Why human-centric design can improve foreign aid

IDEO.org Executive Director Jocelyn Wyatt

The global health community is always looking for new ideas on how to develop, market and scale up sound investments.

It’s really all about finding those opportunities on the ground, developing an innovative approach to the problem and testing a model until it works before asking donors for big amounts of money, according to Joceyln Wyatt, executive director of IDEO.org, a design firm that is becoming increasingly involved in international development work.

“My experience … is that we spent quite a bit of time in conference rooms and boardrooms talking about solutions but very rarely actually went out into villages or into cities and talk to the poor themselves,” she said in an exclusive interview with Devex.

Below are more highlights from our conversation about how design firms like IDEO.org can play a role in development work by contributing to scale innovations in global health:

What can design firms like IDEO teach the global health community on how to develop, market and scale up sound investments in global health?

I think there are a couple of things. The first is that the approach that we take here at IDEO.org, or what a human-centric design approach takes, is really a bottom-up approach and so it really always starts with listening to communities or listening to individual people and asking them great questions, doing observations or spending time with them, developing a deep empathy for people and their lives, their desires, their constraints. And so I think the first principle I would emphasize is just the importance of really getting out there, spending time in the field, talking to people. My experience working in international development is that we spent quite a bit of time in conference rooms and boardrooms talking about solutions but very rarely actually went out into villages or into cities and talk to the poor themselves.

The second piece is around letting ourselves come up with new solutions. We have brainstorming rules at IDEO and a couple of them that I think are particularly applicable are around encouraging wild ideas, deferring judgment and going for quantity. I think one of the challenges that end up happening in international development is that we design approaches, maybe try other ones but then we sort of say again and again , “No, that will never work,” or, “We all know this will work because this is what we’ve been doing for a long time.” And so I would just encourage the community to really think about how can we bring innovation in to come up with new approaches that may work or they may fail? What we need to pursue is to be willing to explore new opportunities, that we believe the status quo is not acceptable.  

And then the third piece that I would say is the importance of prototyping, and being able to attach rough ideas and get feedback on them from communities and some individuals to then be able to refine those prototypes, bring them into pilots and ultimately settle on solutions that are desired by and applicable for the communities in which we’re working. And so I think this model of doing quick and dirty experiments very early on to test things and get them right before writing the five-year grants to get tens or hundreds of millions of dollars of funding for them would be something I would encourage all of us to be more of.

I think there’s now a trend, slow as it is, toward carrying out prototyping.

Yeah, I think that’s true. We’ve seen that with the Gates Foundation Grand Challenges or with some USAID funding, that those $100,000 grants will allow organizations or individuals to actually tap ideas. These are exactly the type of thing we need to see.  We’ve benefited from receiving that type of funding: We’ve won a Development Innovation Ventures grant and a Challenges grant and it certainly allowed us to do prototyping. I think with one, we’ve determined that the idea we had actually didn’t really work very well and I think with another one, we’ve determined that there’s actually a lot of potential there and it’s moving forward. I think you’re absolutely right that it’s starting to happen, and we’d love to see more of that.         

What challenges does IDEO itself face in this process?

I think a lot of it is that it takes time to build new systems.

I can speak about the work that we’re doing with the American Refugee Committee. We’ve been working with them in the Democratic Republic of Congo for the past several months. We worked to design a social enterprise which would provide basic health services, clean drinking water, nutrition and agriculture support to families with the goal of reducing under-5 mortality. This is a program has been supported by USAID and actually we had a chance to meet Administrator Rajiv Shah and share this work with him recently; he was really encouraging and enthusiastic about it. But I think it just takes a lot of time.

When we’re creating new systems like this, especially when we’re thinking about the integration of services and we’re building new business models that require talent on the ground and require pretty significant investment from donors, it’s going to be years before reaching the scale that we hoped to reach. ARC is a relatively fast-moving organization and so from the completion of the design work that we did with them late in the fall, it’ll only be a few months before they actually open their first couple of clinics. But then to go from two or three or five clinics to a place where you have thousands of clinics throughout the DRC and even beyond the DRC is going to take some time and investment. So I think one of the challenges that we see is the need to be patient as we launch new models and also to really think about how we design those models for scale.

Do you see donors are embracing that notion that results will take time?  

I think it really varies. I think in this case, USAID seems to understand and I think they recognize that we’re working in a really tough context, in the DRC, and to take an integrated approach between different service offerings is often not very common. And to take a social enterprise model to do that, it requires local entrepreneurs or franchisees, and it just takes a while to build.

I think they do understand it. There are certainly times when people are more impatient about it. But what we’re finding is that as we’re able to explain why and what’s happening, so progress along the way, then that impatience is not as strong because people see that progress is being made. It’s just that there’s a lot of stuff that needs to happen in order to get where we want to be.

What are some innovative solutions you’re most excited about?

We’ve found a lot of innovative solutions around social enterprise models. A couple that we’ve worked on have been with Unilever in water and sanitation for the urban poor. The first program that we worked on is in Ghana, where we designed a sanitation business; we actually designed a business where people would be able to pay a monthly service fee to have a toilet in their home that would be emptied three times a week by an operator. Now there are up to 350 toilets within family units. So it’s reaching 2,000 to 3,000 people at this point. I think that type of model, where we actually think about how we could really provide a different type of sanitation option that is outside the normal options of a public toilet or a personal pit latrine, is something that’s interesting.

I think another is the work that we did with World Health Partners in India. They’re an organization that’s working in rural India and in some of the areas where they’re working, there are a lot of quack doctors or unlicensed medical practitioners. Instead of trying to put them under an entire new cadre of health care providers, they actually said, “Why don’t we provide training and network opportunities for these health care providers to actually bring them into a system and help them improve the care that they were giving?” I think that type of model, where we’re actually looking at existing networks or systems and building off of those rather than creating new ones, will allow us to scale much more quickly.

What role can partnerships with traditional aid groups  multilaterals, bilaterals, NGOs and consultancies  play in scaling up health innovations?

I think there’s a huge opportunity. We’ve seen that we’re able to do so much more when we’re able to form those partnerships.

Just a couple of examples of the work that we’re currently doing: The first is a project where we got philanthropic funding from the Wasserman Foundation to understand if and how drones can be used in last-mile health; it’s sort of an edgy, crazy topic. But we really want to explore what the opportunities were. What we’ve been doing is bringing together donors and speaking with organizations like the Bill & Melinda Gates Foundation. We’ve spoken with other private sector funders. We’ve spoken with individual philanthropists. We’ve spoken with a number of health-related NGOs, social enterprises as well as nonprofits that are working on the ground to understand the context and the challenges they’re facing related to distribution of last-mile health. And then we spoke with a number of drones companies and other technology firms to understand where the technology is going, as well.

So we’re running a series of convenings over the course of this program and at the end of it, it will culminate in a convening where we bring together 30 to 40 people who represent those different communities in San Francisco and sort of say, here’s a vision that we’ve created for how drones could be used in the future, who’s interested in taking this work forward? Who wants to work together? How can we match-make between organizations and form unlikely partnerships and find support for them to pursue those initiatives?

Another example: We have a grant from the U.K. Department for International Development called Amplify and this is a grant that allows us to take 10 challenges over the next five years, each focused on a different topic. The first challenge is focused on safety and empowerment of women and girls in low-income urban settings. The funding came from DfID but they really wanted to engage a wide spectrum of participants. So we organized a convening in London where we brought together USAID, the Gates Foundation, DfID, a number of different international NGOs that were working globally, several NGOs that were working on the ground locally or community-based organizations, academics, think tanks; we had 50 people or so that represent all these different sectors and asked them to help us understand that challenge and help us shape a challenge that we could put on the open IDEO platform.

And what we’re doing is really encouraging all of those partners that participated in the convening as well as others in our wider network to contribute and come up with new solutions related to this topic. We have both funding and design support from DfID to be able to provide to organizations or entrepreneurs that come up with great ideas for this challenge.

How can design principles be applied to health systems change, since that’s what everyone’s talking about right now in global health?

I think it could help tremendously. Traditionally, global health systems have not been as open to innovation or design support as some of the more entrepreneurial, business-based models or international NGOs have. I think there’s a tremendous opportunity. It hasn’t been a place where we’ve engaged much yet but I certainly think the same approach as human-centered design and the same principles will apply when working at those large-scale institutions.

We’re working right now with Marie Stopes International in Zambia on a project to tackle family planning and reproductive health for teenage girls. MSI is working in the public health system in Zambia, so they’re pretty scaled-up. They definitely see the applicability of human-centered design for their work. It seems a great fit with their approach and this approach has involved talking to and learning from teenage girls and coming up with new, interesting solutions around how to reach girls in a way that’s less clinical and more casual. Our team has got back from a few weeks in the field where they were prototyping the solutions, including everything from doing interventions, talking with girls in clubs about sex (which didn’t work really well) to running a free nail salon where the girls would come in and our team members would ask them questions about sex and contraceptives (which worked really well) as well as getting a group of people to come to a pop-up family planning clinic to be able to explore different options and get birth control in different ways, but to really take that family planning clinic outside of the health clinic and make it more acceptable for girls to take advantage of these services.

I do think if we can deal with organizations like MSI, who’s working both nationally in Zambia as well as globally, we can do it with other similarly scaled organizations as well.

What’s the best way to address resistance to health systems change?

I think we have to find advocates within the public health system who are enthusiastic or at least open to seeing change happen, and then showing them what a different approach could be. So maybe that means through our work with Marie Stopes International, inviting some of those people in to actually see the work once we have a pilot clinic up and running, for instance, bringing them into that and then explaining the story about how we got there.  

In some cases, we’re going to have to find some easy converts by showing them the impact of what this approach looks like and getting them on board. I think the same thing is true in the DRC. Trying to work with government health institutions is a real challenge. But we firmly believe that once we have an amazing clinic up and running that is able to provide services at a fraction of the cost that the government is able to provide them, and we’re seeing improved health results in those communities, we’re going to convert a couple of individuals into thinking about things differently and turn them into advocates within their own institutions.

How do you best scale up innovations in global health?

I think if we rely on designers to solve these challenges, to come up with all the solutions, we’re never going to get there. But if we provide tools to the people working in the field of global health, whether that’s through the course that we’ve developed with +Acumen or the HCD toolkit or HCD Connect, or just encouraging people to pursue design education and learn about human-centered design in some way or another — I think if we can get the whole community practicing this, we’re going to see solutions and we’re going to see great impact. It’s as much about equipping people with the tools to do this type of thinking in innovation as it is about having a handful of great solutions to point to.

This story is part of Best Buys in Global Health, a campaign by PSI, PATH and Devex to highlight sound investments in global health. Find out more.

About the author

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    Ma. Eliza Villarino

    Currently based in New York City, Eliza is a veteran journalist focused on covering the most pressing issues and latest innovations in global health, humanitarian aid, sustainability and development. A member of Mensa, Eliza has earned a master's degree in public affairs and bachelor's degree in political science from the University of the Philippines.