Challenge #1: Identifying relevant knowledge, expertise or practice to transfer.

In the initial phase, partners had difficulty articulating the concrete knowledge, expertise, or practice that Coca-Cola could transfer and that MSD would value. Trial and error was needed for MSD to articulate specific gaps in their operations that could be addressed through Coca-Cola’s core business expertise and for Coca-Cola to identify the specific processes and ways of working that matched the needs and local realities of MSD. Executives from Coca-Cola reflected on early struggles to define what new knowledge would be of value to MSD:

It was a massive learning experience… we wanted to hear and understand what the needs were like before we put on the table what specifically we could offer. So it was a bit of a chicken and egg. (ID3)

MSD staff also expressed initial skepticism about the relevance of Coca-Cola’s expertise to medicines and medical supplies. As one MSD employee reflected, the distribution of beverages to villages was a ‘completely different animal’:

The Global Fund came with Coca-Cola to MSD to tell us about partnership with Coke. The whole management team was just staring at them. What are these people talking about?…This is a completely different animal—Transporting a bottle of Coke to the village and transporting medicine to the village.… I mean you can't compare these two… (ID39)

Emergent strategies to address challenge #1.

Three strategies emerged to help identify knowledge that could be translated from Coca-Cola to MSD: leveraging the receptivity of MSD leadership, engaging a boundary spanner to identify concrete knowledge to transfer, and promoting local recognition of commonalities across industries.

First, the partners leveraged receptivity of MSD leadership. Despite initial skepticism from both senior and mid-level MSD staff, the MSD Director General emerged as a champion of the project. He was receptive to non-traditional partnerships and recognized the potential for transferability of Coca-Cola’s knowledge. The Director General bridged cultural divides (a Tanzanian who had been educated in the United States) and industrial divides (experienced in several different industries) to bring the project to MSD senior management. This receptivity at the top was translated down the organizational hierarchy to those in critical operational roles, such as demand planners, logistics managers, and human resource managers. An MSD official recounted that once he was ‘sold’ on the issue, he worked towards convincing his peers of the potential merits of the partnership:

I will share with you openly that not everybody, even in my management team, was sold on this issue …I was sold first and then I started convincing my fellow directors why this is important…As we started moving along, [ADP] came in and [we] saw how systematic and professional they were approaching the problems and proposing solutions. People can see the light bulbs going off. Okay, maybe this will lead to something. (ID7)

Second, the partners engaged a boundary spanner to identify concrete knowledge to transfer. Boundary spanners are individuals who facilitate the sharing of expertise by linking two or more groups of people separated by location, hierarchy, or function [45]. To span organizational boundaries in the early stages, Coca-Cola contracted an expert who had extensive experience in Coca-Cola supply chains in Africa to conduct an analysis of MSD and Coca-Cola’s value chains. This expert had a “passion for development work” (ID3) and had worked with Coca-Cola on prior corporate social responsibility (CSR) initiatives. He was able to identify 13 concrete opportunities where Coca-Cola tools and expertise closely matched MSD needs. When describing the role of this consultant, one respondent emphasized the importance of identifying specific, clearly defined opportunities between partners:

We worked on the ground with a local Coca-Cola Kwanza bottling facility to better understand a few things…how they currently run their supply chain operation, looking at people, process and technology…what skills do they have, what training do they have in place in order to meet the [MSD] skills gap (ID33)

Third, the partners worked to promote local recognition of commonalities across industries. As the partners explored areas for collaboration, they visited each other’s warehouses and discussed shared challenges of operating in Tanzania, including difficult climate and road conditions, import and export controls, telecommunication gaps, and difficulties in recruiting skilled staff. These shared experiences created the opportunity for collaboration between mid-level/operational staff from each organization. As a staff member from Coca-Cola Kwanza reflected:

One of the things [MSD] learned was that the challenges that we face are the same challenges that they face…clearing containers from the port, transferring product around the country. So, it was actually an eye-opener to them that they are not unique in these challenges…I think the big learning was how we proactively plan to mitigate these challenges. (ID56)

Challenge #2 Creating operational solutions that were feasible for MSD.

A second challenge was developing solutions that were feasible for implementation within MSD. Coca-Cola’s solutions had developed within their particular cultural and regulatory environment, and required adaption to fit MSD’s environment. For example, although Coca-Cola had extensive knowledge about how to respond to their market, they were not obligated to distribute to unprofitable locations. Consequently, Coca-Cola had limited knowledge about some of the most remote markets. Commenting on these differences, a USAID representative in Tanzania expressed:

While the supply chain has a lot of similarities between public sector and private sector, and there are a lot of core competencies that can be pulled out, they are inherently involved in serving completely different markets. The public sector has to go to places whether it makes business sense or not. Coke can choose not to go there. (ID57)

Furthermore, some of Coca-Cola’s operating models (such as performance based compensation and contracting out to distributors) posed a challenge for MSD to adopt due to government regulations. Although MSD enjoyed considerable autonomy, it required government approval for any major changes to its organizational structure. When Coca-Cola recommended a performance-based compensation structure, implementation within MSD was slowed by review for approvals from the Ministry and labor unions. Coca-Cola staff described the barriers:

They are different from us because we are a private sector. We have [more] autonomy [than they do] because they're under the Ministry of Health. It's very difficult for them…because they have to follow the bureaucratic chain to get it done. (ID52)

Similarly, although Coca-Cola shared extensive information regarding the use of third-party distributors, MSD had to overcome regulatory barriers to outsourcing. As one MSD employee commented:

We have this drug regulatory authority…who [is] responsible for regulating the business of pharmaceuticals in the country…It’s very easy for Coke to say, okay, now we want in this area distributors for Coca-Cola….With [medicine], you have to comply to the regulations. (ID13)

Emergent strategies to address challenge #2.

Emergent strategies to adapt Coca-Cola solutions to MSD’s context included the engagement of experts to manage translation activities and the development of tools with visible benefits for MSD.

First, the partners engaged experts to manage translation activities. Neither Coca-Cola nor MSD was well positioned to translate Coca-Cola practices into MSD operations. To fill this role, Coca-Cola engaged consultants from ADP to manage day-to-day partnership operations and translate Coca-Cola’s knowledge for MSD. Working collaboratively, ADP adapted and packaged Coca-Cola knowledge, expertise and practices in a way that was useful and feasible for MSD. An ADP manager described:

You can have technical knowledge from a private sector organization, you can have the will from the recipient organization… but you need somebody to facilitate it all and make it happen…getting stakeholders together and coming with and working through solutions. I think it’s that glue in the middle. (ID27)

A respondent from CCK described the role of ADP:

ADP played a very big role because they broke it up into different work streams…I allocated each one of my functional aides into those work streams and ADP had a person heading up each of those work streams and I think that’s how the knowledge transferred. (ID10)

Second, the partners developed tools with visible benefits for MSD. ADP introduced a number of practical tools adapted from Coca-Cola to enhance skills of MSD staff [34]. ADP provided organized site visits to Coca-Cola’s bottling facilities to help MSD employees understand how Coca-Cola’s tools and procedures could be applied within MSD. ADP also used participatory knowledge transfer techniques to engage staff and teach practical aspects of business operations common in the private sector. For example, the “Supply Chain Game,” adapted from a game developed at MIT [46], was used to highlight the importance of planning and communication. MSD staff noted the value of this experience:

The game went on and people are noting, “So, I have a role to play in improving this performance.” …That thing brought us together, as an organization… It was difficult at first but through these games everybody in the organization understands that we really need to do it the way Coke does. (ID50)

Challenge #3: Stalled momentum between project phases.

Because the partnership was a start-up venture, partners worked in discrete pilot phases to demonstrate proof of concept, punctuated by periods dedicated to parlaying early results into additional financial investment in the partnership. Momentum stalled between phases, as described by one respondent from Coca-Cola:

One of the limitations of this project has been the funding cycle. We’ve had too long a gap between phases driven by a lack of funding for ADP. We’re working so hard on a global collaborative agreement, where we have a multi-year funding mechanism that we can draw down on and therefore make quick decisions as a partnership group rather than have to apply on an individual basis for funding. But, look that’s a natural reality of starting something. You won’t have a multi-year funding mechanism up front. We haven’t proven anything. (ID 58)

Each phase had to overcome the inertia of these gaps, a process that was complicated by staffing changes and competing demands within each partner organizations.

Turnover within each organization limited continuity in key roles. There was no single “custodian” (ID 53) on the ground in Tanzania holding the partnership together between phases. Some turnover was planned (each phase was staffed by a different team of consultants from ADP) and some was driven by natural attrition of individuals. Describing turnover at CCK, one participant described:

Our challenge on this project is being that there’s been quite a high staff turnover in the time period that we’ve been working with them as a bottler. And so it definitely impacts our access because you start building a relationship with a new person and you build trust with a new person. (ID 4)

MSD and Coca-Cola staff needed to manage competing demands (MSD working on several large-scale reform efforts, and Coca-Cola balancing CSR with core business operations), and needed to be re-engaged with each phase. An MSD employee reflected on the challenges of prioritizing:

We were implementing several other projects. So, it was very difficult to prioritize….The same people are supposed to be in two different places at the same time. That was a big challenge, to align people. By the end of the day, we managed but we should say that some areas also suffered. (ID50)

Emergent strategies to address challenge #3.

Two strategies emerged to address stalled momentum: investment in local relationships and roles, and provision of time and space for the partnership to evolve.

First, the partners investmented in local relationships and roles. The partners recognized that relationships between staff at CCK and MSD would be critical to ensuring the sustainability of the partnership beyond the phases that were actively supported by ADP. Counterparts at MSD and Coca-Cola were matched as connection points for each of the project’s workstreams. A staff member at CCK described the match between demand planners (individuals responsible for forecasting demand for products from outlying distributors or facilities):

“I expect our demand planner to keep visiting their demand planner and attend their meetings. But now it’s dependent on MSD. We won’t close our doors; we have told them. If they need us, they will get us.” (ID7)

Second, senior leadership provided time and space for the partnership to evolve. To allow the partnership to evolve from a global idea to fit in Tanzania, Coca-Cola provided salary support for a full-time project manager from within the Coca-Cola system, and gave him a high degree of autonomy and flexibility to shape the Coca-Cola role of knowledge contributor. An executive from Coca-Cola commented on the freedom to innovate:

I think it’s been an incredibly positive aspect of the project that our leadership has given us the freedom to allow [the partnership] to develop into something. If we had been forced up front to define harder and clearer how exactly we were going to engage, I think it would’ve limited our innovation tremendously. (ID58)

Perceived benefits of the partnership.

Although this process evaluation was not designed to quantify the impact of the partnership, participants identified a set of benefits that they believed they had realized through the collaboration (Table 4).

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Table 4. Perceived benefits of the partnership.

https://doi.org/10.1371/journal.pone.0186832.t004

Participants from MSD described experiencing several benefits from the partnership, including a shift in MSD culture toward ‘a more of a private sector way of doing things’ (ID14). New cross-functional meetings, processes and tools introduced through the project: 1) facilitated greater collaboration and teamwork at MSD, 2) allowed MSD to adopt a more proactive orientation in managing operations, 3) improved system-wide communication, and 4) generated greater attention to the management of employee performance at MSD.

First, MSD staff experienced greater collaboration and communication within their organization. Participants shared how they gained a new appreciation for the interconnectedness of the supply chain, as well as the importance of alignment and accountability across all of the departments within MSD. Based on Coca-Cola’s planning processes, ADP facilitated the creation of structured, cross-functional bi-monthly meetings at MSD to facilitate integration across units. Several MSD staff reflected on how these meetings created a sense of teamwork and accountability as well as a formal structure for knowledge exchange in which employees would need to prepare, discuss, and then execute agreed upon actions. Planning had historically been relegated to “inventory analysts” who were located low within the organizational hierarchy. Through the partnership, the planning function was elevated to report directly to senior management and new roles of demand planner and supply planner were created to increase communication with end users and suppliers, respectively. As an employee of MSD commented:

I see now that we are more integrated in the units within ourselves, knowing that I cannot do it myself. I must make sure that all of the people involved in the whole supply chain are doing the right thing at the right time… So this is more of a private sector way of doing things. (ID14)

A staff member from MSD described:

The best success I saw was when we started having these bi-monthly meetings … cross-functional work where someone in the inventory department is able to point out when our stock outs are, and procurement would chime in and it’s like we can actually prevent this. If we didn’t have these meetings, we would have the stock out for a week. (ID9)

MSD staff also described a shift within MSD to become more proactive in managing operations, and to ensure information flow up the organization in order to preempt potential problems. In contrast to earlier, ‘reactive’ ways of working (ID30), MSD adopted some of Coca-Cola’s practices related to demand and supply planning. Reflecting on the changes that occurred throughout the project, a staff member from MSD described:

The big difference between the way we used to do it and the way we are training to do it now, is that our previous approach was very reactive. Things have already happened… Now the way we’re training our people now is to be proactive, to always be on top of what is happening on the field, filtering that information upwards, digesting it, and seeing potential things that would happen and take actions ahead of time. (ID30)

Finally, staff at MSD reported a greater recognition of the importance of monitoring employee performance. Through exposure to human resource processes at Coca-Cola, MSD sought to create job clarity and accountability among employees. Working with Coca-Cola and ADP, MSD designed a new performance management system (DRIVE) to allow employees to set concrete objectives that would be measured objectively on organizational values and rewarded based on improved performance. A staff member from the HR team of MSD explained the benefits of the new performance management system in this way:

So this [new performance management] system assures that every individual will work hard in order to get increase of his or her salaries. So we are sure that MSD will change and will grow, because every organization needs people who work hard to achieve objectives. So we will achieve more than what we expect. (ID49)

Participants from Coca-Cola also described having benefitted from the project in two ways: 1) developing stronger knowledge transfer capability and 2) enhanced job satisfaction. The process of learning how to effectively package and share its expertise with MSD prompted Coca-Cola to re-evaluate and improve upon some of its own practices, a sentiment shared by one employee who remarked “the best way to master something is to teach something” (ID56). Coca-Cola team members initially struggled to articulate the value of their expertise to MSD, ultimately recognizing the need to improve documentation of their processes and practices. A manager from Coca-Cola reflected:

After the last meeting [with MSD] we sat back and we said, we actually are so used to our processes that we don’t even know how to sell the benefits of what we do…so I asked [employees] to go and change all of our slides for every meeting that we have. I told them you have to go back to the drawing table and rethink about how to market the benefits of the processes that we have put in place…We launch all kinds of products… we think it’s normal to just keep doing it…And yet, we don’t talk about all the mess that we have gone through, the background and what we have saved and not saved the company from, and so we can go back and also begin thinking about how to package our reports differently. (ID53)

Staff from the Coca-Cola system also described enhanced job satisfaction associated with their participation in the project. The partnership provided an opportunity for employees of Coca-Cola to engage in corporate social responsibility efforts in a new, more emotionally meaningful way. An executive described the enhanced sense of meaning and motivation that staff derived from working towards a social good:

There’s been a motivational element, positive outcome, from a Coke system point of view. Even from those of us from a more corporate point of view, there’s no doubt there’s a sense of personal fulfillment of being able to contribute on something which has such a positive outcome of disease being prevented and lives being potentially saved. (ID58)