KOKONO™

KOKONO™ is an innovative cradle made out from banana fibers, manufactured in Uganda. It's been co-created with end-users and healthcare workers so to protect babies from the main mortality causes below 1 year-age. It is rigid, washable, locally made with natural fibers for 70% of its surface and frugal, so to be financially accessible to low-income communities in need of a safe space for babies during night-time and day-time. If scaled at a global level KOKONO™ - meaning "the empty pumpkin" in an Ugandan dialect - will increase local employment engaging women as distributors and health ambassadors, share circular economy models by re-using banana fibers from old trunks (without competing with food production) and, most importantly, curb infant mortality rates by providing a safe space for babies living in need, both in rural or poor urban areas of Sub-Saharan Africa.

In Sub-Saharian Africa causes of newborn mortality are infectious diseases, accidental hits, animal attacks and asphyxiation due to co-sleeping/bed sharing practices. Malaria is the main cause of death among under 5 years old children (WHO 2011), responsible for 20% of infant deaths. The only tool to limit malaria is the use of mosquito net, which reduces its spread up to 63%. According to Uganda Health Census, 13% of households have mosquito nets and only 8% of kids under 5 uses one. They are mainly used by adults and only indirectly by infants through the practice of bed-sharing, causing baby suffocation and crushing. Beyond malaria, in Uganda 69.8 every 1000 children are exposed to  burnings, scaldings, accidental falls and animal (insects/reptiles/rodents) bites. Incidents happen on the street or in household where the babies lack a specific safe area (Hsia et al., 2011; Mutto et.al 2011). UNICEF (2014) underlines as children diseases and injuries are strictly correlated to their poor living conditions: “Children don’t sleep on anything; they sleep on the ground. Some poor children sleep covered with their shirts and others sleep on dry banana leaves as their bed. Other children sleep in the bush”. 

Our portable baby-holder named KOKONO™ aims to reduce infant mortality in under-served communities by protecting the baby within its rigid shell, isolating the baby from flying insects with its incorporated mosquito net, avoiding co-sleeping behaviors by providing a safe shelter. All this improves the precarious hygienic and safety conditions to which babies are exposed during day-time and night-time. Moreover, KOKONO™ is portable, washable, it allows back and frontal ventilation. It's highly resistant and not deformable, its components are easy to replace, it can be assembled directly by the consumers, it is affordable to the customer target and it can be distributed in remote areas thanks to a network of local agents operating on the last-mile. Finally, the cradle is made out of banana fibers, avoiding plastic and engaging local manufacturers in processing local biomasses to which giving a second-life. Indeed, KOKONO™ is made out from old bananas' trunks and does not compete with food purposes of banana plantations. In this sense, KOKONO™ relies on a circular economy model, re-using natural materials to produce a locally-made object that addresses basic needs, and being itself re-usable for more than one baby, ultimately connecting sharing economy practices with inclusive business models. 

KONONO™'s direct beneficiaries are the nearly 3 million babies (43% of all under-five deaths) dying, globally, during the first month of life and almost 5 million (72% of all under-five deaths) within the first year of life. The risk of a child dying before completing the first year of age is highest in the African region (68 per 1000 live births). Looking at the country where we implemented our project, Uganda, figures show that people living in need are 32% or the population, roughly 13.7 million people, with a natality rates of 1,8 million newly born/year (WHO,2011). Indirect beneficiaries are the families of such babies, finally able to protect their newborns. At a broader scale, local institutions and NGOs are also beneficiaries, as they can use KOKONO™ cradle for their humanitarian/social initiatives. To fully understand and address local needs and expectations, KOKONO™ has been co-designed and co-created during different focus-groups held in Ugandan communities in 2018 and 2019, engaging more than 100 people among mothers, Village Health Teams, institutions, artisans, farmers, community leaders. Finally, the choice of manufacturing and distributing KOKONO™ in Uganda helps involving vulnerable people in business activities, offering them an opportunity to improve their livelihood.  

KOKONO™ addresses neonatal health by decreasing the risk of disease's contraction and premature death among babies below 1 year age, thanks to its features that comprise a rigid shell (resisting to bumps, animal attacks and hits) and mosquito net (avoiding insects' bites). Newborns are safer and mothers do not need to bed sharing or leaving babies below trees or on muddy grounds while cooking, farming or processing food (e.g. mashing cassava). It provides a safe space during night-time and day-time and can be carried around safely, thanks to its light and ergonomic shell made out of banana fibers. 

A cradle made out of banana fibers, designed by De-LAB's team together with end-users was not existing before, which is why we patented it and registered the trademark in order to secure the original version to local people, avoiding fake items. Innovation stands, in terms of process, as we are contributing to the definition of local standards for cradles, previously absent in Uganda, and we are doing that in collaboration with the National Bureau of Standards. From a product-design perspective, we completely re-shaped our approach to product-design so to adopt inclusive dynamics leading to increase local participation in the design and testing phase. Also the business model is innovative due to its participative approach: we co-created it with our local partners (the Ugandan Federation of Small and Medium Enterprises). Lastly, KOKONO's distribution model relies on a network of local women and NGOs working in remote villages to maximize the reach of the product at a country-level. KOKONO™ uniqueness stands in squaring the circle between usability, affordability and people-centered design, which are three key-features of De-LAB's cradle, absent in similar items on the local market. Indeed, existing cradles cannot be used for the many purposes of KOKONO™: either they are more expensive, or they are less robust, or they are less sustainable as done in plastic. None of the existing cradles are produced locally in Uganda or East Africa.     

The technology behind KOKONO™ has to do with re-using old banana trunks, obtaining "debranned fibers" that are used to shape the cradle.

The manufacturing process is specifically designed to this end and it implies machineries and knowledge on natural fibers' treatment. 

De-LAB's personnel is specifically devoted to train local people on that, building on both local knowledge and innovative insights, previously tested by De-LAB in its headquarters in Italy. 

Natural fibers have been used as an alternative to synthetic ones for their greener character. The use of banana fibers is widely spread in the Global South to manufacture carpets, paper and textiles. Banana fibers have the advantage of coming from an agricultural residue: fibers have been extracted by mechanical means from banana tree pseudostems, as a strategy to valorize banana crops residues. 

Literature review 

> http://www.m-hikari.com/ces/ce... 

> https://www.researchgate.net/p...

> A. K. M. Mohiuddin et al., (2014), Usefulness of Banana (Musa paradisiaca) Wastes in Manufacturing of Bio-products: A Review, The Agriculturists 12(1): 148-158.

In sub-Saharan Africa most threats to newborn lives are linked to indigence and poor hygienic conditions, due to precarious habits and few possibilities to secure babies in their early months. In most cases babies live on the ground, exposed to burns, accidents, parasites, insect and other animal attacks both at night and day-time. It happens, for instance, that babies are left on muddy grounds or below a shady tree, from which reptiles descends. In other circumstances, babies sleep together with parents to share the only one mosquito net available, risking suffocation. These risks - less reported than casualties related to childbirth - are very frequent but would be preventable by diffusing the use of cradles designed to work in low-income communities. KOKONO™ is a "shelter" conceived to protect babies from 0 to 12 months from the above risks, sharing a more sensitive approach in childcare thanks to a network of female distributors and Village Health Team, working in parallel on KOKONO's diffusion and risk prevention. 

Summarizing:

OUTPUTS: locally made cradles (KOKONO™ cradle)s, shaped using banana fibers, addressing basic healthcare needs of newborns living in low-income communities. 

OUTCOMES: baby protection, increased local employment, women training and education, setting standards on childcare object with local institutions. 

IMPACTS: decrease in the incidence of newborn deaths; diffusion of circular economy models re-using local biomasses; women empowerment. 

Direct beneficiaries in Uganda only:

current number of babies we’re serving: 0 (waiting to kick-off the production due to Covid restrictions)

number of babies we’ll be serving in one year: 1000

number of babies we’ll be serving in five years: 10.000 

Indirect beneficiaries in Uganda only:

currently: 15

in one year: 4.000

in 5 years: 30.000

*figures above refers to first-end users of KOKONO™, besides those that may re-use the same cradle for other babies. Considering all newborns belonging to the same family who already bought and used a KOKONO™ cradle, the number of beneficiaries should be tripled. 

Within the next year we aim at mainstreaming the production of KOKONO™ in our production sites in Uganda, so to make the process more efficient and building economies of scale by reinforcing our partnerships with local NGOs (for last mile distribution) and local Institutions for education modules to be delivered by women and VHT (Village Health Team). 

In the next 5 years we aim at replicate our business addressing refugees and IDPs coming to Uganda from neighbor countries (e.g South Sudan) opening up a news market to serve. Also, we aim at scaling KOKONO™ venture in the Great Lake Region (East Africa). 

Next year in Uganda: 

• financial barriers: budget shortages due to prices' peak after Covid crisis 
• technical barriers: none
• legal barriers: none 
• market barriers: new competitors; 

Next five years in Uganda for refugees and neighbor countries

• financial barriers: inflation and purchasing power's reduction
• technical barriers: none
• legal barriers: limits in scaling up business activities in different legal contexts 
• cultural barriers: different preferences among users from other countries, leading to a re-shape of the cradle
• market barriers: market saturation; political instability

Next year in Uganda: 

• financial barriers: budget shortages due to prices' peak after Covid crisis > we are simplifying the shape of the object so to reduce unnecessary components and decrease production costs so to keep KOKONO™'s price stable
• technical barriers: none
• legal barriers: none 
• market barriers: new competitors > we will characterize our project for process and product innovations that will not only address the needs but also spread intangible values along the value chain that will diversify our cradle from others.

Next five years in Uganda Great Lake Region's refugees:

• financial barriers: inflation and purchasing power's reduction > we plan to optimize logistics costs so to reduce their incidence on the final price of the cradle
• technical barriers: none
• legal barriers: limits in scaling up business activities in different legal contexts > we are already mapping local entities that can partner up to design the best legal fitting for KOKONO™, according to different local regulations
• cultural barriers: different preferences among users leading to a re-shape of the cradle > we consider the option of design a new object from scratch with different communities, so to make it more adherent with different/local expectations 
• market barriers: market saturation > we may design new version of the object for different end-uses and niche markets; political instability > we will keep part of the production located in stable areas of neighbor countries. 

In De-LAB's solution team, based in Italy, 4 people are specifically dedicated to KOKONO™ project. In Uganda there are 2 local partners dealing with banana fibers extraction and 4 people taking care of the logistic and sales operations. 

KOKONO Project Manager is De-LAB's CEO. She's been studying International Development and Frugal innovation models for years, as Italian member of the Inclusive Business Global Network. She is specialized in stakeholder engagement and value sensitive design and she's been awarded as Italian Young Innovator of the year (2019). Her BIO is here: https://www.linkedin.com/in/lu...

KOKONO's account is a 10 years marketing specialist, specialized in sustainable consumption and ethical supply chain. 

KOKONO's designer is an award winning designer, working for De-LAB and famous "Made in Italy" firms and brands. He's specialized in designing brand-new objects for emerging markets, Mong others the Chinese market.

KOKONO's manufacturer is an Italian model maker working with firms on moulds and prototypes manufactured with natural materials.  

De-LAB has an agreement with an Ugandan social enterprise working on extracting and processing natural fibers. They engage and train youth and women to process fibers and build KOKONO™ cradles. 

De-LAB has a partnership agreement with the Ugandan Federation of Small and Medium Enterprises, with which we work for coordinating sales and logistics, as well as making local institutions (e.g Ministries, Chamber of Commerce, Industrial Associations) aware of the potential of SMEs in dealing with basic needs and social challenges.   

De-LAB has a partnership agreement with the NGO Amref Health Africa, (specifically with its country-unit in Uganda, opened in 1987) which will engage needy women in the last-mile distribution network. They will also carry out childcare education modules designed around KOKONO™ targeting urban communities and suburbs. Amref Health Africa is currently the biggest medical NGO working in Africa.     

Finally, De-LAB collaborates with Doctors with Africa CUAMM for including KOKONO™ cradle within their community projects located in remote rural areas. Doctors with Africa CUAMM started working in Uganda in 1958 and in 2019 supported 16 hospitals in 20 districts. 

Other NGOs, both local and international, are engaged mainly as buyers of KOKONO cradle, including it within their WASH interventions addressing critical health conditions and supporting health facilities. 

Our value is provided to: 

- direct beneficiaries, namely mothers and babies (reached thanks to the engagement of a network of sales agents, VHT and NGOs) to whom KONONO™ provides a physical protection for their babies, reducing infant mortality rates on the long run. 

- indirect beneficiaries, namely all those people involved in the production and distribution model who earn out of their efforts for diffusing the cradle, while improving their livelihood and social inclusion within their community. Also, indirect beneficiaries are local institutions who can support a new, locally-made object useful to provide alternatives to imported plastic-made objects, while saving lives and increasing local employment.  

What we provide is:

the cradle, namely KOKONO™ + the complimentary education module on risk prevention which is carried out by our partner NGOs. The strategy is mixed: mostly B2C (reaching end-users in Uganda) and B2B reaching NGOs in Uganda (but working in the entire Region) who can buy KOKONO™ and use it within their local health projects. Sales agents are key for the last mile distribution and will be rewarded in proportion to their sales. 

Buyers are: 

mothers living in Uganda, who can buy the single cradle for their babies, humanitarian officers who can buy the cradle for their beneficiaries, including refugees in need of a safe shelter for newborns. 

End-users are: 

mothers in need, people who want to support a locally made, sustainable and co-created object.  

Our sustainability strategy is blended.

KOKONO has been kicked off thanks to the obtainment of the Italian Development Agency's grant "Bando Profit AICS", which provided seed funds to ignite the project, covering the upfront costs. 

KOKONO's business model is profit-driven, namely KOKONO's sustainability is linked to KOKONO's sales in Uganda (revenue based). 

As additional financial support, we apply to international grants and  engage firms willing to support KOKONO as a corporate philanthropy project. 

I am sure SOLVE will be helpful in reinforcing De-LAB's strategic approach to establish long-term institutional partnerships in Uganda, as well as fine-tuning KOKONO's distribution model in Uganda and beyond, thanks to the knowledge of SOLVE's experts and peers, as well as SOLVE's fundings. 

Additionally, KOKONO™ project will benefit from SOLVE's support by being presented and discussed within international cohorts where to establish connections able to maximize collective ingenuity applied to basic needs in Sub Saharan Africa. 

Overall, we aim at keeping KOKONO™ project as an evolving and participative initiative that may be enriched and improved by the more people it gets in touch with, being presented and discussed within professional networks and impact-driven initiatives. 

Product/service distribution: strengthening our last-mile distribution model in order to reach more beneficiaries located in rural areas, or suburbs. In both areas of impacts, further support will help us in diversifying our strategies according to different users' preferences & response, so to adapt our initiative for better serving our end-users. 

Funding and revenue model: considering its profit-driven model, KOKONO's project may be reinforced by other partners providing further insights and tangible (or intangible) resources, optimizing the blended strategy that underpins KOKONO's business model.

Legal or regulatory matters: scaling up KOKONO™ to reach new beneficiaries requires a great effort to align with different national, regional and district-based norms and regulations. Hence, KOKONO™ project will benefit from such external support to deal with different legal requirements related to different markets' standards and procedures. 

We would like to reach impact investors interested in supporting profit-driven initiatives that prioritize societal benefits. We aim at presenting KOKONO™ as a practical example of how to engage low-income communities in South-Saharan Africa through co-creation processes providing frugal, commercially-viable and scalable solutions to childcare, with particular reference to newborns' health diseases. With such type of supporters, we will boost KOKONO's diffusion in Sub-Saharan Africa.  

We would like to partner up with networks and alliances of practitioners creating synergies among different health-related solutions applied in Sub-Saharan Africa, so to strategize a systemic way within which KOKONO™ can serve different projects and vice-versa. 

Finally, we would like to interact with MIT faculty to research on frugal innovation impacts in Sub-Saharian Africa, so to deepen the theoretical insights related to KOKONO inclusive business model.  

We believe that KOKONO™ fits with the impact requirements and expectations of the Health Workforce Innovation Prize. Indeed, KOKONO™ cradle targets primarily newborns, pregnant women, and new mothers in low-income countries, where newborn mortality put at risk the lives of thousands of babies. 

KOKONO™ is a brand new object, deriving from a participative and co-created product-design experience, which engaged end-users and healthcare officers who participated in the concept-design phase, at the inception of the project. KOKONO's empathic design, led by De-LAB's team, allowed health workforce focussing on their needs and preferences, immediately transformed into specific product's features (materials, functions, aesthetics). In so doing, nurses, Village Health Teams and midwives were able to conceive a new way to train beneficiaries on how to caring newborns, ultimately designing new informal process and new healthcare services. 

Among the latter, the idea of using KOKONO™ to assist and train mothers with babies directly at the hospitals or in their villages, using the cradle to exemplify basic but crucial hygienic and safety norms. Indeed, KOKONO™ can be used as an "entry point" to introduce broader topics like weaning, child feeding and other puericulture practices.  

In sum, KOKONO™ represents a solution that expand health workers possibilities to reach beneficiaries, introducing a new tangible tool for extending the reach of childcare best practices, thanks to its frugal innovation processes. 

We believe that KOKONO™ is eligible for the Bill & Melinda Gates Foundation Funded Award as it represents and innovative solution that improves maternal and newborn health in low- and middle-income countries, starting from East Africa (Great Lakes Region). 

KOKONO™ is a cradle, locally manufactured using natural fibers, targeting mothers who cannot physically protect their babies due to poor living conditions. Due to its innovative design process, which engaged local end-users (mothers) and intermediary actors (midwives, Village Health Teams, NGOs, etc.), it builds on the assumption that co-creation is key to design, develop and diffuse innovative solutions addressing childcare challenges. 

As innovation needs to be systematized to reach impacts, public institutions are crucial partners in KOKONO™ project, indeed, they have been engaged at two levels: 

- product design: public institutions are involved as key-actors in the last part of KOKONO's prototyping-phase, where the technical features of the new cradle will be examined and concur to define and set the official national standards for cradles and baby-beds (currently absent in Uganda). More precisely, De-LAB will collaborate with the Ugandan National Bureau of Standards for assessing specific quality features of KOKONO™ cradle, which will eventually set the basic standards and enter the local legislation, contributing to reduce the circulations of dangerous cradles lacking quality certificates. Such standards will raise the playing fields for all producers and importers, ultimately ensuring the entrance of safer baby products in the local market.  

- policy design: KOKONO™ supports public healthcare training programs, at national or regional level, representing a useful and affordable tool for Village Health Team officers, maternity wards, midwives training junior and entry-level staff. It also complements national or regional policies aiming at assisting low-income mothers after childbirth. For instance, KOKONO™ may concur to strengthen healthcare policies distributing the cradle to vulnerable beneficiaries (poor families, refugees, IDPs), together with products such as diapers, additional mosquito nets, blankets, vaccines, etc.