shamiriOS: Development and Early Deployment of an Integrated Digital Platform for Scalable Youth Mental Health Service Delivery in Kenya

Background: Scaling youth mental health services in low-resource settings requires digital infrastructure that supports not just clinical delivery but the full operational, supervisory, and engagement demands of community-based, task-shifted models. Existing platforms — whether commercial health systems, open-source medical records, or consumer-facing wellness apps — address fragments of this need but none provide the integrated, offline-capable, and affordable architecture required for lay-provider delivery at scale.Objective: We introduce shamiriOS, an open-source, modular digital platform comprising three interlinked suites — the Shamiri Digital Hub (SDH) for operational management, Rafi for youth engagement, and the Shamiri Provider Platform (SPP) for clinical workflows — designed for scalable, stepped-care youth mental health delivery in Kenya. Our objectives were to: (1) conduct an environmental scan of existing platforms and characterize their limitations; (2) describe the user-centered design and development of shamiriOS; and (3) report early deployment outcomes across centralized and decentralized settings between 2023 and 2024.Methods: We conducted a structured environmental scan of six case management platforms and 28 youth-facing mental health applications, assessing cost, usability, open-source availability, customizability, offline capability, and suitability for task-shifted delivery. Based on identified gaps, SDH was built as a browser-based operations platform, and Rafi was developed as a native mobile application (Android/iOS) with offline-first architecture. The SPP was adapted from an existing electronic medical record system. Development followed a user-centered design process with community consultation, including co-creation workshops with 77 university-aged youth. Deployment was evaluated using usage analytics, usability ratings, and Net Promoter Scores.Results: No reviewed platform met the combined requirements for stepped-care delivery. SDH was deployed across eleven sites serving 76,344 youths via 1,195 lay providers and 111 clinical supervisors by Q1 2024. Staff reported high satisfaction (usability M=8.36/10; NPS M=8.63/10). Rafi achieved 74.7% registration at Mount Kenya University (n=3,837), with 50.4% booking therapy sessions, but sustained engagement with self-guided features declined to near zero by nine months.Conclusions: shamiriOS demonstrates the feasibility of building modular, open-source digital infrastructure for scalable, task-shifted youth mental health delivery. Its component-based architecture is designed for adaptation to other contexts, though extension would require participatory re-design. The most significant obstacles to impact lie not in platform design but in implementation readiness, incentive alignment, and institutional integration. Future priorities include SPP deployment, AI-assisted supervision features (shamiriAI), and strengthening sustained engagement.