Isabelle is changing the way public institutions address the issue of nutrition and food security by providing free or low-cost meals in Rwanda. Today she is scaling her approach with the government to all public hospitals and expanding her reach to the prison and education systems amongst other public institutions.
The New Idea
Historically, Rwandan public hospitals relied on patient families or expensive private vendors to supply food, often leading to malnutrition for low-income patients especially those without caregivers. Isabelle is working towards ensuring that all in-patients in public hospitals have access to medically tailored food at an affordable price or for free in specific cases. Her bigger vision, however, is to have an impact on nutrition landscape by changing how food is delivered and perceived amongst the Rwandan population and replicate her model in other public institutions where people are fed in large quantities such as public schools and prisons, as well as private companies.
Solid Africa’s Farm2Fork model, a closed-loop food system, grants them control over almost every step of their integrated supply chain while maintaining market-based prices, quality of food, and consistency that the patients need for a quick recovery. From their strategy to their daily operations, Isabelle is obsessed with cutting costs at every single step without decreasing the quality and nutritional value. With the understanding that farming is cheaper than buying from the local market, she started growing food at her parents’ farm. The organization applies an environmentally sustainable agricultural system and grows 84% of the food that they serve on their 21 hectares of land using their own organic fertilizer. Isabelle established the first Rwandan based social enterprise and subsidizes 24% of her operations by selling 6,300+ lunches to private companies and schools daily as well as kitchen management services and staff training in three private hospitals, a new niche market that Isabelle pioneered.
Nutrition and food security affects over 80% of the population in Rwanda. For the longest time, society has relied on a few crops that were easy to grow and filling enough to satisfy their hunger. As a result, Rwanda became a country with minimal culinary art and severe consequences in cognitive capacities for a large portion of the population. Similar to many developing countries, people eat the cheapest food for ‘survival’, meaning that there is little to null attention to nutrients leading to unhealthy eating habits. On the other hand, the “doctor centric” approach that colonial powers implemented in the first hospitals in Rwanda, gave no importance to nutrition and food security by not including it in the repertoire of services that they offered. In other words, food was not considered as an essential part of a patient’s recovery treatment.
Until the early 2000s, most of the Rwandese population couldn’t afford to go to a hospital and would stay at home even in the most difficult and painful times. This changed when the government under Paul Kagame’s leadership launched Universal Health coverage (or public medical insurance) at an annual fee varying from US$3 to US$80 depending on the economic category of the population. The government subsidizes the full amount to the 16% of the population who cannot afford to pay the US$3 annual fee.
In post genocide Rwanda and with a government budget primarily reliant on international aid, the Ministry of Health prioritized medicine, equipment, doctors, and infrastructure over others (e.g., food) to make the public insurance affordable to many people. Authorities feared including food in public health insurance would increase costs and reduce uptake by citizens. Furthermore, it was very difficult for the government to estimate the cost of feeding medically tailored meals to every hospitalized patient because this was never done in a consistent, systematized, and efficient way in the history Rwanda.
There is a handful of the patients who are “privileged” enough to receive a visit from a caregiver or family member (who usually commutes 5-9 hours a day) who delivers street-food ranging from chips to fried bread that they buy for US$0.05 and lacks the essential nutritional values for a quick and proper recovery. Besides, visits typically come once a day, this means that the patient must ration the (most probably) unhealthy meal/snack to last the entire day without refrigeration and with a high chance of dirt and insects sitting on it.
In their efforts to bridge the gap for those patients who don’t have anyone to bring them meals, the Ministry of Health awards a concession contract through a public bidding process to one private company (or restaurant) to run the food business at a specific public hospital. However, their meals go from US$0.80 – US$2 (equal to 75% of a patient's daily income who could no longer work and earn money while hospitalized) and no option for patients with a special diet. These are unreachable prices for economically vulnerable in-patients considering that most of them cannot even afford to pay an annual fee of US$3 for public medical insurance. This leads to a staggering prevalence of malnutrition among most in-patients in public hospitals which translates to higher costs -for the already stretched- health system in view of the fact that they must stay longer in the hospital to fully recover.
In a country which is still in rehabilitation and reconstruction from the 1994 genocide, Isabelle understands that the most effective, efficient, and sustainable change happens by collaborating with the Government crafting their young systems. At this point, in their efforts to build solid and long-lasting public institutions, the Rwandan regime is the gatekeeper of any initiative or model that has the potential to reach national scale. Solid Africa is the only organization in Rwanda who is feeding low-income patients sustainably grown medically tailored meals for free in public hospitals in a consistent and systematized way. As a result, Isabelle created a new role while generating new resources in the form of know-how and data for the public healthcare system to better understand how much it takes to scale her model nationwide, and the rules that could govern this change.
Isabelle established Solid Africa in 2011, an NGO purely led by volunteer efforts. She used to cook at her parent’s kitchen for a handful of patients while getting advice from a nutritionist that worked in one of the public hospitals. Family and friends contributed either with donations or cooking skills to help Isabelle prepare the meals. After some time, these efforts were enough to feed 60 patients and volunteers supporting the delivery and serving. Soon after, the movement grew, and Solid Africa was dispatching 120 meals from three homes and by 2014 they were serving 400 patients one meal a day in one hospital in Kigali. At this point the operation was so big that they couldn’t go beyond this number because the resources were scarce, but still enough to be consistent.
Solid Africa’s track record feeding medically tailored meals for free to low-income patients consistent and systematically, made the government look their way when the pandemic hit the country and requested Isabelle to scale her operations to all five public hospitals and three Covid-19 treatment centres in Kigali. This meant that the organization duplicated their reach, and in the span of 13 days, they were feeding 800 patients for free, three times a day. This leap was possible with the help of the government who introduced them to donors who funded their operations (UN Women, Save the Children, UNHCR, etc.) and organized the delivery of food. Since then, they have been collaborating closely, especially when it comes to unlocking funding from international organizations, and in-kind donations (worth of USD2.6M) such as a 12-hectare farm, tax exemptions, and even the land where a centralized kitchen was built. Today, Solid Africa is providing 3 medically tailored meals a day to 1400 patients for free in 6 public hospitals.
For the first time after 10 years of knocking on the Ministry of Health’s door, Isabelle’s voice was finally heard with the urgent need to provide a reliable and affordable source of nutrition to patients in public hospitals nationwide. Isabelle shifted from cooking from home for a handful of patients, to building a state-of-the-art first semi-automated kitchen in Rwanda with the capacity to cook up to 30,000 meals per day, with funding from Mohamed V Foundation for Solidarity (Morocco). For such event, Isabelle’s team traveled to China to customize cooking equipment perfectly suited to preparing tasty, culturally appropriate dishes in high volumes and fast.
In 2022 Solid Africa sealed a partnership with the Government in what they call a Public Private Partnership (PPP) for five years. In essence, the Ministry of Health agreed to fund the construction and equipping of the kitchens in all 47 public hospitals, and Solid Africa will be responsible of the execution, management, and cooking. This was a tremendous win because finally they changed the government’s mindset about the importance of food as part of holistic medical care. In the next 4 years, Isabelle aims to cover 50% of the non-profit costs from the revenue generated by the social enterprise and the remaining 50% from donations, while the government contributes the funding for expansion to all public hospitals. By 2025 she expects 50% to be covered by the social enterprise and the other 50% by the government. Isabelle envisions the latter to gradually transition to covering 100% of the cost to feed 10,000 patients, three times a day in 47 district hospitals as they build data and craft the regulations of this new model together.
Scaling their work to all public hospitals in the country means that the organization will have to increase their staff to meet the demand, and Isabelle already has a plan for it. She has funding from the Deutsche Gesellschaft für Internationale Zusammenarbeit (also known as GIZ, Germany’s leading provider of international cooperation services) to build a school of culinary arts and nutrition that will guarantee enough staff to employ Solid Africa and other companies in the private sector. It will also ensure that every graduate from this school will be fully equipped and prepared to work by Solid Africa’s highest standards. There are other aspects to consider for this massive scaling of operations such as their strategy to secure a steady supply of food. But Isabelle also has a plan for this. Most of the public hospitals own land close to premises which are not in use, and they will complement local farmers and cooperatives who will be trained by Solid Africa’s agronomists to ensure that the harvest is up their quality standards.
Since Solid Africa’s inception in 2011, Isabelle knew that to sustain the impact beyond donations, she had to set up a parallel social enterprise (or Community Benefit Company –CBC –) 100% owned by the NGO to subsidize part of their operations. As of February 2023, they have four paying customers (three companies and three private schools) serving a healthy lunch to 6300 people daily. The revenue is reinvested in the for profit to keeping such massive operations afloat, while the surplus subsidizes 24% of the non-profit costs.
As part of Solid Africa’s CBC growth strategy, they have sealed a business agreement with Partners in Health (PIH), an organization that provides healthcare to individuals by managing public hospitals in Rwanda, who shares the same vision. Solid Africa will oversee the equipping, managing, and training PIH’s kitchen staff at a fee in three hospitals. Based on this pilot, there might be potential to replicating the same in PIH’s hospitals and clinics that they have in 10+ African countries. Isabelle has created a new niche market in Rwanda that previously did not exist, kitchen management services for institutions.
Solid Africa is consulting the Ministry of Education to design a sustainable and efficient public-school feeding system. Additionally, the organization signed an MOU with the Rwandan Head of Prisons who was also interested in her model. With 85,000 inmates being held in 13 prisons across the country, the first pilot will entail the redesign and management of the kitchen at the biggest prison with 12,000 inmates, while showing the authorities that it is possible to provide the inmates three nutritious meals per day with the same budget. Additionally, the Board of the Rwandan Early Childhood Development Centers (3000+) also approached her to replicate the model in the ECDs and train their staff on how cook nutritious meals.
Isabelle understands the Solid Africa must operate in a network with other organization to achieve her ultimate vision of shifting the nutritional landscape in Rwanda. For this reason, she partnered with Ashoka Fellow Julie Carney, who founded Gardens for Health, an organization that gives advice and empowers families on how to grow and cook nutritious food through community gatherings at their demo farm and cooking demonstrations. They create capacity to Solid Africa’s field officers on a quarterly basis in healthy cooking, nutrition and farming tips using very didactic material in the local language that the field officers use to educate the patients. After more than ten years working with hospitalized patients, Isabelle realized that they are more receptive to such insights because they experienced first-hand the results of a healthy diet in their recovery process and becoming changemakers in their communities when it comes to affordable healthy cooking.
Moreover, Solid Africa is showing the patients how having three healthy meals a day is not only possible, but also affordable and without cooking a lot. In fact, at the hospitals there is no despair for either food or nutrition insecurity because patients know that they will receive three meals a day. Solid Africa’s meticulous practices in cooking and serving are some of the keys for their efficiency in the use of resources and they are working on passing them on to the wider population. The shift that Isabelle is aiming for is where people understand that with the same budget, a whole family can eat healthier.
Solid Africa partnered with the University of Global Health Equity, the Africa Institute of Mathematics, and Rwanda’s largest public hospital to prove that feeding patients with medically tailored meals three times a day could reduce patient recovery time by 16%. The study will also show how much it costs for the healthcare system to feed each patient and evidence how a faster discharge would reduce costs. As a result, patients go back to their normal life faster, work, consume and ultimately contribute to the economy of the country. This is an essential element of the organization’s agenda for their advocacy work that will inform the Government of the next steps in their efforts to include food as part of the public medical insurance.
Isabelle is empowering people to become changemakers starting from the patients all the way up to the Government officials, including companies who are eager to support her mission by buying lunch from them. Throughout these years she has used mass communication channels such as TV shows and radio to share the changemaking mindset she was thriving for which helped her build a movement of 200 volunteers who serve food at the hospitals and see that they can create starting from a young age. Many of them have witnessed how Isabelle, with almost no budget, was cooking at home for a handful of patients, and now they are part of a massive movement with the potential to reach a nationwide scale.
Isabelle recognizes that the African continent is behind when it comes to mass cooking initiatives or models in a sustainable way. Despite isolated efforts doing it in different settings, there is no centralized entity who takes the lessons learned and experience to another setting with the same intention: cooking healthy at mass scale with minimum costs. “Whoever is cooking in mass scale is doing it in their own way and lenses”. Even though her solution is tailored specifically to the local context in Rwanda, Isabelle is convinced that components are replicable for tackling malnutrition in hospitals and other large institutions feeding crowds across countries in the region. In other words, Isabelle is after a silver bullet that could be adapted to different settings across the African continent and beyond.
Isabelle had a happy childhood living in Burundi’s capital city, close to her mom’s side of the family, and some of her first memories are around food and cooking. She recalls waking up earlier than her sisters and accompanying her mother to the bustling markets. Isabelle was fascinated by how the tomato sellers spent all day together in a community, raising their children on the street and laughing all the time while making a living. For young Isabelle they were the happiest people on the planet and dreamt of becoming one of them someday.
Growing up, Isabelle was taught that Rwanda was “Paradise” and “the land of milk and honey”. However, it was closer to “hell” when she experienced the genocide in first person when the family moved there in 1994. Crossing the Burundi-Rwandan border by foot in the middle of the night was not easy, especially for an all women family. For the first two days they slept in the bush, and afterwards they hid in a military office surrounded by trucks reading “TUTSIS HAVE TO BE KILLED”. Isabelle’s family knew that the only way to survive was by working as a team, even when that meant cleaning up after dead bodies to survive. She recalls her father’s advice to play a role in healing and rebuilding the country, which resonated deeply from a young age.
Isabelle struggled a lot during her first year at university. As opposed to her excitement when studying in high school, she had a hard time because she didn’t find any motivation for it. She felt like “dying inside slowly by slowly”. Isabelle had an existential crisis because even though she knew that she wasn’t happy with her studies; she was raised with the mindset that “you need to have a diploma to be someone in life”. However, the most frustrating part was that she didn’t know what she wanted to do.
This existential crisis led her to search for meaning and purpose. Isabelle went through a process of self-discovery and finding her calling. Reading the Bible led Isabelle to question her impact on others' lives. One day, in her commute to work, Isabelle saw a homeless man at a bus station, and she realized that it was the same person who she had seen 2 years earlier. She felt a lot of shame because she had been ignoring him for all these years, like he didn’t exist. Now that she had “seen” him, she sat down to have a chat with Charles, the homeless man. The next morning, while she was having breakfast at home and packing her lunch for work, Isabelle prepared an extra sandwich for Charles, and realized that it only cost her € 1.00, so she reached out to friends to help her feed more homeless people to a point where they dispatched 200 sandwiches every week. This self-realization ignited her motivation to engage actively with the world's problems and embrace her identity as a changemaker.
As her interest grew, Isabelle visited to Kigali’s biggest public hospital and seeing the situation with her own eyes, she recalled her father’s words advising of her duty to rebuild Rwanda and decided to address the problem from the roots. A turning point for her was to set up an NGO and address the nutrition and food security issues that she saw at those public hospitals.