What is the history of design in health?
Designers have been working with health for a long time, whether to improve healthcare products, technologies, and facilities, or to increase patient awareness and engagement. At the core of this partnership is the recognition that design and global health share many of the same human-centered and outcome-driven principles.
Health product companies, like Philips and GE, have long employed designers, not just to create more desirable products, but also to observe and understand the situations in which design is best used to drive desirable, health outcomes, particularly with key populations like children and the elderly. More recently, this interest in design has broadened to include, not only companies developing healthcare products, but also those providing healthcare services. Today, many of the top healthcare providers, including the Mayo Clinic, Kaiser Permanente, and Memorial Sloan Kettering, are building internal design teams to improve health outcomes. Additionally, in the public sector, many actors, including national governments, are incorporating service design on a national scale. According to a survey in the Service Design Network Impact Report 2017, the public sector is already the largest client for service design across the world.
In particular, the past years have seen an increase in the application of design to global health challenges due, in part, to its potential to address a number of concerns critical to achieving global health goals. We have identified more than 35 projects that used design as an essential component in a global health program. Global health researchers, publishing their work in peer reviewed journals such as PLOS One, have begun to study the role of design in the field of public health. A number of large, non-profit organizations, such as UNICEF and the International Rescue Committee, have hired teams of design practitioners both to build their own organizations’ capacity and also to address key development issues in the humanitarian sector. Leading funders in the global health space, such as USAID and the Bill & Melinda Gates Foundation, have created dedicated roles and funding streams to strengthen the application of design within their portfolios.
What do we mean by "design"?
Design is a craft and discipline that applies a specific mindset and skillset to a creative problem solving process, enabling the development of informed, sensitive, inclusive, purposeful, appealing, and innovative solutions. These solutions incorporate functional and aesthetic demands based on the needs and behavior of the people being designed for, as well as the broader systems within which they live. Design can be applied to the development of products, services, processes, messages, digital experiences, and environments. Design can link each of these elements into a cohesive and meaningful experience, particularly in the context of fragmented health systems. While designers have contributed to the improved effectiveness of health interventions in all of these areas, design, as a process, is broader than any single application.
Design alone is not enough, nor is it always the right approach for every challenge. Interventions built to address complex health challenges generally require a multidisciplinary set of approaches and expertise. Through a creative, effective, and rigorous process, design can bring people's needs to the forefront when decisions are made about how to design and implement interventions intended to bring about positive changes in their lives. Design can also help bring diverse disciplines together in a collaborative manner to unlock new opportunities for positive change in health systems.
In these materials, we use the term ‘design’ to capture all facets of design being applied to global health initiatives. For this reason, we have embraced a broad definition of design that includes concepts like human-centered design, service design, design thinking, and systems design. By adopting a broad definition, we are attempting to combat some of the common misconceptions that limit the role of design, such as:
Design is about making things look pretty and is superfluous to achieving global health outcomes.
Design is only valuable when applied to end-users and beneficiaries and is not relevant when considering other stakeholders in the ecosystem.
Design is only relevant when developing products and services.
Design insights are only useful to address demand-side challenges after the ‘right’ solution (e.g., product or service) has been defined and piloted.
Design as mindset.
Typically, design is understood as a way to make products aesthetically attractive or to enhance appeal through smart, evocative, communications advertising. However, designers are effective collaborators across different project stages because they apply a mindset that can help reframe challenges and test assumptions. The design mindset focuses on engaging people throughout the process of developing solutions for them. Design seeks to rapidly move from insights to action by translating learnings into concepts that can be tested, adapted, and improved directly with end users. In global health, design often incorporates a systems approach to problems by facilitating deep collaboration amongst stakeholders.
Design amplifies these principles by actively engaging target audiences to uncover root causes, generate ideas, and test prototypes. Ultimately, the goal of this approach is to create solutions that satisfy people’s needs and desires and shift behavior toward more optimal outcomes. To adopt this mindset and enable the creative, problem-solving process, designers must be curious, defer judgment, take the time to be reflective, and embrace collaboration.
In global health, solutions must balance a deep commitment to designing for people’s needs and behaviors with a number of other opportunities and constraints that exist in fragmented health systems and resource-constrained environments. When framing opportunities, designers in global health must take a broad, systems-based view rather than narrowly focus on the end-user. The design mindset can add value to interdisciplinary collaborations by translating a range of insights from different disciplines into actionable ideas and strategies that can be rapidly tested across the health system.
Design as skillset.
For non-designers, the diversity of design skills and titles can create uncertainty and confusion about what skills are needed to address particular global health challenges. While design, as a whole, seeks to apply different skills, based on specific challenges and across different project stages, individual designers typically possess a depth of knowledge in one or more design specializations. In this respect, design is not too dissimilar from health with its many different specializations.
Just as health professionals embody a basic understanding of clinical practice, designers possess common skills in creative problem solving, visual thinking, and the craft of making things. Depending on your project, and the role design plays in your program, you will likely need to collaborate with a designer who can help your team both navigate the entire design process as well as solve for a more specialized project need (e.g. designing a new medical product, health record, or media campaign).
Type of design skill
There are many different specializations within design that require training and expertise. Below is an illustrative list of some of the types of design skills that could come in handy while working on global health projects.
Communication design and visual design are closely linked. Communication design is about strategic engagement with an audience—designing how a message is delivered through a variety of channels in a consistent and engaging way. Visual design is more tactical, concerned with delivering a certain message in an aesthetically beautiful way. This means a communication designer may work on the strategic plan around message design and delivery, whereas a visual designer would perhaps execute part of a strategy, i.e. design a website or brochure.
Experience design focuses on ensuring that the user has the best experience for a particular problem. It is the practice of designing products, processes, services, events, and environments with a focus on the quality of the user's experience, particularly the level of engagement and satisfaction that the user derives from a product or service while the product or service addresses their needs and context.
Interaction design is the design of the interaction between users and products, often digital. The aim of interaction design is to make digital products or interfaces as easy and pleasant to use as possible. Interaction design is also sometimes referred to as user experience design.
Product design is the discipline of researching, ideating, conceptualizing and building products that better fit within the lives of consumers. Effective product design transcends usability to address both the functional and emotional benefits of products – the latter dimension can be neglected in the development of products for global health.
Service design involves the activity of planning and organizing people, infrastructure, communications, and material components of a service in order to improve the value, convenience, and interaction between service providers and customers. Service design emerged out of the private sector with a strong focus on certain service industries such as hospitality and health. Service design gained widespread adoption in the UK, for example, where it was applied to make the national healthcare system more user-friendly at each touchpoint.
Visual design, closely related to graphic design, is the design of media in support of visual communication. As such, it focuses on communicating information and messaging effectively through the skillful use of graphic hierarchy and visual storytelling elements such as images, colors, and fonts. A successful visual design ensures that content is communicated in an engaging and effective way and is consistent with the brand of a product or organization. Visual design can play a critical role in global health by making technical information clear and by ensuring that health messaging is engaging and compelling to a broad audience. Visual design is also critical in the effective display of dense health information, such as reports, so that it is actionable by key decision makers.
The first cycle starts with discovering the challenges and needs of the people and systems you are designing for, and then converging on opportunities to address these challenges and needs. This cycle helps ensure that you’re designing the right things.
The second cycle ensures that you’re designing things the right way by developing and testing ideas, based on the opportunities identified in the first cycle, and then converging on and delivering a solution. This model emphasizes testing and iteration, which helps weed out bad ideas and prioritizes effective, desirable and sustainable ideas.
Design as process.
Designers use their mindsets and skillsets to develop solutions to people’s needs that can be rapidly tested and refined. While each design specialization (such as visual design or product design) works in different ways, they share commonalities in their creative process.
The British Design Council developed the Double Diamond model to illustrate these commonalities.
It reflects the two primary cycles of divergent and convergent thinking in the design process.
How does the process link to global health?
The global health community develops solutions through continued learning in research and/or implementation science. It then uses findings from this research and/or implementation science to develop and refine interventions that address global health challenges. Mapping this approach to the Double Diamond model shows the complementary nature of the design and global health processes.
The design process can expand global health practitioners’ approach by providing new perspectives on existing challenges and different ways to visualize insights. The process can then facilitate understanding of traditional research outputs and methods to more rapidly translate these insights into tangible prototypes and solutions that can be tested and refined. Design, thus helps operationalize findings from traditional research approaches by ensuring that programs not only incorporate their results, but also that the insights gleaned are designed for local contexts.
Similar to design research, clinical research involves the rigorous testing of solutions in appropriate settings, but this process is characterized by a different (often longer) timeframe, and incorporates the more stringent requirements appropriate for development of drugs, vaccines, etc. However, for interventions that pose a lower risk, clinical-level, randomized, controlled trials may be either unnecessary or inappropriate. For example, when developing a new vaccine, it is vital to follow the necessary rigor and requirements of the clinical trial process. But when developing or testing new medical recording mechanisms that allow parents and providers to better track the protection of a child’s health (e.g., the receipt of preventive services), the process can be more flexible. This provides the opportunity for design research to play a significant role. As designers and global health practitioners continue to work together, we hope that they will continue to identify the appropriate contexts in which design research can either support clinical studies, or provide the primary research platform.
What role can design play in global health programs?
The design process can be applied differently in global health programs depending on the program’s challenges, timelines, and resources, and depending on the availability of the appropriate design skillset. Based on these factors, design can be applied as a short spark to encourage new thinking, infused as an ingredient across a program cycle, or incorporated as the main process by which to develop new or improved solutions.
We have identified three different design intensities that can guide you as you consider using design within your work.
Design as a spark
Design methods are applied as a light touch at the beginning or middle of a program to spark new ideas, thinking, or concepts or to deliver one specific output as part of a larger program. This can involve conducting limited design research to inform program planning; a co-creation workshop to develop new ideas; and/or product design sprints to improve a product or service as part of a larger intervention.
Use the design dose tags to filter project examples that have used design as a spark.
Design as one ingredient
Design is used in combination with other approaches, such as formative research or behavioral sciences, across the program cycle.
Use the design dose tags to filter project examples that have used design as one ingredient.
The program is scoped to match the design process through its entire cycle, from informing the program design at the beginning, to implementing solutions at the end. End-to-end programs are design-led, meaning a design firm plays a critical and leading role throughout the program evolution.
Use the design dose tags to filter project examples that have used design end-to-end.
How can design help prioritize resources and drive alignment toward people’s needs in global health?
Some organizations, like UNICEF, have used collaborations with external design consultants and partners to bootstrap the development of an internal design capability. Other organizations, like Grameen and Medic Mobile, have hired individual designers directly and embedded them with their project teams as part of a multi-disciplinary approach. A number of NGOs, such as Jhpiego and Proximity Design in Myanmar, have formed longstanding partnerships with university programs to tap into design talent. Finally, some global health organizations, such as D-Rev, were founded specifically with design as a core capability. Regardless of which model you adopt, we hope that these resources will help you get the most out of your investment in design.
The design process can surface key questions that inform global health programming at each of its stages. These questions can help programs incorporate the needs and expectations of those being designed for, ultimately increasing the likelihood of impact. The purpose of the table below is to highlight some of the key questions that those involved in the project should endeavor to answer. They should especially work to address those questions for which they don’t have immediate or clear answers. Doing this will ensure that the process aligns well with a human-centered design way of working.
When considering these questions, it is also important to recognize that there are a number of different engagement models for design in global health.
1. Prioritize investment opportunities
2. Problem definition and context
3. Research and design
4. Pilot and test
5. Introduce and scale
6. Sustained learning
What is the problem you’re trying to solve?
Why does this problem need a solution, and how is your solution different from other potential solutions?
Who are the key people you seek to affect, and what benefits might you provide them by addressing this problem?
Who else in the health system needs to experience benefits in order for your solutions to be successful?
How well do you understand your users' context?
How well do you understand the different stakeholders involved and their relationships and dependencies with one another?
What are the barriers to use that the users have to overcome?
How are your users currently addressing this need today?
How much effort is required to change existing behaviors and, potentially, existing social and cultural norms?
Who might be disadvantaged? What might be some other unintended consequences?
What are the best opportunities to engage your users?
What are the core features of your solution to address user needs?
Do your solutions address the needs of all the relevant stakeholders in the system?
What incentives would help users overcome barriers to use?
How will users access your solution?
Which solutions are likely to have the greatest impact?
Which solutions are unlikely to work and why?
What is the solution that best addresses user needs, the health system’s demands, and your priorities?
What are the values of design that resonate with social norms and culture?
What are the usability and delivery challenges?
What are the key leverage points to shift behavior?
What are the best pathways to reach your target users for maximum impact?
What is the behavior change model, and how have you validated it?
What are the best marketing and distribution channels to reach your target users?
What are the user-specific barriers to increase uptake and ensure long-term engagement?
What are the key qualitative metrics of user engagement?
How can features and incentives be optimized for increased engagement and adoption?
How might you adapt the solution to other contexts or changes in the existing context?
How can you build the capacity, with local partners and stakeholders, to sustain and expand impact?