Gates Foundation and USAID team up to bring design to health

SAN FRANCISCO — The United States Agency for International Development and the Bill & Melinda Gates Foundation have joined forces to encourage more global health practitioners to build their programs around the wants and needs of the people they aim to serve.

Over the weekend, at the annual Aspen Ideas Festival in held in Aspen, Colorado, representatives of the U.S. donor agency and the world’s largest foundation launched a set of resources called “Design for Health.”

Leaders from both organizations are convinced that approaches such as human-centered design — which came from the private sector and is increasingly being applied to complex global challenges — are the key to achieving global health outcomes.

“While the principles of design have been employed throughout USAID’s health work broadly over decades, we saw a real opportunity to bring it in more deliberately as a complementary approach. That’s what we’ve been exploring over the last three years through roughly … 10 pilot projects across a mix of health areas and countries. We’ve learned a lot,” said David Milestone, acting director of USAID’s Center for Accelerating Innovation and Impact.

Milestone spoke at Devex World in Washington, D.C., where he previewed the launch of the Design for Health public goods, developed in partnership with Dalberg, and spoke about opportunities to apply the approach to global health and international development challenges.

“One of the interesting things we’re looking at applying human-centered design to is this idea of this youth bulge in Africa,” he said.

Milestone joined USAID from the private sector, where his work with the medical technology company Stryker taught him the power of design in both product and business model creation in the U.S. and India.

Last November, Milestone and Tracy Johnson, senior program officer for user experience and innovation at the Gates Foundation, worked together with Sonder Design to convene 48 designers, global health experts, and implementers, in Berlin, Germany, for an event called HCD Uncut.

“Design thinking in global health is moving from its infancy into adolescence,” read the invitation. “We no longer simply have to convince people to give the method a try, rather, we are beginning to gain a clearer picture of what are the challenges to integrating this innovative methodology into the field of global health.”

After two days focusing on the failures and roadblocks as well as successes and opportunities, the group made a commitment to form a community of practice, and began to develop a roadmap to mainstream design — including human-centered design, service design, design thinking, and systems design — across the global health community.

“One of the most fascinating and unexpected results of the convening was the spirit in which we all began to speak to one another,” Ledia Andrawes, co-founder of Sonder Design, told Devex via email. “It shifted from one of competitiveness and caginess, to one of sharing and support.”

The community of practice that grew out of this convening is special in that it cuts through the usual boundaries of discipline, challenge area, and organization type, she said.

“Although we do have many benefits that smaller donors and other organizations working to integrate human-centered design into the way they work don’t have, I think there is universally a bit of discomfort with ambiguity and being able to hold complexity in your hand for a little bit and say, ‘I don’t know yet how to solve this problem and I need to do some work to figure out what it is I don’t even know, so that I can begin to apply what I do know to solving that problem,’” Johnson told Devex in a past interview.

“Through my years of working at USAID, working in the private sector for Fortune 500 companies, and now being part of the foundation, that is the thing everyone struggles with. Life is messy and very complex. And we have to accept that and start from there.”

Milestone and Johnson announced the partnership over the weekend at Spotlight Health, a three-day health conference that opens the annual Aspen Ideas Festival.

They appeared together on a session Saturday in the Disruptive Health Systems track called “Design Thinking: A New Strategy for Shaping Global Health.”

“This novel approach to decision making is going democratic, with well-funded efforts to share it more widely, and apply it more equitably. Design thinking offers a package of tools to promote human-centered, financially viable solutions, opening the door to creative solutions that address long-languishing problems. Design thinking has become a trend, one that may reshape health systems, sanitation practices, payment mechanisms, and much more,” the session description reads.

Joining Milestone and Johnson in Aspen was Jocelyn Wyatt, chief executive officer at IDEO.org, who has been a partner in this effort.

“There have been many people that have incorporated human-centered design approaches into participatory development for decades,” Wyatt told Devex in a past interview about human-centered design in the social sector. “Though people sort of know that it is best practice to engage the community, it’s oftentimes a step that just gets neglected in the rush to put together a proposal or to get a new project started.”

From the HCD Uncut convening to the Aspen Ideas Festival, these design-thinking leaders have used the HCD process themselves, by working with global health practitioners to develop ways to support them in the use of design for their work.

They developed five different user types to represent global health practitioners at different stages in their path toward adoption and implementation of design, and each of these profiles appear as illustrations on the Design for Health site. These include the newbie, who has a hard time seeing the value of design for health; the curious, who wants resources to understand that value; the trialist, who wants to see the value beyond other participatory approaches; the believer, who wants support to spread the word about the value of design; and the pioneer, who has a strong understanding of the value of design, regularly incorporates the practice, and advocates on behalf of design.

Dalberg was a key partner in taking the lessons from the Berlin meeting and packaging them in the form of online resources.

“We wanted to make sure that this groundbreaking investment from Dave and Tracy translated into immediate, concrete value back to the community, and not just more discussions. Our team felt a tremendous responsibility to follow through on that mandate, while continuing to devote most of our efforts to facilitate and engage the design and global health communities throughout,” said Robert Fabricant, co-founder of Dalberg’s Design Impact Group.

He said this partnership between USAID’s Milestone and the Gates Foundation’s Johnson holds a few lessons for the sector, including the need for a mandate, the importance of maintaining engagement throughout, and the importance of deadlines, in this case the Aspen Ideas Festival.

“Efforts in applying design in global health have been fragmented and siloed. As a result, no consistent framework exists on what design for global health means, the value it adds, and the different ways it can be applied. Global health practitioners keep telling the design community, ‘you use too much jargon, you are not flexible enough, you are too expensive, etc.’ And we knew we needed to come together, listen more intently, understand where these objections and fears were originating from, align on some answers, but most importantly, take a long hard look at ourselves and think critically about what we need to do differently as a design community working in the global health space,” Andrawes said.

The launch of Design for Health is just the first step in a roadmap that includes near-term, medium-term, and long-term activities.

For the next three years, this community of practice will expand the work by refining and expanding resources, as well as encouraging partnerships and creating new investment opportunities, supporting local markets to train the next generation of designers around the world, and establishing ways to measure the effective use of design.

From then on the group will work to institutionalize design as a norm within global health — but it remains to be seen whether they can convert the newbie and the curious, not to mention the skeptic, into trialists, believers and pioneers.

“Success is not about mainstreaming design in global health, though that is an important goal,” Fabricant said.

“Success comes from a much broader desire within the global health community to realize a world in which health systems are more adaptive and responsive to people’s needs; in which level of participation in shaping health outcomes is distributed more equitably and effectively. Success is when the people we serve are full, creative participants in shaping their health care experiences.”