bit of ORS. They usually get the concentration wrong so it’s less effective.’’
And so the kit was tailored to resolve the issue of measurement and has been designed as an all-in-one measuring, mixing and storage device, while also serving as the cup that children drink from.
And the winner is…
The great design of the kit has been recognised, as it picked up the 2013 Product Design of the Year award in London. “It’s fantastic that something designed with the poor and for the poor, and with the word ‘diarrhoea’ in it, has won a mainstream, international design award,” says Simon. “I congratulate the judges for being so brave.”
Important to the kit’s success is also the fact that, unlike most medicines on the market, it has been designed not only to help the sick but also to assist local retailers. Consequently, in its first six months alone, 20,000 kits were snapped up by rural shopkeepers in trial districts and as a result of its availability at an affordable price, the team believes around 60 lives have been saved already.
Now the Berrys know it’s time to start rolling out the initiative nationwide, and they have been pushing ahead keenly with the Zambia trial to compile credible evidence that the kits successfully decrease the number of diarrhoea-related deaths. They have partnered with the esteemed not-for-profit private research University in the US, Johns Hopkins, to generate positive hard facts to this end.
It’s a grand scheme for a simple but brilliant idea, to have rural shops across Sub-Saharan Africa stocking the kits in the same way they stock Coca-Cola. And what a coincidence that in 1886, under the belief that carbonated water was good for the health, the world’s biggest soft drink brand actually started out as a pharmaceutical drink for the sick.