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Lily

Empowering low income female youth with personalized and timely reproductive health information via interactive digital conversations.

Photo of MacGregor

Written by

Tell us about your vision for this project: Share one sentence about the impact you would like to see from this project in five years

By 2022, we will be delivering the Lily service in Asia, Africa, and Latin America. We will be enabling 10 plus million young women annually to confidently make more informed reproductive health decisions and live healthier lives that they otherwise would.

Who will implement this idea? Or what’s your strategy to implement in the next 6-18 months?

MacGregor, Emil, and Stephen work full time. Mercy will switch to full time. Jacaranda Health will continue to provide and improve the medical content. Oxygen8 will continue to facilitate telco connections and mobile terminated billing. Everyone is based in Kenya and both partners have offices in Kenya. We will need 1 additional customer service employee per 50 to 100K additional end users. We will need to hire additional language and programming support in the next country we expand to. Our technical advisors will continue to provide strategy advice (Suha and Santosh). Ideally, another organization will help us perform impact assessments.

How has your idea changed based on feedback?

We planned to deliver menstrual cycle reminders. Sathy Rajasekharan, Chief Innovation Officer for Jacaranda Health explained that many young women struggle to get accurate family planning and pre and post-natal care information. We therefore pivoted to make Lily more comprehensive. We designed Lily to work in partnership with a telco. Neelofar Shariff from Safaricom Innovation (formerly GSMA) explained to us that we need to grow Lily as a stand alone product and then negotiate with telcos.

Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?

Big Change/Decision Making Steps 1. MacGregor or Emil identify big decisions or need for changes (or they are brought to our attention by team member or technical advisors) 2. MacGregor and Emil consult our advisors and/or team members if issue overlaps with his or her expertise 3. MacGregor and Emil analyze decision by modelling with actual numbers whenever possible (or best guesses if actual data is not available) 4. MacGregor and Emil make decision 5. Entire team acts on change

How long have you been working on the project?

1

What year was your organization or group started?

2017

How many full time staff are needed to implement your idea?

4

What most attracted you to the UNFPA Young People's Sexual and Reproductive Health Challenge?

We were attracted to the opportunity to gather feedback and new ideas and force ourselves to go through a rigorous exercise explaining and testing our proposed solution. We were also very excited to potentially cross-pollinate with others working on related solutions.

Share the URL for your Business Model Canvas Here

Canvas: https://canvanizer.com/slideshow/wKmNW78mh8zV3

Opportunity Areas – Select those that apply

  • mHealth
  • Data

What specific problem(s) are you trying to address? (300 character limit)

Young women in low resource settings lack easy access to relevant reproductive health information. Whereas a woman in the U.S. might use an App or Google to inform herself, many women in countries like Kenya don't have access to smartphones and internet and are less confident using these tools.

What are some of your unanswered questions about the problem(s) you are working to address? (500 character limit)

We don’t know how scalable our marketing strategies are. As we increase spending on marketing will the cost per acquisition decrease because of network effects? Or will the cost per acquisition increase because the market will be saturated? We have built our core platform with the purpose of handling 1 million plus subscribers daily but we don't know if our partner telcos will have any trouble handling that volume of SMS for us.

Who are your end users? (1000 character limit)

Faith is a college 1st year and doesn’t use a smartphone because they are expensive. She wants a baby in 5 years. Faith receives a daily SMS from Lily reminding her where she is in her menstrual cycle with tips on managing it and living a healthy life. Faith makes sure to read each message she receives because she is paying for them. Because each day she hears from Lily, it has top-of-mind status with her and whenever she has a question about her body, she just asks Lily directly on SMS. Faith doesn’t mind if it is an embarrassing question because she knows Lily is private. Once for instance she was considering family planning methods and asked Lily if it was true that IUD reduces your chance to have a child later in life. Lily’s response corrected this misconception. Because Faith thinks of Lily as her SMS friend, Faith trusts Lily’s answer. Now Faith will make a better family planning decision. Lily is built to simultaneously communicate with millions of 18-24 year old women

Explain your idea. (500 character limit)

Insights: 1.Users want to know about their menstrual cycle and reproductive health however many don’t have smartphones and are most comfortable using SMS. 2.Users trust a service more if they pay for it and use it frequently. Idea: Lily sends SMS daily to users explaining where they are in their menstrual cycle and related tips. Users SMS Lily any updates on their cycle, or health questions at any time and Lily responds. User is automatically debited $.02 each time they receive SMS from Lily

What is your value proposition? (500 character limit)

The service helps users understand and plan for PMS and menstruation and provides personalized reproductive health advice. Access to this information empowers women to be more confident in their bodies and their decisions and makes them feel more in charge of their future. For instance, many users start out telling Lily that they aren’t interested in using family planning but then as they become more aware of their reproductive health they start to ask more and more family planning questions.

What's different about your idea compared to current solutions? (500 character limit)

By charging users for each message, Lily is unique because it is 1. a sustainable business and 2. forced to constantly deliver value to customers (because users can unsubscribe at any time). There are many reproductive health smartphone apps however most low income young women don't have smartphones and are more confident using SMS. By delivering via SMS, Lily is unique because it creates more engagement than any app (over 60% of users talk to Lily each month).

What are the key reasons why end users would turn to your organization over another?

  • Convenience / Accessibility: Making products accessible

What would success look like for your end users? (500 character limit)

Greater understanding and awareness of her body, and particularly her reproductive health. Which long term results in: - More confidence - Less likely to contract STD’s - Less likely to have unplanned pregnancy - More successful life

How would you measure the impact your idea has on your end user(s) ? How will you measure the success of your program? (500 character limit)

We will randomly select a control group of new subscribers and not deliver the service to them. This control group and a matched group of similar users who do have full access to the service (treatment group) will be repeatedly surveyed on their income, health, and attitude towards, and knowledge of, reproductive health. The difference in the changes of the groups' responses over time will indicate Lily’s impact while controlling for other variables (difference-in-differences model).

What strategies will/are you testing to acquire end users? (300 character limit)

We have tested: - Facebook marketing and achieved a $.40 per customer acquisition cost. We think we can reduce it further with more testing. - Referral model which appears to work at $.30 per customer acquisition. - On-the-ground promo force but it didn’t seem scalable. We will also test radio

Key partnerships - Who will you partner with to make your idea work? (500 character limit)

Signed Partners: -Jacaranda Health - Innovative maternal healthcare provider in East Africa. Helps us develop health advice for users as well as collaborates with us to optimize the message language and product design. -Oxygen8 - A global technology provider of multi-channel engagement. Facilitates our telco connections and mobile terminated billing. In Discussion: The Busara Center for Behavioral Economics – Experts in applying behavioral economics in emerging market

What is your organization’s name? (150 character limit)

Our legal name is "Development Technology Services Limited" (DTSL) however our only product and brand is "Lily".

Tell us more about you: (750 character limit)

Fulltime team (all in Kenya): -MacGregor Lennarz-Operations and Product Design- Formerly Juntos Commercial Director -Emil Sjoblom-Customer Acquisition and Technology- 10 years Africa telco experience -Stephen Ndirangu–Developer- SMS technology expert. Previous clients include Equity Bank and the Government of Kenya. -Mercy Cheruiyot-User Researcher and Operations- Student at Jomo Kenyatta University Advisors: -Suha Patel: Obstetrician/gynecologist and public health professional. Board-certified. Experience designing, implementing, and evaluating innovative approaches to improve the health of women in low-resource settings -Santosh Kulkarni: Millicom Financial Services Africa Regional Head of Products

Where will your idea be implemented? (200 character limit)

Piloting in Kenya now. Will continue to iterate in Kenya and intend to later expand to other markets (Philippines, Brazil, Indonesia, Bangladesh, Ethiopia are potential targets).

What do you need to get started? (500 character limit)

Financial – for marketing - With additional financial backing we could take more risks on testing marketing strategies and scale effective marketing strategies faster and larger. Human or Intellectual - for marketing - We are learning as we go with marketing. With experts on social media and/or traditional marketing we could accelerate our growth curve. Human - For language optimization - With more help we could test and improve our messaging faster and thereby improve the product faster.

What is the current scale of your proposed innovation?

  • National - expansive reach within one country

Experience in Implementation Country(ies)

  • Yes, for more than one year.

Expertise in Sector

  • I've worked in a sector related to my idea for more than a year.

Organization Location (200 character limit)

The company is registered in the Seychelles. The main team is all based in Kenya.

What is your organizational status?

  • We are a registered for-profit company (including social enterprises).

What is the maturity of your innovation?

  • Existing Prototype or Pilot: I have tested a part of my solution with users and am iterating.

19 comments

Join the conversation:

Comment
Photo of Deb Levine
Team

Loving Lily! Using text messages is the best way to reach the largest number of low-income and rural women with critical sexual health information.
I'm wondering if you've received feedback about Lily from your current users, and how you will incorporate that feedback into future versions of the product.

Photo of MacGregor
Team

Thanks Deb! Yes we get lots of feedback from users because they are constantly in conversation with Lily and often vocal in SMS conversations about what they want.

Lily users have given feedback that they want more help finding a doctor or clinic. If for instance the advice from Lily to a user is to go see a health care professional, most users will respond asking for advice on which health care provider is recommended by Lily (because they trust Lily), how much it will cost, what are the hours of operation, what is the contact information, and is an appointment required. As a result, we are focused on a building a better health care provider database with more information. Additionally, the forthcoming new version of the Lily platform (under construction now) includes the functionality to connect directly with healthcare provider customer relationship management tools (CRMs) to provide a more seamless experience for Lily users (such that if they confirm they want to go to a healthcare provider, they can be automatically put in that healthcare provider’s queue of people to see or reach out to in order to schedule an appointment).

We also receive feedback from users that they prefer receiving a message from Lily each day and they prefer receiving the message first thing in the morning. When we have not sent the daily personal message we get lots of messages from Lily users asking things like “Lily where are you today? I need you”. We have also experimented with sending personal messages later in the day instead of the morning and we received complaints from users (they say things like “Lily it doesn’t help me to get this information late in the day etc…”). As a result, future versions of the product will send the personal message each day in the morning.

We have also received feedback from users that they would like more information on how to self check for things like breast cancer. Future Lily versions will incorporate more of this type of content.

Photo of Deb Levine
Team

Thanks MacGregor. You clearly have a group of engaged users in Kenya. And great responsiveness and iterations from the Lily team

Photo of Emil
Team

I can add we are constantly learning on the what "tone of voice" Lily should have, and when. We are striving for Lily to be a knowledgable and trusted friend by the customers. As with any friend Lily sometimes is firm and factual, sometimes it's girl talk and interesting tips, and sometimes it's more about support and letting her know that she is not alone and others are/have experienced the same.

Photo of Deb Levine
Team

Here's another question: How will you decide which countries to expand and scale to after Kenya? Where have you seen the most demand?

Photo of MacGregor
Team

We ran the same advertisements that we run in Kenya in 16 different countries (translated into local languages). India, Bangladesh, Brazil, and Philippines showed the highest demand per viewer (showing 2x the demand level per viewer that we see here in Kenya). We have thus just launched a “Lily Light” product in Bangladesh and expect to launch in these other three leading markets by end of year.

Photo of Deb Levine
Team

So interesting! I love how you do the user research before entering new markets. Higher likelihood of success when you’re ready to scale!

Photo of Leisa Hirtz
Team

Hi Emil and McGregor,
We met at the UNICEF meeting in Kenya in February. I've just realized that you've participated in this submission as well. It was such a delight to learn about Lily and your mission. I trust we'll have an opportunity to meet again as I'm in Nairobi and Kenya quite often.

Best of luck and let's connect when I'm next in Kenya in June.

Leisa Hirtz

Photo of MacGregor
Team

Hi Leisa Hirtz . Likewise! It was a pleasure to meet you at the UNICEF meeting and we are excited to have your product in Kenya. Please please do let us know when you will be here next. I seem to have lost your email. I am Mac[at]Lily.Health
Best,
MacGregor

Photo of Leisa Hirtz
Team

Great MacGregor, I've sent you an email. Hope to see you in June :)

Cheers,
Leisa

Photo of MacGregor
Team

Ashley Tillman  and Iliriana Kacaniku Just wanted to share our new website. https://lily.health/

Photo of OpenIDEO
Team

Hi MacGregor and Team,

We’re excited to share feedback and questions with you from a set of experts that are supporting this Challenge.

We encourage you to think about this feedback as you continue to improve your idea, whether that’s refining it or adding more context. You are welcome to respond in the comments section and/or to incorporate feedback into the text of your idea. Your idea and all associated comments will all be reviewed during the final review process, but we recommend putting all critical information in the body of your contribution somewhere. It's ok if you don't have all the answers, we know you are tackling really hard problems and are also interested in how you are thinking about these challenges.

Experts were excited about:
1) This idea targets low-income women and youth to provide them accurate sexual and reproductive health information. 
2) One expert shared, “This idea has taken into account sustainability and feasibility very well. And although the author aims to scale this project globally in the future, I would be curious to see more piloting in Kenya and hear learnings before scaling to different countries.

Questions experts had:
1) What is the current reach of this service within Kenya?
2) Are women from more rural regions also using this service?
3) Are all of Lily's responses in English or are they also in Swahili?
4) How are you ensuring the privacy of your users - i.e. where and how are these messages being saved or stored?
5) It is unclear who is providing the reproductive health information in this idea. Provide a bit more information about who is creating the content of the texts and how these individuals are trained in youth-friendly services, cultural humility and SRH issues.

In case you missed it, check out this Storytelling Toolkit (ideo.to/OZznV4) for inspiration on crafting strong and compelling stories. Storytelling is an incredibly useful tool to articulate an idea and make it come to life for those reading it. Don’t forget - the last day to make changes to your contribution on the OpenIDEO platform is December 10 at 5:00PM PST.

Have questions? Email us at youthsrh@ideo.org

We look forward to reading more, and thank you for the important work that you are doing!

Photo of MacGregor
Team

Thank you for the feedback and questions!

1) We have just hit 1000 users. In the past week we have allowed our product to become more visible and are growing at approximately 30 additional users per day.

2) Most women are from rural or peri-urban areas (we have called them to try to set up focus groups and the majority of users live far outside of the capital Nairobi).

3) We use a combination of English and Swahili. Our user research and A/B testing has shown that women like to receive the initial messages from Lily in English (users said it gives the messages more legitimacy). Subsequent conversations can use combinations of Swahili and English. The purpose is to make the conversations as comfortable as possible for the user so if someone writes to Lily in Swahili, Lily responds in Swahili and if the user writes to Lily in Sheng (English and Swahili slang) we respond with Sheng.

4) We don’t collect any personally identifiable information.
We store all numbers in encrypted format.
We use a cloud server. Our cloud storage has the the following security: https://www.digitalocean.com/security/

5) Jacaranda Health has provided us with the core reproductive health content and continues to provide us with answers as new questions come up (but the majority of questions are repeats of previous questions). Jacaranda Health uses their licensed medical staff to provide medical content.

The tone of the texts is a team effort and the result of a continuous iterative process. We do workshops where we bring in users and potential users of Lily and review the language with them and get their ideas on how to improve it. We then a/b test messages and measure response rates and opt-out rates. We then take those learnings and create new messages and repeat the process.

We are also careful to not use judgmental tones. We see ourselves as simply presenting the information and it is up to the young women how they want to use it (with the exception of condom usage which we always strongly advocate).

We have also gotten help from some womens’ rights advocates which helped make the messages more empowering.


Also in regards to the comment about piloting before moving to more countries, we completely agree and would like demonstrate feasibility and impact at scale before expanding to a second market.

Photo of Ashley Tillman
Team

Hi MacGregor this is great additional information to have! Also love your interactive business model canvas and demo.

Two more quick questions:
1) Do you have partners to connect or refer women to access resources and services if needed?
2) Are you starting to track when people return to your application?

Thanks for sharing the important work you are doing!

Photo of MacGregor
Team

Hi Ashley Tillman ,

Glad to hear!

Regarding partners:
We frequently do get young women that Lily ends up telling to see a doctor and then they ask “Lily, where should I go?”. Right now we ask our partner Jacaranda Health (health care provider in Kenya) and then they give us the contact info for the health clinic or doctor near our customer and then we give that info to the customer. In order to scale we need to automate this process more. We would also like to develop more partnerships with more health care providers so we can refer women quickly and accurately. It is on our to do list but we haven’t yet had time to pursue it.

Regarding customers coming back:
We haven’t tracked that yet. We do know our churn rate is around 25% month-on-month (75% of young women using Lily in Month 1 tell Lily when their period starts in Month 2 and then the same for Month 2 to Month 3 etc...). Also, around 40% of customers ask Lily health questions each month (in addition to just receiving tips and updating their period information).

Photo of Iliriana Kacaniku
Team

Hey MacGregor ,

As the deadline to refinement phase is only 4 days away, we look forward to reading your refined idea afterwards. To this end, we highly encourage you to respond to the experts’ feedback in the comments part and upload the completed business model canvas as a separate document. The template for the canvass is available in the following link: https://d3gxp3iknbs7bs.cloudfront.net/attachments/11ed3970-7b4b-4168-95e4-42f44cf1bf72.pdf?utm_source=UNFPA+Shortlist+Announcement+%28To+Shortlisted+Ideas%29&utm_campaign=35344cc5a0-EMAIL_CAMPAIGN_2017_11_14&utm_medium=email&utm_term=0_19296933e1-35344cc5a0-

Should you have any question regarding the canvass, please feel free to reach out to us and we’ll make sure to respond to you timely.

Best regards,
Iliriana

Photo of MacGregor
Team

Thanks Iliriana Kacaniku 
The refinement phase toolkit also mentions prototyping and gathering user feedback. Is there a specific place we are supposed to share our prototype experience or user feedback? I can't seem to find it.

Photo of Iliriana Kacaniku
Team

Hey MacGregor 
That's a great question. Should you prefer to share your user feedback and prototype experience, I would recommend you do that by attaching separate documents for each. If there is a finding from either process that you really like or find important, you can integrate it in the text/description of the idea. Just make sure to mark that part as [UPDATED], for easier read.
Hope this helps.
Best regards,
Iliriana

Photo of MacGregor
Team

Got it. Thanks!