A human-centered approach to design for development

Designers from California and development professionals from Tanzania wore T-shirts reading “Kuwa Mjanja,” Swahili for “be smart,” as they presented a movement that starts with girls at menses and continues with them to marriage. They pointed to their Kuwa Mjanja pads, condoms, and birth control packs, and screened a video of their conversations on the streets with the people at the center of the project design: the girls themselves.

 “A conversation outlives a product. It outlives an intervention. It outlives all of us,” said Rena Greifinger, who focuses on youth-friendly sexual and reproductive health services, in her Kuwa Mjanja shirt.

This “design immersion,” hosted by Population Services International in Dar es Salaam, focused on the question: “How might we inspire medical professionals to be more willing, even excited, to provide contraceptive services to unmarried girls?”

Long days of presentations, interviews, collaborations, and field visits in taxis dispatched all over the city concluded with a workshop on what participants would keep or change about the immersion, exemplifying a key tenet of “human-centered design,” that it starts and ends with the beneficiary.

“What continues to stun me is organizations that have operated for years without anyone actually leaving the head office,” said Ravi Chhatpar, who left Frog to co-found the Design Impact Group at the global development advisory firm Dalberg. “A participatory approach versus a top down approach can also provide programs with more credibility and accountability.”

Also called user-centered or design thinking, human-centered design is an approach to problem solving that incorporates the wants and needs of end users of a product or service in every stage of the design process.

While this approach should be the basis of any effective strategy in an industry with the stated aim of improving lives around the world, some global development organizations tend to forget the importance of taking the perspectives of the people they serve into account. They can learn from groups such as PSI that are leveraging the human-centered design process within their own organizational structure in order to determine the way that same process can have an impact in the field.

“You’re customizing an HCD approach based on what will work for a particular stakeholder environment,” Chhatpar, who was also in Dar es Salaam last week for a separate project working on a financial inclusion project for the Bill & Melinda Gates Foundation, told Devex. “You prototype that, pilot that, deploy that, iterate on it.”

Frog and IDEO, both edgy Silicon Valley design firms, are increasingly applying the design thinking they do in their commercial work to challenges in emerging markets. They have started partnering with NGOs to involve their beneficiaries as designers in developing solutions.

“HCD is great at generating new solutions, and uncovering the nuance in these complex problems that can be difficult to understand with more traditional quantitative research methods,” Adam Reineck, design director at IDEO.org, IDEO’s nonprofit spin-off with a mission to leverage human-centered design to challenges of global poverty, told Devex. “Beyond research, we use many tools that allow us to visualize, prototype, and present people with solutions that feel as real as possible in order to understand how a new service or experience could really work in the world.”

The innovation unit of UNICEF incorporates design thinking principles across its programs, and organizations such as the International Rescue Committee are also setting up innovation teams.

Design thinking is central to the approach of the global NGO Concern Worldwide’s Innovations for Maternal, Newborn & Child Health initiative, funded by the Gates Foundation. And for its part, the Gates Foundation has its own in house design thinking specialist.

As with many trending fields, HCD practitioners have faced concerns that enthusiasm has outpaced rigor at the intersection of human-centered design and development. Concern Worldwide’s team told Devex they are working to bring more metrics and evaluation to demonstrate how design thinking is driving outcomes in global health. The team is working with John Snow Inc to collect more data.

“How do you get donors to spend money on fancy designers when in development our goals are to help the hardest to reach places and the poorest of the poor?” Katie Waller, a senior program officer at Concern Worldwide, asked.

Waller said that for HCD to have a future in global development, it will require organizations to incorporate principles such as an abundance mentality, a bias for action, and leading with empathy into their practice areas, not to commission expensive outside expertise. She and two other Concern Worldwide colleagues attended a Stanford University Center for Professional Development course last month called “Strategic Innovation and Design Thinking” in Palo Alto, California. Other courses and toolkits are available from groups such as +Acumen and IDEO.org.  

Many of the facilitators at the PSI design immersion last week were formerly with IDEO.org. They included Stacy Barnes, the former design lead for IDEO.org who consults with a wide range of NGOs and the husband and wife duo Danny Alexander, who went on to cofound Who Gives a Crap, and Mariana Prieto, a freelance designer who will lead the design team at the IRC innovation lab. Together with Pam Scott, a philanthropist whose work focuses on the intersection of design and impact, these designers helped PSI build HCD capacity among its Tanzania-based staff.

“I do think human-centered design has become a buzz term. Practitioners of HCD need to prove the methodology has relevance to the social sector. They also need to be careful not to position HCD as something entirely new but respect the rigor and the empathy and all the creativity that the social sector has brought to humankind,” Scott, who is sponsoring the PSI project on unintended pregnancy in Tanzania and serving as a creative consultant, told Devex. "As human-centered designers, we could approach the social sector with greater humility. Let's see if this approach can complement what you're already doing and then work hard to help you make it your organization’s.”

Immersions such as the one PSI hosted last week can bring practitioners, beneficiaries, and even donors together to brainstorm and prototype solutions, make adjustments based on feedback from the field, and test the solutions that may later be scaled. But whether or not an organization makes design thinking central to its operations, any and all global development professionals could benefit from understanding and applying the basics of the HCD approach.

This most recent PSI design immersion built on work that began last year. In January 2015, Scott traveled to Morogoro and Bagamoyo, Tanzania for design research with teenage girls and the influential people in their lives including parents, boyfriends, and medical professionals. The trip led to insights including how girls are tempted to sexually experiment but lack the agency and cultural permission to protect themselves, and how the lack of opportunity provides many girls with little reason to not get pregnant.

In April 2015, a team of 34 design thinkers including former Yahoo CEO Tim Koogle, who is Scott’s husband, and PSI board member and Facebook marketing executive Rebecca Van Dyck, gathered in Bagamoyo, Tanzania, for a design immersion that resulted in prototypes including a girl-friendly bajaji, or taxi.

The marketing team at PSI Tanzania entered 2016 determined to address the supply side as well as the demand side of contraception by inspiring Tanzania’s medical community to provide adolescent girls with the reproductive services they need. Scott, who says the real power and potential of HCD will only be unleashed when practiced and scaled by NGOs, is working with PSI to carry on this work themselves.

Melissa Higbie, deputy country representative for PSI Tanzania, talked with Devex about her own growth as a human-centered designer. Last year, she was learning from Scott, trying to keep up. This year, she co-led the immersion, with the two constantly working to align their visions. “I don’t think you need to get one of the big names or an expert in design in order to use these principles in your day to day working life,” Higbie told Devex. “You learn it by jumping in and doing it and you can’t mess up because the entire point is to fail fast and learn from your mistakes.”

On the first day of the immersion, Higbie and Scott walked participants through the basics of HCD. The group heard from experts such as Matthew Willcox, executive director of the Institute of Decision Making at the advertising agency FCB, who shared lessons from behavioral economics.The group was divided into teams, bringing together multidisciplinary participants such as Dan Orwa, a senior lecturer at University of Nairobi who has worked on mobile phone-based solutions for the urban poor, and Jane Schueller, senior family planning adviser for the U.S. Agency for International Development in Tanzania.

“Some of the ideas we thought were brilliant were crushed when we went out to the field, which is an okay thing, because you’re failing fast versus failing much later,” said Susan Mukasa, Tanzania country representative for PSI. Mukasa plans to scale the human-centered design approach from Tanzania to the entire region when she moves to Washington, D.C., this summer to become PSI’s senior regional director for East Africa.

My team focused on the question “How might we leverage traditional milestones and trusted sources to deliver consistent and accurate information and linkages to services?”

Based on interviews with providers, teenagers, and nyakangas, who lead girls through ceremonies that marks their transition from girlhood to womanhood, we discovered how a closer relationship between these three stakeholders might turn detractors or passives into advocates in attitude or advocates in action.

Over the course of five days, we went from brainstorming ideas to pivoting around feedback to prototyping a ceremony called Msichana Maisha, Girl’s Life. A provider and nyakanga brought contraception into a conversation that built on cultural traditions, elaborating on the points made in ngoma ceremonies to be clean, be respectful, and be smart to their audience of 13 girls.

Scott explained that HCD begins with empathy, the centerpiece of any design thinking process. By engaging with end users, organizations create intentional feedback loops that gives those users a constant say in the way programs are being implemented. For example, by asking girls what they want, and presenting girls who might have a hard time articulating those preferences with prototypes they can react to and improve upon, PSI can gather insights to inform the design of their products and services.

There is some skepticism of HCD, in part because of a perception that the process can generate ideas that will never go anywhere, without consideration for the viability or feasibility or scale of a given product. But that criticism should not be used to shoot down the fundamental principles of design. And there is a difference between the HCD methodology, which some organizations embrace more than others, and a broader cultural change that is inspired by HCD principles and needed across the board.

Scott told Devex the most important thing to keep in mind, at PSI or any NGO, is that the people these organizations serve are human beings rather than data points on a spreadsheet.

“This happens in business and the social sector,” she said. “We spend so much time at a distance from the people we serve that we no longer have the human connection vital to seeing real needs, wants and aspirations.”

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