Emulating Value Chains of Consumer Goods to Save Lives: A Case Study of ColaLife’s Work in Zambia

Reliable health and supply systems are identified by the World Health Organization as a key element for improving access to medicines. This becomes even more problematic in developing countries with populations residing in remote locales. Getting life-saving medicines to these areas is fraught with man challenges. In a general sense, it is challenging getting health commodities into many of these countries, but even more challenging is getting medicines to those in need who live in remote regions once these medicines are in-country. Given many of these very same remote areas have access to various commercial products such as soft drinks, this reality begs the question: why can’t the supply chain, the value chain, used to get non-medical commodities to remote regions be used to get medicine to where it is needed most? This new report, Emulating Value Chains of Consumer Goods to Save Lives: A Case Study of ColaLife’s Work in Zambia, by Paulo Savaget, Cassi Henderson, and Steve Evans of University of Cambridge, takes up this question, exploring the successful work of ColaLife, a U.K. nonprofit, in Zambia emulating the value chain of a consumer good to provide one life-saving treatment: Oral Rehydration Salts (ORS) and Zinc, for one global killer—childhood diarrhea.

This report presents a roadmap based on an innovative and very successful approach undertaken in Zambia by the nonprofit ColaLife, which bypasses these deep-rooted bottlenecks for medicine delivery. The authors present a roadmap based on an innovative and very successful approach undertaken in Zambia that bypasses deep-rooted bottlenecks for medicine delivery. This work started with the observation that “Coca-Cola seems to get everywhere in developing countries, yet life-saving medicines do not.” Analysis of how fast-moving consumer goods, like Coca-Cola, get into the hands of people living in remote areas of sub-Saharan Africa (SSA) began. This analysis sparked the idea of emulating Coca-Cola’s value chain to improve access to diarrhea treatment—the second biggest infectious killer of underage five children in the region. More than a supply chain, a value chain can be thought of as an ecosystem of relevant players, processes, and resources needed to effectively deliver a product or service to the end user.

Value Chain Framework

• First, the report discusses the role of the “catalyst,” which has shown to be critical to designing and organizing a value chain. This can be performed by anyone (or any organization), as long as they do not wish to become an integral part of the emulated value chain.
• Second, the report offers a process for how to set up a value chain, focusing on over-the-counter medicines. This explains the value chain focal-areas, what they entail, how they are meant to be addressed, and the expected timeframe for each activity.
• Third, the report explores the requirements to ensure that the emulated value chain becomes self-sustaining and gradually more independent of the catalyst, of foreign aid, and more resilient towards unforeseen events, given the unstable nature of some low-income contexts.
• Lastly, the report provides insights into the possibilities of scaling-up access within Zambia, to other geographical regions, and to cover a broader spectrum of healthcare products. The authors combine the perceptions of stakeholders in Zambia, directly and indirectly involved in the project, with knowledge of experts in and development based in other regions. The report explores the most notable challenges to expand access to life-saving healthcare products

Seven Key Recommendations for Value Chain Expansion

Speed up organic expansion. If the emulated value chain becomes progressively more resilient, it is likely that expansion of access to other regions within the same country can happen organically. In Zambia, for example, this seems like a natural process, since “the manufacturer and Ministry of Health are taking long-term responsibility.” However, this expansion of coverage might not occur at the speed needed to tackle such an urgent and widespread healthcare problem.

Expand to other countries. Other low-income regions, especially in sub-Saharan Africa, face similar challenges and can use the roadmap developed in this report as a ‘playbook.’ As described by one of our interviewees, the intervention in Zambia is “something we can be proud of, the government is proud of, the country . . . can take pride in that and say, ‘We are leaders.’ Because we have something to show others, that things can change.” Catalysts are best positioned to design and enact a value chain. The role of the catalyst can be performed by individuals, as well as by new or existing organizations. In addition, governments and intergovernmental organizations can incentivize agents keen on playing the role of catalyst to promote access to ORS+zinc. The report provides practical guidance to those willing to take up a similar role in other geographical contexts.

Promote a self-sustaining legacy to boost local economies. Particularly relevant to the stakeholders in Zambia was to ensure the principle of maintaining a self-sustaining legacy. One interviewee, for example, emphasized that, in order to be a self-sustaining intervention, there must be a “component of local manufacturing,” which not only is a “boost to the local economy,” but also contributes to ensuring the continuity of the supply and the adaptation of the medicine to local contexts. This focus on the empowerment of local partners is echoed in the literature and by initiatives of global health—e.g., a workshop held during the Geneva Health Forum 2016 considered how to increase access to quality diagnostics in low and middle-income countries using social innovation centering production around local communities.  

Experiment and adapt accordingly. It seems clear that learning from the experiences in Zambia can be very useful to scaling-up beyond its borders. However, the intervention in Zambia has also shown that these interventions are essentially context-dependent. For example, the balance of healthcare access between private and public sector will vary country to country. In Zambia, access was primarily though the public sector but with opening expansion into private sector. On the other hand, India and Nigeria, for example, have a larger private sector pull. Hence, any intervention will require scope to experiment and will need to adapt accordingly, learning how to best engage with relevant agents to ensure that value flows throughout the value chain.

Engage stakeholders. It is important to include a range of stakeholders throughout the design process. A review of commercially available medical devices specifically designed for use in low income countries has noted that “a limited number of commercialized devices were designed for use by non-physician health providers”.  When designing devices for resource limited settings, design processes should consider the broader context and engage stakeholders throughout all its phases. A framework has also been suggested that includes contextual categories of industrial, socio-cultural, infrastructure, technology, public health, economic, geographical, and institutional. Thorough human-centered design studies should, therefore, be employed in the design of any intervention identified for this approach.

Be mindful of regulatory hurdles and enablers. While it is important to focus on design to create value-pull from the end users, delivery is also tied up in regulation challenges. The application of the framework to other public health products will require adaptation based on product complexity and regulatory level, factors that affect any medical device development process. Product complexity refers to the complexity of generating and diffusing a technology. For instance, mixing ORS sachets in water is a lower level of complexity than taking a finger prick of blood for a rapid diagnostic test and nterpreting the results. Anything that requires a level of technology that is beyond the skill set (existing or which can be harnessed) of frontline retailers is out of scope for this approach. Product complexity is closely tied to regulatory level.

Conclusion

Emulating the value chains of fast-moving consumer goods that already reach these areas has shown to be a successful approach to overcoming the lack of lifesaving medicines in remote, low-income regions. We would thus encourage policymakers, governmental agencies, nonprofits, and other entities to use value chain emulation of fast-moving consumer goods as a powerful tool for providing life-saving medicines in regions that are persistently lacking access. Overall, the ColaLife case study reveals key principles that would allow its success to be replicated across regions and across medicines. The report draws out the most important lessons from this example.

We hope that this report, which tells a story about an effective response that offers insights, reflections, and lessons learned, will be valuable for policymakers and organizations working on access to healthcare. This report joins another IBM Center report, Responding to Global Health Crises: Lessons from the U.S. Response to the 2014-2016 West Africa Ebola Outbreak, which focus on how best to leverage innovative tools, techniques, and successful processes use to respond to healthcare crises in an international context.