Co-producing access to care with young people living in Zambia through digital and vending machine-enabled innovation in sexual and reproductive health: A place-based, human-centred design research approach.
Place-based, youth-led co-production involving six stages of collaborative design created a technically functional digital health app ('eHealth Yabwela') and web application for sexual and reproductive health services for young people in Zambia, while identifying key adoption and accessibility barriers during the design process itself.
Key Findings
Methods
A six-stage youth-led co-production process was developed and implemented to design a digital sexual and reproductive health pathway for young people in Zambia.
The six stages were: recruitment of youth Co-design Leaders; role play-based care pathway co-design; app co-design; digital prototype development; stakeholder consultation; and digital pathway testing.
The project involved a Zambian public health research partner based in Lusaka, three European universities, and a not-for-profit digital innovation partner.
Methods combined qualitative social science research, community and arts-based, human-centred design, and digital innovation approaches.
Young people were described as 'Co-design Leaders,' indicating a participant-led rather than researcher-led structure.
Results
The co-production process resulted in a technically functional 'eHealth Yabwela' app and a clinical or laboratory worker-facing web application that young people user tested.
Young people traced the digital testing and sampling process from accessing self-testing and sampling kits to laboratory processing of results through to how results should be communicated.
Participants evaluated how these processes would work 'in the context of their everyday lives.'
The ideation work was 'systematically embedded' into the technically functional app and web application.
The pathway involved vending machine-enabled access to self-testing and sampling kits as a distribution mechanism.
Results
Place-based focus enabled elicitation of whole-pathway, in situ logistical feasibility concerns alongside social and technical concerns, allowing engagement with adoption and accessibility barriers during the design process.
The approach allowed the team to engage with 'potential adoption and accessibility barriers during the design process' rather than post-development.
The place-based approach encouraged consideration of 'whole pathway, in situ, logistical feasibility alongside social and technical concerns.'
This contrasts with digital health innovations that 'fail to move beyond prototype or pilot stages or achieve intended outcomes due to a lack of involvement and attunement to local context.'
Results
Youth-led co-production created conditions for participants to lead discussions, voice requirements, and hold the project team accountable.
Participants were described as leading discussions and voicing requirements, indicating an active rather than passive role.
Young people held 'the project team accountable,' suggesting a power-sharing dynamic in the design process.
Role play-based care pathway co-design was used as a specific method to facilitate this participant leadership.
Results
Young people identified that advocacy, overcoming digital inequalities, and further co-production with healthcare workers would be needed to integrate the digital pathway within local health systems.
Young people recognised that 'advocacy, overcoming digital inequalities, and further co-production with healthcare workers already facilitating youth-friendly healthcare provision would be needed.'
Integration within local systems was identified as a requirement beyond the design phase itself.
Healthcare workers specifically identified were those 'already facilitating youth-friendly healthcare provision,' suggesting the need to build on existing infrastructure.
Digital inequalities were explicitly named as a barrier requiring attention for the pathway to be accessible.
Background
The project used a combination of vending machine-enabled distribution and digital health innovation to address access to sexual and reproductive health services for young people in Zambia.
Vending machines were proposed as a mechanism for distributing self-testing and sampling kits, representing a non-clinical access point.
The approach was described as 'place-based' and 'context-attuned,' addressing the specific logistical realities of Lusaka, Zambia.
The innovation targeted young people as a specific population with distinct care pathway needs in sexual and reproductive health.
What This Means
This research describes a project in Lusaka, Zambia, that worked with young people to co-design a digital health system for accessing sexual and reproductive health services, including HIV self-testing kits available through vending machines. Rather than having researchers design the technology and then test it on users, the project recruited young people as 'Co-design Leaders' who actively shaped the app and the overall care pathway from the beginning, using methods like role play, arts-based activities, and real-world testing of prototypes. The result was a working smartphone app called 'eHealth Yabwela' and a companion web tool for healthcare and laboratory workers, both of which were tested by young people in the context of their daily lives.
This research suggests that involving young people as genuine leaders in the design process—not just as consultants—helps surface practical barriers that might otherwise only be discovered after a technology is already built and deployed. By focusing on the real-world setting ('place-based' design), the team was able to identify logistical, social, and technical challenges early, including concerns about digital inequality and the steps needed to connect the new technology with existing youth-friendly health services. Young people in the study also recognized that broader advocacy work and collaboration with frontline healthcare workers would be necessary for the system to work within Zambia's existing health infrastructure.
The study contributes to understanding why many digital health tools never move past the pilot stage: they are often designed without sufficient engagement with local communities and contexts. This research suggests that deep, sustained co-production with the intended users—particularly young people in lower-resource settings—can improve both the acceptability and practical usability of health technology, and can help identify what systemic changes would be needed for new tools to be genuinely accessible and adopted at scale.
Darking M, Ayles H, Belemu S, Chausa P, Gárate F, Gómez E, et al.. (2026). Co-producing access to care with young people living in Zambia through digital and vending machine-enabled innovation in sexual and reproductive health: A place-based, human-centred design research approach.. PloS one. https://doi.org/10.1371/journal.pone.0356398