Vitala Global - Restoring the Balance for Her

Globally women are suffering from or dying of unsafe abortions*, which are entirely preventable. 1 in 3 women experience an abortion in their lifetime. 73 million abortions occur every year, and 45% will be unsafe. Every year, 7 million women and girls are injured or disabled by complications from unsafe abortions, and 22,000 women and girls die as a result of unsafe abortions. Those living in rural, isolated, low-resource, humanitarian crises, or where abortion is restricted and stigmatized face insurmountable inequities in achieving their sexual and reproductive health goals. Enabling pregnant individuals' agency through access to safe medical abortion and contraception is lifesaving. 

Unsafe abortion still accounts for at least one in 12 maternal deaths globally. When compared to reductions in all the other direct causes of maternal deaths since 1990—severe bleeding (or post-partum hemorrhage), severe infection, blood pressure disorders and obstructed labour—there has been little improvement in the negative impact of unsafe abortion. 

About 97% of all unsafe abortions and related deaths occur in developing countries in Africa, Latin America and Asia. When a woman or girl is determined to end her pregnancy she will, regardless of the safety and legality of the procedure. Where safe abortion care is not available, she will risk her life with unsafe abortion, often because the prospect of continuing the pregnancy is unbearable.

Latin America is home to some of the most restrictive abortion laws in the world. Human Rights Watch reports that women face multiple barriers to free exercise of their reproductive rights, including restrictive abortion legislation in Latin America and the Caribbean. Furthermore, Venezuela has been in the midst of a severe socio-political and economic crisis for several years causing the second-largest external displacement crisis in the world. Venezuelans are migrating to escape violence, insecurity and threats, lack of food, medicine, and essential services. 

We chose to focus on Venezuela for several reasons: 

Context: Unintended pregnancies and unmet contraception needs are at an all-time high for Venezuelans due to the protracted humanitarian crisis. According to a study by the reproductive rights coalition, Equivalencies in Action, in Venezuela by 2015, contraceptives, once free at government hospitals and broadly affordable at private pharmacies, began to disappear. Women who could once plan their futures — thanks to contraception — began to lose control. By 2018, oral contraceptives, implants and patches were nearly impossible to find in several major cities. As the crisis has intensified, many women say that abuse has too, making it difficult for them to say no to a partner or leave a relationship. According to the Health Ministry of Venezuela, maternal deaths surged 65% between 2015 and 2016, and then the government stopped releasing data.

Opportunity: 

• There is good smartphone penetration and digital literacy in Venezuela making utilization of a digital tool viable. 

• The humanitarian crisis in Venezuela has exacerbated gender inequities - unsafe abortions and consequently, maternal mortality and morbidity rates are at unprecedented levels, the highest in the region.

• As a result of the crisis, millions of Venezuelans have migrated to neighbouring countries.  Venezuelan migrants are vulnerable and marginalized, facing disproportionate sexual and reproductive health inequities due to limited resources and access to health services tailored for their specific needs in the host countries.

• Safe abortion research and programs, including digital solutions to address this, are very limited in the Latin American context

• Abortion is very restricted in most countries in the region, including Venezuela but there are established grassroots organization networks providing sexual and reproductive health interventions.

*Unsafe abortions are due to the use of dangerous methods such as: inserting sharp objects (e.g. coat hangers, sticks) up through the vagina and the cervix into the uterus; ingesting toxic substances such as bleach; inserting herbal preparations into the vagina; inflicting trauma such as hitting the abdomen, or falling, and taking black-market medications. Many are not effective—but can leave lasting damage or death.

Our innovation, Aya Contigo is an interactive progressive web application with offline capability, that includes optional WhatsApp notifications and virtual live chat support to accompany women through a safe, self-managed medication abortion and family planning journey. Aya is rights-based, inclusive, non-judgemental and uses language to de-stigmatize abortion.  It provides evidence-based, reliable private digital resources to avoid unsafe abortions in Venezuela. 

Aya Contigo is a highly effective digital support platform because of these three interconnected key pillars:

1. Aya Contigo App: contains reliable up-to-date harm reduction information to self-manage an abortion safely and personalized contraception decision-making

2. Aya Care Team: a team of local Venezuelan staff that provides virtual accompaniment that is trauma-informed and healing-centred, and connects users to trusted referrals 

3. Aya Community Engagement Team: a team of Venezuelan staff that represent youth and the rural communities to support mobilizing a network of trustedSRH partners 

Aya takes the user step-by-step to support self-management of a medication abortion, starting with self-assessment of eligibility (how far along in the pregnancy and whether there are any medical conditions that would prevent a self-managed abortion with pills).  Aya then explains what the actual pills should look like and what to expect after the user takes them, and how to take them safely.   The app then takes the user through the possible side effects and highlights when the user should seek medical attention.  Aya provides users with a validated questionnaire for them to self-assess if their abortion is safely completed. Throughout, Aya offers self-care strategies and the opportunity to connect with a live chat with our Aya Care Team that provides support for users as they go through their journey and connects them to a trusted referral network.  Users can also choose to have personalized support by opting into WhatsApp notifications that include timed reminders of when to take the next pills, and weekly check-ins with the user to see how they are doing and to provide ongoing emotional support.  At the end of the abortion journey, Aya gives the option of going through a contraception journey where several questions are asked in order to find a contraceptive method that best suits the users’ needs.  

Aya was developed when we identified the need for reliable contextualized digital safe abortion and contraception information to help prevent unsafe abortions and unplanned pregnancies. We identified the need from our human-centred design research in 2020 with over 1000 Venezuelan women and a dozen grassroots organizations and sexual and reproductive health activists. There is increasing evidence highlighting women's experiences globally who self-manage their abortions through accompaniment models (hotlines, in-person accompaniment, telemedicine) that these tools provide a person-centered approach with key aspects of dignity, trust, support, and effective communication. The WHO released evidence-based recommendations on self-care interventions highlighting the safety, feasibility and acceptability of the process within the first trimester when provided with the right information and access to referral mechanisms. 

Prior to the launch, Aya Contigo MVP version supported 150 users to safely self-manage their medication abortion. Once Aya Contigo was launched on social media and accessible as a URL, and in the Google Play Store in Venezuela, within 3 weeks we had an additional 200 new users come to the Aya Contigo Platform. Our Serviceable Available Market (SOM) which includes women 15-49 living in Venezuela choosing to self-manage their abortions with access to a digital platfrom is 133, 188. Our projected annual SOM projections for the next 5 years is to reach 121, 753 women, which makes up about 30% of the Total Available Market (TAM), aligned with the global and country-level data that 1 in 3 women will have an abortion in their lifetime.  

Our target user/beneficiary for Aya is any pregnant Venezuelan individual seeking access and support for safe medication abortion and/or contraception guidance that has access to a computer, smartphone or tablet. Based on WHO statistics for Sexual Reproductive Health (SRH) and Sexual and Gender-Based Violence (SGBV) it is expected that primary user groups of Aya will be teens/young adults, survivors of sexual violence, survivors of gender-based violence, women and girls living in extreme poverty, and rural and migrant women. 

Averting maternal disability or death benefits all: the women, their children (both in improved life expectancy and educational attainment), and society in general, as women are important (albeit undervalued) contributors to the stability of any country’s economy. Therefore, we expect Aya Contigo to be cost-effective by providing women with an option to avoid potential disability or death from an unsafe abortion while increasing their self-determination. There is ample evidence to show that an abortion with pills is safe and effective. By scaling Aya we also want to empower women and girls to have a safe abortion experience and receive the necessary attention and support, ultimately allowing women and girls to exercise the full potential of their reproductive autonomy

No humanitarian crisis, regardless of the cause, is gender-neutral. They all disproportionately affect women and girls. The ongoing complex humanitarian emergency (CHE) in Venezuela has alarmingly increased gender gaps by placing the rights of women and girls in a grave situation of vulnerability.  Since 2016, the “Equivalencias en Acción” coalition, composed of feminist and sexual and reproductive health (SRH) grassroots organizations in VE, have documented and provided evidence of grave violations of rights such as the right to a life free from violence; the right to health, including the right not to die from causes related to pregnancy and labor; and the right to reproductive autonomy. Aya directly addresses these rights violations for women and girls. 

Venezuela has one of the highest rates of teenage pregnancies in the world, and consequently, these unplanned pregnancies end up in abortion despite it being legally restricted in VE. A report byProfamillia-IPPF identified access to safe abortion and post-abortion care services, and effective and comprehensive care for sexual violence as two of the top 6 most urgent SRH needs at the border for Venezuelan women and girls. Venezuelan women and girls have minimal awareness about their rights to access comprehensive SRH care but have access to mobile networks and are keen to utilize digital tools.

There is growing acceptance of digital interventions with evidence suggesting that clients prefer the practicality and confidentiality of technology-enabled interventions and guided online support, as opposed to in-person services. Aya and other digital interventions have been critical in supporting hard-to-reach, low-income pregnant individuals, particularly in areas with shortages in health and social services, humanitarian crisis settings, migrants and clinical access restrictions due to COVID. 

Our female-led multidisciplinary team of women’s health experts, medical professionals, SRH activists, and public health and technology specialists brings the diverse expertise and experiences needed to implement this project successfully. The core Vitala Team, Dr. Roopan and Dr. Genevieve are OBGYNs with human-centered design research skills, field experiences in humanitarian/challenging settings, operational expertise, technical knowledge, and dedication to providing access to reproductive healthcare.

Genevieve and Roopan met and bonded over their shared passion for addressing health inequities impacting women and adolescent girls during their residency in Obstetrics & Gynecology in Ottawa 10 years ago. Vitala Global was inspired by their academic and clinical experiences working with women and girls living in challenging contexts, both in Canada and in humanitarian settings globally.  

Roopan Gill is the Co-Founder, Executive Director and the Community, Research and Product Design Lead.  She is an Ob/Gyn with expertise in family planning and abortion care. She holds a Masters in Public Health in Global Health from Harvard T.H. Chan School of Public Health. Roopan is Women's Health Advisor for Médecins Sans Frontières (MSF) and has worked as an emergency Ob/Gyn in a number of humanitarian crisis settings.  She has worked with the WHO providing technical expertise to its Department of Sexual and Reproductive Health Research, Preventing Unsafe Abortion Unit and was pivotal in including mifepristone on the core essential medicines list. She was recently featured in Forbes as 1 of 7 female leaders bringing innovation and inclusivity to women’s healthcare.

Genevieve Tam is the Co-Founder, Director of Projects, and Product and User Support Lead.  She is an Ob/Gyn with extensive experience in global women's health from education, project management, and program implementation. She holds a master's degree in Public Health from the London School of Hygiene and Tropical Medicine. She volunteers with the Canadian Network for International Surgery as an instructor and editor for their capacity-building training programs in low-resource settings. She was the Gynecology Team Leader for MSF in a maternal health project for Syrian refugees, migrant workers, and marginalized Lebanese in Lebanon.

Together they built a team of dedicated feminists and sexual reproductive health experts, all passionate about Vitala’s mission to empower women to achieve their reproductive health goals.  The Aya Contigo Team consists of 11 Latinas based in Venezuela, Colombia, Argentina, Mexico, Nicaragua, and Spain.  Together they make up the Aya Care Team which provides virtual chat accompaniment and emotional support for users; the Aya Community Engagement Team which conducts outreach to expand Aya’s trusted referral network and community mobilizing to advocate for sexual and reproductive health and rights; Aya Social Media Strategist and Manager; the Design and Impact team which consists of our UX/UI designer and our impact strategist.  In addition, Vitala has a finance team that supports financial and accounting processes as well as business and sustainability planning, and a fundraising team including a grant writer and a storytelling strategist.

Vitala prides itself on having meaningful and impactful relationships with partners that can amplify impact.  For example, Vitala partners with AnnieCannons Inc, a non-profit software outfit that trains and hires victims of gender-based violence, for the development of their digital products.

What specific financial, technical, legal, cultural, or market barriers that you face do you hope Solve can help you overcome, and how? Keep in mind: Solve aims to connect all Solver teams with partners who can help advance their solutions through monetary and/or non-monetary support.

We are applying to MIT Solve - Equitable Health Systems to assist us in rapidly scaling to increase support for Venezuelans based on our human-centered research. With Solve’s monetary and in-kind support we will further the creation of equitable SRH solutions for Venezuelans, VE migrants with the long-term goal of having the infrastructure to serve humanitarian crisis geographies globally. Solve’s partnership will assist us in continuing to empower our teams and build our community networks to demonstrate that digital solutions such as Aya Contigo are a benefit in contributing to and connecting the community-based feminist ecosystems that already exist in humanitarian settings to the formal healthcare system to build their local capacity to provide SRH. 

The goal is to: 

1.) Scale to all vulnerable Venezuelans: including young people from 10 - 19, women and girls living in rural and indigenous communities and the millions of Venezuelan refugees/migrants in Latin America and the Caribbean. 

2.) Peer-to-Peer Support for youth: our UX design research identified a gap in peer-to-peer support specifically for youth. We plan to co-create with Venezuelan adolescent girls a peer-to-peer support network as an extension of Aya Contigo so that youth can get the interactive support they need. 

3.) Sexual and gender-based violence (SGBV): expand and include an SGBV component to Aya, which would consist of information to raise awareness, support disclosure, to provide reliable resources about their rights to comprehensive care and appropriate referral pathways.

We have identified the following areas for in-kind / consultation support to better develop our product market strategy and expansion strategy: 

Senior Software Engineering: advice on new technologies, for example, AI and machine learning and assist us to integrate different technologies (Whatsapp Chatbot, live chat/counselling features, peer-to-peer network) onto one platform. 

Marketing Analysis: assist in guiding us on how best to position our products in the existing market, how to be less donor-dependent and build a social enterprise model. 

Online Advertising Strategy: assistance on how best to develop a communications strategy for the dissemination of Aya Contigo and help us better articulate to a diverse audience the synergy between our products and our process as Vitala Global. 

Product Management: advice on product development and how best to manage our products and partnerships.

Through Vitala’s work, we are becoming a platform that is bridging the gaps between the formal health system and community care models by embedding our tools within the systems in Venezuela to create a continuum of support and services. We are utilizing, leveraging and retooling technology to provide access and support for pregnant individuals for self-managed care in humanitarian crisis countries. The apps and digital tools currently available provide one-dimensional care in the form of resources. We are the only platform that accompanies women through a safe medication abortion and family planning journey, providing evidence-based, reliable private digital resources to avoid unsafe abortions with one-on-one chat support through a virtual chat and WhatsApp notifications in VE. 

Aya Contigo is unique because it is one of the first examples of a digital self-care tool that has been co-created with women, girls and their community to address a stigmatized sexual and reproductive health issue in a complex humanitarian crisis. Using a human-centered design research methodology, building a robust theory of change, monitoring and evaluation plan and developing and implementing safeguarding and cybersecurity policies, Aya Contigo is demonstrating it is possible to develop quality digital solutions that can empower women and girls and save their lives from entirely preventable causes. 

Aya is accessible as a web app to be used on a web browser or downloaded to a mobile phone or tablet through the Android Play Store.  Once downloaded, it can be used completely offline - this was an important design and development decision based on concerns from the users and stakeholders regarding the unreliable internet connectivity in Venezuela. 

Human-centered design research identified that women wanted the option of having reminders to support them through the abortion process (e.g. pill reminders, emotional support prompts). WhatsApp was found to be the most widely used form of communication, more so than methods such as SMS or email, therefore opt-in check-in reminders from Aya come through WhatsApp, which will then redirect users to the app for evidence-based and safe resources or referrals. 

Aya can change women’s access to sexual and reproductive health supports in humanitarian crises as well as in rural and isolated settings. Through our beta rollout, it has successfully demonstrated a virtual accompaniment model as a safe, acceptable and feasible harm reduction tool in the safe abortion ecosystem to support women’s quality of care through a safe self-managed abortion with pills. It could reduce indirect costs and resources associated with traditional over-the-phone or in-person accompaniment models, empower women to manage their journey, and provide a scalable approach to increasing access to accurate information. Its interactive components use WhatsApp notifications to support the quality of care. 

Aya as a digital platform has been designed for scalable replication to be deployed to all vulnerable Venezuelans, including those living in rural and indigenous communities and the millions of Venezuelan refugees/migrants in Latin America and the Caribbean. 

In the next 12 months, our impact goals will focus on strengthening existing activities to scale Aya Contigo within Venezuela and to adapt and co-create Aya Contigo with youth. We aim to:  

• Scale to women 20 - 49 years of age in Urban areas 

• Co-create new symptom tracking and testimonials section

• Expand emotional self-care section in-app and chat support 

• Refine movement building strategy amongst local partners

• Conduct values-based and sexual and reproductive health workshops with urban providers within formal healthcare system (doctors, pharmacists)

• Youth outreach (10 - 19 years of age), create a Youth Advisory Board

• Co-create with youth new content/features for app/chat

• Expand referral network to include youth-centered services

• Co-create with youth community engagement and movement-building workshops with an emphasis on exploring values around abortion and contraception

We learned from the Proof of Concept (PoC) stage the importance of human-centred research to ensure feasibility, acceptability, and implementation.  We were only able to target women ages 20+ in urban areas, therefore in the next 12 months, we will target youth ages 10-19 to address the high unplanned pregnancy and maternal morbidity/mortality rates in this age group in VE. We also learned from PoC stage the importance of building trust and partnerships with the community to ensure that the platform is acceptable, and therefore improve reach and impact for the intended users. 

In 2 to 5 years, we will first aim to scale the adaptations from youth-centered design research. We will then aim to co-create adaptations to the digital platform with 4 rural communities and expand the referral network. In addition, we plan to continue to iterate on our Monitoring and Evaluation and marketing strategies to increase reach. We will aim to scale Aya Contigo to contexts similar to Venezuela. This includes those with restrictive laws and/or humanitarian crisis. Stakeholder mapping of potential partners in Latin and Central America has begun with the intention to move in parallel as we work on scaling efforts in Venezuela. We aim to partner with international and local organizations and by utilizing our human-centered design process and toolkits, support partners to adapt and implement Aya Contigo to their respective contexts. 

We will also develop a licensing fee model that will be pitched to larger humanitarian organizations such as Medecins Sans Frontieres or International Rescue Committee. We would facilitate the scaling and implementation of Aya Contigo in various countries they support. In addition, we will build a rapid response HCD toolkit that will allow us to quickly build and adapt Aya for acute crisis scenarios as it is during these moments of mass migration that women and girls are in need of support and referral to trusted sexual and reproductive health services.  

We also plan to work in less restrictive settings within Latin America to support existing teleabortion services. Aya Contigo is a useful resource specifically to Venezuelan migrants moving between countries while requiring assistance on information to self-manage their abortions and information on the SRH laws in the different countries they may enter. 

Within 5 years, we envision Aya Contigo to have a significant impact on women’s health in Latin America while also demonstrating sustained implementation and integration within the existing feminist ecosystem and the formal healthcare system. 

In addition, due to ongoing instability in access to SRH in developed countries, there is also great interest in reverse engineering Aya for volatile SRH geographies like the United States. We predict the launch of an iteration of our platform in a number of challenging states and potentially nationally within 5 years. 

We have developed a robust Monitoring and Evaluation Framework based on our Theory of Change. The framework divides our indicators across 5 objectives: Impact, Access, Effectiveness, Quality, Efficacy. We also have specific KPI metrics for the app using Google Analytics. The indicators to measure impact are gathered from quantitative surveys that include NPS scores, qualitative data gathered from interacting with users over the virtual chat support and web and mobile data analytics to explore usage patterns. We are exploring the implementation of a data analytic platform to develop dashboards that will allow us to better visualize and report on our indicators. With the MVP launched across Venezuela, an example of the KPI's we hope to determine after several months of Aya Contigo being on the market are:

• # of Venezuelan women and girls who successfully self-manage their abortions using Aya Contigo ( this includes: self-assessing for eligibility, self-administering and self-assessing for completion)

• # of Venezuelan women and girls who access their contraceptive method of choice due to recommendations by Aya Contigo

• ###p#< of users claim to be able to make their own informed decisions regarding MA after using our referral network and mobile application.

• # of Venezuelan women and girls who feel positively about their abortion experience and received the care they were seeking

• ###p#< distribution of Venezuelan women and girls representing rural/remote areas who successfully self-manage their abortion using Aya Contigo

• NPS demonstrates that majority of users would recommend Aya Contigo to other people

• # and % of users who self-report feeling supported in their decision

• ###p#< of users who felt prepared for what to do if they experienced warning signs or in the event of complications
• ###p#< of users who felt reassured of their privacy and safety throughout their abortion process/procedure

• # of Aya Contigo users who successfully obtain medication abortion pills 

• # of Venezuela women/girls self-reporting improved knowledge and awareness of family planning (safe abortion care and contraception)

• # of trusted referral networks secured through MOUs signed and implemented

• ###p#< increase in referrals to Aya Contigo after formal establishment of partnerships

• Stakeholders self-report a positive change in attitudes on self-managed MA after intervention, by source of agreements and commmitments 

• # of users who keep using Aya Contigo 7, 14, and 30 days after 1st launch 

• # of advocacy interventions made (publications, blogs, social media, etc)

• # of local and international organizations implementing Aya Contigo as part of their programs

Vitala Global has conducted primary research with Venezuelan people, SRH organizations and activists to understand the crisis, services, experiences and barriers that pregnant individuals are experiencing. Vitala Globals interventions and this theory of change are rooted in human-centered research, global health organizations' recommendations and guidelines as well as the team's clinical and medical expertise to create the desired change.   

Impact Enabling conditions to experience reproductive autonomy: Venezuelan women have a greater ability to exercise control over their reproductive lives as empowered agents in their needs and decisions.

Long-term outcome 

Effectiveness: Highly effective digital support system for self-managed MA: Aya Contigo provides quality and accurate information and care digitally that enables the user to feel prepared and supported through their self-managed abortion and/or post-abortion contraception journey.

Short-term / Medium-term Outcomes

Quality: Improved ‘quality’ abortion care: Aya Contigo delivers a *women-centered, integrated approach to comprehensive abortion care where the merging of self-managed care, clinical care and community is centered in empathy, support, expertise, and safeguarding human rights.

Efficacy: Strengthened and empowered abortion community: Community of partner organizations, activists, feminists are committed to support women in their SMA journey and safe abortion advocacy 

Access: Improved self-managed abortion experience: Women are able to self manage a medication abortion through Aya Contigo and access a reliable referral network that supports their abortion and contraception needs (utilization, satisfaction, confidence).

Outputs: 

Quality:

• Aya Contigo team has the technical competence necessary for delivering quality abortion care from the point of screening to guiding in MA and providing aftercare

• Strong comprehensive communications and referral systems are in place alongside technologies and staff for access to high-quality abortion care

Efficacy: 

• Increased capacity of local organizations to support women to access MA via Aya platform

• Created a safe space to facilitate technical exchange/dialogue within the abortion community

Access:

• Increased knowledge of and access to Aya Contigo mobile platform

Context: Vitala conducted a human-centred research study in 2020, with over 1000 Venezuelan women 12 grassroots organizations and sexual and reproductive health activists. It identified the need for reliable contextualized digital safe abortion and contraception information to help prevent unsafe abortions and unplanned pregnancies. There is growing acceptance of digital interventions with evidence suggesting that clients prefer the practicality and confidentiality of technology-enabled interventions and guided online support, as opposed to in-person services.  Evidence and guidelines from The WHO have proven that women can self-manage their own abortions with pills safely and meet their unmet contraceptive needs if they are provided with the right information and access to referral mechanisms as well as decentralizing and optimizing the use of healthcare resources. Many interventions in medical abortion care, particularly those in early pregnancy, can now be provided at the primary-care level and on an outpatient basis, which further increases access to care. Medical abortion care reduces the need for skilled surgical abortion providers and offers a non-invasive and highly acceptable option to pregnant individuals. Furthermore, self-assessment and self-management approaches can be empowering for individuals.

The tech that powers our solution is a progressive web app that can be used in web browsers and also can be downloaded as an offline app on any operating system, and can also be downloaded from the Google Play Store in Venezuela.  A progressive web app was the solution for us to be able to quickly iterate content and features in response to user feedback using an agile content management system (Contentful), without the user having to wait for updates to be published.  We have WhatsApp API integration (Twilio) for chat support and pill reminder notifications, and an embedded chat platform (Crisp) within the app for real-time accompaniment while using the app.  We are exploring automation, ethical artificial intelligence, smart filters, and peer-to-peer matching/community building are all areas we would like to explore to provide further support to Aya users. Anonymous and passive data collection on users' use of the app will assist us in geomapping and better understanding where the users are coming from and where we need to target our outreach. 

EDI consideration is at the forefront of our organization and this proposal. Vitala Global is female-led throughout our value chain as a core value we have is to ensure that we are inclusive and equitable in an intersectional feminist approach ensuring those who are the most marginalized are given the opportunity to work with us, provide feedback and are represented in our digital solutions. We engage people representing the communities with whom we are implementing Aya to ensure lived experience in context to each location is represented. Examples of this are: 

• 12 local Venezuelan staff 

• team leads for the community engagement team and aya care team are Venezuelan migrants 

• Vitala Global’s staff under 30

• software developers are queer-led female-led that focuses on training people who have been victims of gender-based violence

We are using the inclusive and respectful language of the bodies and lived experiences of individuals who can experience pregnancy.  A diversity of perspectives and experiences are engaged through the multi-level collaborations built into the project, including people with lived experience, community partners, and academics at various stages in their careers. We will foster equity through open dialogue, transparent processes, and a fair distribution of resources (e.g. ensuring that lived experts receive appropriate compensation for their time). Inclusion is an outcome of diversity and equity strategies created in this initiative through ongoing reflexivity amongst the project team about reducing barriers to participation and cultivating full and meaningful engagement of stakeholders at every level. Vitala is committed to providing high-quality, innovative, collaborative anti-racism anti-oppression (ARAO) services. 

Vitala Global scales and impacts in two ways: through its product and its process. 

1. Product:

Value proposition: explained in detail in previous questions

Key customers: explained in detail in previous questions

Key activities: explained in detail in previous questions

Key revenue:

Aya Contigo should be a public good, therefore no users or partners are being charged to access Aya Contigo. The application can be downloaded free of charge through Google Play Store (only available in Venezuela currently). 

Funding sources:

• Grants 

• Consultancy fees (Point 2 Process below)

• Monetization of North American platforms (development in progress)

Key expenses:

• Aya Contigo application: development, UX/UI, M&E

• Aya Care Team 

• Community Engagement Team

• Research and Design

1. Process:

Value proposition: we integrate our public health knowledge and humanitarian experience into our research and design approach to enable human-centred innovations that are relevant and meaningful to individuals and communities that seek digital solutions for self-managed abortion and contraception care. This model not only enables Vitala to scale its human-centered design process in SRHR solutions across NGO partners that support similar causes as Vitala, it also subsidizes Aya user fees in Venezuela at 18-20% margin per project.  

Key customers: organizations (e.g. NGO partners) that support similar causes as Vitala 

Key activities: We consult organizations that are developing digital tools and solutions to SRHR issues using our expertise from developing Aya Contigo

Key revenue: consultancy fee

Key expenses: staff costs 

Goals:

• By 2024: operational sustainability; i.e. activities are accurately costed and funds cover all expenses; co-founders’ in-kind contribution ends then

• 2025 and beyond: financial sustainability i.e. effective and consistent cost management to continuously build up surpluses to reinvest back into the organization to deepen impact

Below are the financial strategies we have in the pipeline: 

Immediate to short-term (2022-2024) [already in place]

• Continue grant application (grant writer hired, seek consortium formation opportunities, establish network) 

• Consultancy revenue: First consultancy with Profamilia in Colombia using our human-centered research and design processes to increase beneficiary reach through a digital tool. We will seek similar HCD consultancy opportunities in the short run.

Medium-term (2025-2026)

• Seek consultancy projects with INGOs with bigger budgets to increase margins 

• Establish partnership models to diffuse technology to local and international partners: create social franchises or consider licensing fees for Aya Contigo

• Adapt and monetize Aya Contigo to the US market 

Long term (2026 and beyond)

• Establish partnerships with Canadian health insurance companies to provide mental health support for early pregnancy loss 

• Establish partnerships with large companies (e.g. Spotify) to include early pregnancy loss support as part of employee benefits

• Earn subscription fee from early pregnancy loss platform (digital platform currently being co-designed with North American women)

We currently have an OPTions grant from Grand Challenges Canada (GCC).  The OPTions initiative seeks innovative and transformative approaches that put women and girls in control of where, when, and how they terminate their pregnancy in countries where there are one or more legal grounds to support it.

With this grant of CAD$250,000, awarded over 2 years, we were able to complete the proof of concept stage, followed by extensive prototype iteration, and then move on to the development and pilot testing of the MVP, and finally the launch of the MVP in Venezuela in Q1 2022.

GCC has been very supportive of our work, process and adaptation of our protocol for us to continue our work despite the challenges of COVID19.  There is an opportunity for us to apply for a Transition to Scale  (TTS) grant from GCC. To be eligible for this TTS grant of up to 1 million CAD, we need to secure match funding.  We are actively seeking funding opportunities like the Cisco Global Challenge through other granting agencies such as the Internet Society Foundation, Packard Foundation, Botnar Foundation, and also through partnerships with established INGOs working in SRH in humanitarian settings and the Latin American and Caribbean region.  We have partnered with Twilio’s non-profit program for our WhatsApp notifications and feedback mechanism for our users, and we hope to leverage that partnership to build the chatbot addition to our Aya Contigo platform.

We also have anonymous angel investors that have provided significant operational funding support to Vitala Global due to their interest in safe access to SRH. They have supported us with $206 000 CAD for one year with plans to continue their investments. 

As part of our sustainability plan, we are licensing our unique process that combines the intersection of human-centered design, sexual and reproductive health focus, digital platforms, and challenging contexts (humanitarian, restrictive abortion laws, marginalized groups).  By providing consultancy services with our expertise we will use the consultancy funds to cover the costs of maintaining and scaling Aya Contigo to other challenging contexts.  We are currently providing consultancy services to two organizations: 1. Profamilia, a large non-profit SRH provider in Colombia, to co-create digital solutions to extend their teleabortion platform reach to marginalized populations; and 2. International Planned Parenthood Federation, to develop a digital health intervention statement to support their member associations increase reach of their existing services.