1 Consumer-focused supply chains: a cross-case comparison of medicine appeal and acceptance in India, Uganda and Nigeria EurOMA 2015 Peter Michael Ward, WMG, University of Warwick Kate Kynvin, Clinton Health Access Initiative

2 Nine percent of child deaths – 0Nine percent of child deaths – 0.6m annually – are due to diarrhoea despite the availability of simple, effective and affordable treatment Effective treatment with zinc and ORS is simple and affordable at less than US$0.50 per course But fewer than 1% of children in high-burden countries1 get that WHO-recommended treatment. The rest get suboptimal or no treatment Oral Rehydration Salts Can avert estimated 93% of diarrhoea deaths ~US$ /sachet Zinc 40% reduction in treatment failure/death 25% reduction in duration of diarrhoea ~US$0.25/course (10 tablets) 1 Bangladesh, Dem. Republic of Congo, Ethiopia, India, Kenya, Niger, Nigeria, Pakistan, Tanzania, Uganda

3 We examined the problem using the lens of Service-Dominant Logic to determine what supply chains might be able to do to address it Change the patient Service-Dominant Logic Change the offering Service-Dominant Logic’s view of consumption is that it is the co-creation of value by exercising agency within the constraints of context to exploit the affordances of the value proposition

4 We predicted that at the point of sale the Appeal and Acceptance of ORS is critical to the decision to buy. Research assessed opinions of 630 caregivers in 3 countries Examples of current 1-litre pack designs on the market Seven potential new formulations Three potential new pack designs

5 Caregivers demonstrated preferences for specific affordances in their contexts when considering their own agency and the other value propositions available Country Pack design 1 Pack design 2 Pack design 3 Purchase preference India 4.85 4.90 N/A (all 86%) Nigeria 4.49 4.65* 4.77* Design 2 (78%) Uganda 4.72 4.91* Design 2 (91%) Average appeal scores out of 5 plus “definitely buy” purchase preference for the 3 package designs by country. Asterisked numbers for designs 2 and 3 are statistically significantly different (p<0.05) from design 1 Average appeal scores out of 9 plus purchase preference for the 7 formulations by country. Asterisked numbers are statistically significantly different (p<0.05) from the smaller sachet Country Smaller sachet Effervtablet Premix Tetra Pak Premix bottle Premix pouch +Water purifier Co-pack with Zn Purchase preference India 8.32 8.28 8.25 8.02* 7.64* 8.35 7.36* Tetra Pak (43%) Nigeria 7.39 7.67 7.52 6.76* 6.99 6.95* 7.01 smaller sachet/ Tetra Pak (27%) Uganda 8.50 8.22* 8.48 7.89* 7.60* 8.45 Tetra Pak/ co-pack with Zn (15%)

6 Supply chains are already applying the results in new pack designs and formulations. These new designs will reach the market very soon Supply chain research increasingly highlights the importance of understanding customer needs (including appeal and acceptance) and then to make them known to supply chain partners. Our research shows it is possible to put this into practice. Positioning consumption as the “last yard” of the supply chain facilitates this. It means that consumption is simply the last link in the supply chain. Supply chain partners can therefore take responsibility for consumer outcomes rather than just product inputs. New Indian New Ugandan New Nigerian ORS sachet ORS sachet co-pack

7 Peter Michael Ward, WMG, University of Warwick [email protected]Thank you! Peter Michael Ward, WMG, University of Warwick Kate Kynvin, Clinton Health Access Initiative This research was orchestrated by the Clinton Health Access Initiative with funding from the Norwegian Agency for Development Cooperation (NORAD), Bill & Melinda Gates Foundation, Ikea Foundation and ARK and ELMA. IPSOS Kenya ran the interviews and focus groups across the three focus countries. Emilie Chambert was the Innovation Study Manager. Melinda Stanley, Global Marketing Manager at CHAI, was overall coordinator. Support for attendance at the conference was provided by the University of Warwick and the ESRC Impact Acceleration Account.