TABLE 2.

How Learning From the ColaLife Operational Trial in Zambia Influenced Costing and Pricing for Scale-Up

Innovation/Aspect	Trial Learning/Evidence	Action
“Price minus” costing: value-chain price points for the product and ex-factory target price derived from willingness to pay and expected margins.	Margins and RRP were acceptable to retailers, wholesalers, and end users.17	Trial pricing and margins retained for scale-up; ex-factory subsidy successfully removed (see below).
Restrict use of subsidy to the reduction of the ex-factory price to allow expected margins and achieve a retail price that matched willingness to pay.	Design modifications based on trial findings (Table 1) reduced the cost of production.	Manufacturer deployed savings to reduce the ex-factory price and eliminate the subsidy, to avoid having to change the price points, value chain, and market expectations established during the trial.
Through the learning and steering group, involve the MOH in understanding the process of developing a private-sector product and its benefits.	Product benefits fully understood by the MOH.	Toward the end of the scale-up phase, the MOH commissioned a government-branded version of the co-pack for distribution, free of charge, through health centers.
Use of discount vouchers during the first 6 months of COTZ distribution, to prime the value chain.	“Scratch card” vouchers redeemable by mobile phone were complicated to administer. Cessation of vouchers 6 months into distribution did not unduly undermine demand at the COTZ trial RRP.6	Electronically managed discount vouchers were costly/unsustainable and ruled out of scale-up plans, although simple paper vouchers were deployed to kick-start the value chain in scale-up projects.
Cost of social marketing/marketing.	It was too ambitious to fully establish the brand within a 12-month trial, even in the trial areas.	Funded scale-up projects continued social marketing, with the manufacturer gradually taking on some commercial marketing by the end of scale-up and fully from 2018 onward, although their investment capacity in marketing is low.
Cost of retailer training/CHW training in product benefits/basic health issues.	Product benefits and basic health issues were well retained, both by trained retailers and CHWs. COTZ training materials (large-scale booklets for use at public meetings) were too costly for scale-up.	Scale-up training materials reduced to 10 illustrated flash cards39 (Figure 5); these were offered as open-source materials. Knowledge of the product’s benefits began to be embedded with health staff/CHWs by the end of scale-up and now form part of CHWs’ practice.40

Abbreviations: CHW, community health worker; COTZ, ColaLife Operational Trial in Zambia; MOH, Ministry of Health; ORS, oral rehydration salts; RRP, recommended retail price.