Coca-Cola and Public Health

(photo credit: Mara Gordon)

I never thought somebody working in public health could love Coke so much. It all began when I arrived in Tanzania last July. My first assignment for the public health NGO where I worked was to head down to Mtwara, a region in southern Tanzania about an hour from the Mozambique border. It was the first extended period of time I had spent in rural Africa, and boy was I in for a surprise.

Like a typical American, I noticed first what we didn't have: reliable electricity, smooth roads, running water. But then I started to look at what we did have. I could always find a cold Coke - or at least a lukewarm one.

Ever since, I've been fascinated by the miracle of Coca-Cola in Tanzania. Thousands of smart people spend millions of dollars trying to get life-saving medications to the people who need them. And too often, we fail. But Coke is everywhere in this country, from the fanciest hotels in Dar es Salaam to little shops in the Serengeti. They're doing something right.

That's why I was excited to discover that one of my co-workers got his start at Coca-Cola in Tanzania. He currently puts his expertise to use on our malaria projects, but he shared with me some of his secrets about how Coke manages to get over the distribution challenges inherent to working in Tanzania.

I know, of course, that comparing bottles of Coke and medication is like comparing apples and oranges - supply-chain management for health commodities presents manifold challenges that supply-chain management for sugary beverages simply does not. (I also decry my love for Coke with a certain degree of irony. Just because I think we can learn from the private sector doesn't mean that I think it should be all free markets, all the time - or that soda is a healthy addition to the world's diets.)

But there's a lot to be said for how Coke runs the show. A few particular points I think are applicable to public health:

1. Follow up, follow up, follow up. My co-worker told me that Coke Tanzania has teams dedicated to
tracking which vendors buy from specific distribution centers and exactly where bottles are sold. If things aren't working, they identify the kink in the chain and fix it, as soon as possible. Too many times, I've encountered NGOs that start projects and then abandon them when employees move back to their home countries or funding runs out. Even if nonprofits don't have the same financial incentives to see projects through to their completion, we need to act as if we do.
2. Utilize what already exists. In much of Tanzania, advertising isn't billboards or TV commercials - it takes the form of what's feasible at the local level. That means that wall paintings are very common. So Coke works with local artists, not against them, contracting out painted advertisements in villages all around the country. (Zain, a multinational cellphone company, is also very good at this - oh-so-distinctive Zain magenta paint covers storefronts in the smallest of towns.) Applying this principle isn't as obvious in health. Medicine, of course, requires expertise. But encouraging healthier living doesn't. I've come across a few excellent examples in public health, like selling mosquito nets via roadside shops, or working with traditional healers to promote voluntary HIV testing. There are lots of situations where the status quo just won't do. But when we can find a way to tap into an existing economy or social structure, I think it chips away at healthcare inequalities more effectively than redesigning those structures.

3. Work with other organizations that have specific areas of expertise. The wall painters are only one example. My co-worker told me that in in Kenya, where he worked for a time, big multi-nationals like Coke sub-contract with local companies to do their distribution work. He said that local companies know the market much better than the Coke headquarters in Nairobi, and they save money by outsourcing the work. It's obvious how this attitude could benefit public health. I encounter so many NGOs unwilling to partner with other organizations - they won't work together on projects; they won't share data; I've come across NGOs working in the same field in the same region that are unwilling to even sit down and communicate with one another. What's wrong with this picture?

4. Keep it local. Coke Tanzania is managed right here, in Tanzania. They work with the Atlanta headquarters for certain marketing materials, and of course for the secret Coca-Cola sugar syrup - they need those things to maintain their brand integrity. But for most everything else, they're on their own. The company is based in Dar es Salaam, staffed largely with Tanzanians, and in charge of its own distribution and pricing. Public health, even more so than Coke, needs its brand integrity. Tanzanians deserve effective, genuine, and non-expired drugs. They deserve well-trained health professionals with rigorous scientific knowledge. But just as Atlanta doesn't try to price Cokes in Mtwara, nor should somebody in Geneva design an HIV education message for Tanzania.

5. Make it easy. When I'm in a rural area and I need to buy something, I look for Coke. It's not that I always want a soda, but when much of the architecture looks the same, I can distinguish a duka - a little roadside shop - from a house or a restaurant by the kind of advertisements it displays. Coke understands that rural shopowners benefit from the brand, and they capitalize on this. They give out free posters, tables, umbrellas, you name it. Just as Coke makes it easy for vendors to advertise its brand, NGOs need to make it easy and advantageous for ordinary people to adopt healthier behavior. An obvious example in international health is childhood immunizations. In many successful disease eradication efforts, vaccinators go out into villages around the world, knocking on doors and providing on-the-spot immunizations. Mothers don't need to take their children to clinics or to pay for the drugs. The medication comes to them.