CyberRwanda

I am a doctor and design thinker, creating global solutions with and for youth. Trained as a physician, I have 15 years of research, clinical and design experience in adolescent sexual and reproductive health, HIV and maternal and child health. As Executive Director and Co-Founder of YLabs, I specialize in applying human-centered design, robust data and my public health expertise to develop seamless strategies that improve adolescent sexual and reproductive health globally. I’ve worked alongside partners like Marie Stopes International, Pathfinder International and Population Services International to design, evaluate and scale innovations to improve youth-access to SRH and HIV services in Sub Saharan Africa, North and South America, and Asia. My belief is that a creative, nimble approach to program design and evaluation, that fully engages youth and their communities, leads to better solutions to improve young people's health and economic opportunity.

Globally, shame and stigma prevent young people from accessing the reproductive health information and services they need to be in control of their reproductive health and choices. Conventional health services are not working for them, and innovations in healthcare delivery have not ensured that youth feel welcome, supported, and safe. 

CyberRwanda is a digital self-care platform that brings comprehensive, confidential health information and products to a young person’s fingertips. Through interactive stories in a language they understand, young people learn about their bodies, relationships, and future planning. Through our online SHOP feature, youth take action and order health products in safety and privacy, including family planning and HIV tests, for nearby pickup.

With CyberRwanda, access to accurate, quality healthcare doesn’t have to be out of reach for the world’s 1.8 billion youth. It can exist right in the palm of their hands.

Young women often have no one to ask about how to protect themself from an unwanted pregnancy or disease that are common, yet life-altering, occurrences for many of their peers. One in ten Rwandan girls engage in transactional sex - and their first sexual experience may be driven by a need for money when they cannot find work in a competitive labor market. 

In Rwanda, only 12% of sexually active adolescents use contraception, and teen pregnancy is the leading cause of school dropout for girls ages 12-19. Globally, 23 million adolescents have an unmet need for contraception. An estimated additional 15 million unplanned pregnancies are expected this year due to COVID-19-related disruptions in access to family planning. Our project addresses the main drivers of teen pregnancy and HIV globally: lack of accurate reproductive health information, and the stigma and shame youth face when seeking family planning and reproductive health products, such as HIV tests and preventive medicines. 

CyberRwanda goes beyond health alone to support youth to develop key employment skills, given the inextricable link between poverty and teen pregnancy. In Rwanda, youth unemployment exceeds the global average of 16% - over 20% in 2019 - with urban girls particularly vulnerable.

CyberRwanda is a digital one-stop shop for reproductive health for youth. The platform addresses youth’s most pressing needs: learning accurate information on socially taboo topics, locating youth-friendly services, and then ordering and picking up products. Designed in partnership with youth, it uses storytelling to integrate family planning, reproductive health, and economic empowerment information into fun and engaging narratives with discreet access to contraception and other essential products from trained pharmacies through the ecommerce platform. 

In the shop for contraceptive and menstrual hygiene products, youth answer medical screening questions in privacy, order necessary products from a local healthcare provider, and collect products in a streamlined manner using an SMS code. The platform tracks user interactions and allows for real-time tracking of service referrals and product purchases. It provides a national 'clinic finder' for private and public providers, based on users’ geo-location.

The platform is accessible online and offline via responsive web, tablet, and mobile apps and integrates with FB Messenger, WhatsApp, SMS, USSD and IVR. Having completed our pilot, we are poised to scale to reach 25,000 youth from 2020-23 in partnership with the Ministries of Youth, Health, and Education, the National Pharmacy Council, with an accompanying randomized controlled evaluation (n=6000).

CyberRwanda’s target audience is vulnerable young people ages 12-19 who live in urban and peri-urban areas. Rwanda’s average income per capita is less than $3/day with 50% of Rwandans, living in extreme poverty. 

At YLabs, we believe that the only way to truly understand young peoples’ needs, especially vulnerable youth, is to partner with them in the design of solutions that are meant for them. Our team of young Rwanda designers have engaged them in focus groups, interviews and co-design workshops, including community leaders, parents, teachers, and healthcare workers. We’ve designed CyberRwanda to meet the needs young people expressed: for a private, safe, respectful experience when seeking services, combined with age appropriate and easy-to-understand content. Every line of educational content has been approved by the National Health Communications Committee to ensure it is aligned with national guidelines, and the product has been reviewed by teachers in partnering schools. 

When designing digital solutions for vulnerable youth, we know the importance of reaching those without personal access to technology. That’s why we’ve partnered with 68 schools and youth centers to deliver CyberRwanda on preloaded tablets to make sure that we are reaching all young people across the digital spectrum, at scale.

Adolescence is a critical window of opportunity to influence future behavior, growth, and decision-making. Youth, however, are routinely excluded from the design of health and economic solutions meant for them, and digital solutions are not designed in the communities they are meant to serve. As a result, these products often fail to achieve meaningful impact. 

CyberRwanda has been designed, tested, and developed by youth, with youth. Our team of young Rwandan designers, writers, and researchers work in partnership with youth, including structurally disenfranchised youth, sex workers, domestic workers, LGBTQ youth, and those living with HIV.

The initial idea emerged in 2016 in a co-design workshop with East African youth while discussing how to leverage technology to bypass the stigma and biases they experience whilst seeking contraception. The final product results from three years of collaboration with young Rwandans and I submit this application on behalf of the young people, parents, and healthcare providers who worked with our team.Our early concepts received seed funding from Packard Foundation’s Quality Innovation Prize and through an iterative process of prototyping with youth, the final solution emerged.

We built robust partnerships with the government, healthcare organizations and our national implementing partner, Society for Family Health. Using technology to deliver healthcare is not novel and there other online pharmacy products exist. What gives us confidence that our product can achieve sustainable scale to reach Africa’s 230 million youth is that youth own this platform. Everything has been developed with youth, for youth, with privacy, equity and accessibility top of mind. 

At this critical time, when we need innovative ways to provide healthcare, we seek to rapidly scale in 2020-22. The Elevate Prize would offer the mentorship, advice and partnerships I am seeking to expand our reach throughout Rwanda and beyond.

I have dedicated my career to supporting young people to have the best possible health and economic opportunity. Growing up in North-East England, despite free access to family planning, teen pregnancy was a major challenge. By age 16, one-third of the girls in my class dropped out due to pregnancy, effectively ending their education and limiting their future livelihoods. They could access family planning, yet in a time of mass unemployment with little opportunity, my friends saw motherhood as a way to be valued by others. When I became homeless at age 17, seeking work to support my studies, I understood first hand how especially vulnerable youth are to economic shocks.

As a doctor through my work with youth in multiple countries (in Rwanda since 2013), I saw firsthand the impact lack of opportunities on young people’s health choices. Family planning services alone are not enough; holistic approaches to support broader opportunity and aspiration for youth are critical. 

Two guiding principles shape my work:
1. To design for youth, we must design with youth and
2. To effectively support disenfranchised youth to prevent unplanned pregnancy we need to integrate family planning and reproductive health services with programs for economic opportunity.

Over four years, I have successfully founded and built a leading global design and research organization of 22 staff, a partner of the major global health organizations, institutions, and government partners in 15 countries to date. My background in medicine and public health means that I am highly data-driven and grounded in evidence, combined with the creativity and iterative approaches from my experience in design for social innovation. YLabs has been recognized by international awards as a leader in innovation for adolescent health by the David and Lucile Packard Foundation and the Society for Adolescent Health. I sit on multiple global advisory boards on digital health and design for reproductive health including HCD Exchange and the World Health Organization’s Digital Health Communication Interventions for Youth working group.

I have a long track record of designing programs that have considerable impact for youth at scale. In my previous role as IDEO.org’s Technical Design Lead, I redesigned Marie Stopes International’s youth reproductive health services in Kenya, developing the Future Fab campaign. This has increased seven-fold the number of adolescents accessing contraception nationally in MSI facilities. Reaching over 18,000 young people, it was recently recognized as one of Children’s Investment Fund Foundation’s “most successful adolescent sexual health programs in the world.” Our Beyond Bias project in Pakistan, Tanzania, and Burkina Faso, funded by the Bill and Melinda Gates Foundation, is poised to reach an estimated 200,000 young people over the coming year to provide youth-friendly, unbiased reproductive health services.

CyberRwanda was an ambitious project from the get-go. Just before we won our first seed funding grant, I had no job, no income, and no team. I didn’t know if the project would ever get funded but I believed in the work and in my partners in Rwanda. We completed the first research and built our team in Rwanda when I was six months pregnant. Subsequently, we tested the initial prototypes for a digital platform with youth and healthcare providers. They were a resounding failure - the product design was too complicated and text-heavy; the branding didn’t appeal to youth. We needed to start again to design trusted characters who could deliver information to youth in language they understood. Using paper dolls, we asked youth to design and dress characters: how would they look, what would they say, what are the questions you most need answering? 

Instead of focusing on clinics, we met youth where they were already going - the pharmacy - and built a network of trained private pharmacists to better serve youth. Since then, we’ve built a nine-strong team of Rwandan experts, designers, writers, healthcare workers and secured funding to develop, iterate, and implement CyberRwanda.

I believe that great leaders make others successful. Great leaders unite and inspire others behind a vision and know when to step back and support as needed. To build a resilient, sustainable enterprise, I have learned that your most vital resource is your team and their talent. Throughout my own life, I have sought to be an advocate for young people and elevate young people’s leadership and talent in their community and on the global stage. 

Throughout this project we have sought out young leaders in Rwanda, provided them with training in human-centered design, and paid opportunities to contribute to the product’s design. It has been one of the biggest rewards of my work to see how these young leaders have grown into some of Rwanda’s leading health innovators, recognized with international awards. Mireille Sekmana, who started with us as an intern, is now trained as one of Rwanda’s only product designers, in a country without formal product design training institutions. She has been recognized as an UN global talent and presented to global leaders at UNAID’s Health Innovation Exchange. Both in our work and on our team, I seek to amplify the voice and creativity of young people. 

YLabs Studio (Rwanda) is a for-profit entity that is a subsidiary of Youth Development Labs, Inc, a California-based non profit, classified as a 501(c)(3).

A TRANSFORMATIVE APPROACH TO REACHING ADOLESCENTS: To our knowledge, there are no existing integrated digital education tools that target both youth and providers, facilitating guided referrals to services and online ordering of health products, including contraception. CyberRwanda:

1. Demonstrates strong proof of concept as CyberRwanda’s content, delivery channel, and visual design was co-designed and extensively prototyped with over 800 youth, parents, providers, and community leaders in three regions (2017 - 2019) giving us confidence that this is a scalable, socially acceptable solution. We have also gained approval from key government partners, such as the MOH and Rwanda Education Board.

2. Is grounded in theory and best practice. Both the content and intervention design are guided by the Theory of Planned Behavior, and address not only knowledge and attitudes, but also perceived control and norms surrounding our target behaviors. Additionally, all content is derived from Rwandan and global evidence-based guidelines, informed by principles of positive youth development, gender equality and women’s empowerment.

3. Is unique in targeting of adolescents and providers to generate demand, provide linkage to products/services, direct-to-consumer, and train public and private providers. 

4. Is the only program in Rwanda to integrate reproductive health information and services with economic empowerment tools and skills, meeting two pressing needs for Rwandan youth. 

The RCT, the first of its kind for such an intervention, will add key data to the field on the impact, dosage and delivery of digital interventions, not only on the impact on SRH outcomes, but also on the efficacy and cost-effectiveness.

Currently: our pilot reached 2508 youth in three secondary schools
One year: Reach 11,000 young people (5,500 men and 5,500 women) with 7,000 accessing services 
Five year: Reach 50,000 young people in Rwanda, with 20,000 accessing services.

By 2030, we aim to be:

• The go-to learning source on employment and reproductive health for Africa's youth population of 230 million, reaching 60% of urban youth and 45% rural youth
• The largest direct-to-consumer provider of contraceptive and other wellness products to youth
• And, revenue supports the sustainability of the program, with no need for donor support

Next year: COVID-19 has delayed our implementation timeline by 5 months, but we have secure funding for implementation and schools are due to re-open in September. Should there be a resurgence and schools stay closed, we would have to delay implementation with the current model.

Five years: Expanding the reach to rural populations will require a different approach as the phone ownership is much lower among youth.

Next year: Should there be a resurgence and schools stay closed beyond September, we would modify our implementation model and evaluation. Instead of limiting to schools and youth centers whilst the randomized controlled trial (RCT) is in progress, we would adapt our evaluation methodology and promote the platform ahead of schedule for use on personal devices. Currently this is on hold until the RCT is complete to avoid spillover effects into control schools. 

Five years: Build partnerships with the public sector clinics and work with community health workers to adapt the platform for use as a tools for education, referral and product order by healthcare workers. This would allow us to reach a less digitally connected, less literate, rural population. 

Society for Family Health - Rwanda is our implementing partner with national reach. They lead the engagement and training of schools and our network of healthcare providers.

Minstry of Youth: guide implementation in schools.

Rwanda Education Board: guide implementation in schools

Rwanda Biomedical Center / Ministry of Health: Technical advice and Co-investigators on the evaluation

University of Rwanda: Leading evaluation of the project

National Pharmacy Council: provide advice and accreditation for our pharmacist training tools. 

Seeking $600,000 grant and/or equity to support additional work to develop and test revenue models, and adapt the platform for additional country contexts. 

In only three years, we have secured long-term funding for implementation and evaluation, built a stellar team of young Rwandan talent and stable partnerships with the national government and key partners. We are at a critical inflection point as we move from pilot phase to implementation. We are also looking to adapt the platform for additional country contexts where we already work in East and West Africa and this Prize would provide us with the mentorship and support to:

1. Develop a sustainable business model for CyberRwanda as a revenue generating product
2. Amplify the work in order to attract additional investment of talent and funding
3. Build new partnerships to scale the platform in other geographies in sub Saharan Africa and South Asia
4. Build in resilience to our business model during uncertain times

At this moment, we seek mentorship and advice from those who have experience scaling digital platforms and products, specifically on digital marketing, revenue models and intellectual property law. To increase my capacity to build the team and continue to secure sustainable funding, I am looking for mentorship from experienced leaders of for profit and nonprofit organizations and advice to build our global board.