Why design for health?
 
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Significant progress has been made in improving global health outcomes. Since 1990, preventable child deaths have declined by more than 50%, and maternal mortality has declined by nearly 50%. Despite this significant progress, we will not reach the Sustainable Development Goals by 2030 if current rates of progress remain the same. For example, the rate of reducing maternal mortality needs to double in order to reach its SDG target.


To amplify impact, global health practitioners should look to other approaches and methodologies that can be incorporated into their programming. Design is increasingly recognized as an approach that can improve uptake and adherence; strengthen strategy and implementation planning; introduce new capabilities and collaboration models; and boost buy-in and ownership across all levels of health systems. Design can also play a role in better understanding how to apply an equity lens to programming so as to target the most vulnerable populations.

 
 
 

 

What is the value of design in global health?

 
 
 
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1. LIMITED ACCESS / LOW ENGAGEMENT

PROBLEM STATEMENT: High barriers to access contribute to low engagement among target populations for promising intervention.

VALUE: Design provides a holistic understanding of user needs and behaviors with which to surface new channels, touchpoints, and influencers to increase user engagement, particularly among hard to reach groups.

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2. POOR UPTAKE

PROBLEM STATEMENT: There can be low uptake of health interventions despite proven clinical outcomes.


VALUE:  Design provides a structured approach to test and iterate solutions with users to surface barriers early and ensure a high level of appeal to maximize the potential for uptake.

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3. LACK OF SUSTAINED USE

PROBLEM STATEMENT: Many health interventions encounter a lack of sustained use, particularly those that require significant behavior change.

VALUE: Design provides a holistic understanding of user needs and behaviors so that interventions can better fit into the context of their day-to-day lives and increase the likelihood of sustained use.                                                                                           

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4. LOW VIABILITY IN LOCAL CONTEXT

PROBLEM STATEMENT: Interventions can lack local buy-in and are ill-suited to the local context

VALUE: Design engages users across the local ecosystem, in a participatory process of co-creation, to increase buy-in for solutions that are contextually relevant and locally sourced, hence, sustainable over time.

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4. LACK OF REPLICABILITY

PROBLEM STATEMENT: Successful interventions struggle to achieve outcomes when replicated in new markets.


VALUE: Design provides an agile process to adapt interventions to diverse user behavior and local conditions and to increase the likelihood of achieving desired outcomes in new markets.

1. INCREASED MOTIVATION

PROBLEM STATEMENT:  Some stakeholders are motivated by supply-side concerns and do not see demand side issues as complementary.

VALUE: Design translates data and insights into visual materials and rich storytelling to convey end-user context in a compelling and inspirational manner that engages and motivates decision-makers.

 

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2. FAULTY ASSUMPTIONS

PROBLEM STATEMENT: Assumptions by decision-makers, who may be removed from context of use, often don’t take into account evolving needs and behavior.


VALUE: Design questions assumptions early by prioritizing demand-side variables (such as the needs, desires and contexts of users) to ensure that solutions are designed from the user's vantage point.

5. LENGTHY DATA COLLECTION

PROBLEM STATEMENT: Research data takes a long time to collect and document, missing the window to affect meaningful changes in early program design.


VALUE: Design accelerates the process of acting on data and insights to demonstrate value for money and increase the speed of innovation and adaptation.

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3. SLOW & INFLEXIBLE PROCESS

PROBLEM STATEMENT: Clinical timelines and long development cycles limit opportunities for feedback and adjustment until late in the development process.


VALUE: Design provides a structured approach of testing and iterating solutions to improve the efficiency of development and the value per dollar invested throughout the clinical timeline and development cycles.

 
 
 
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1. INCREASED MOTIVATION

PROBLEM STATEMENT: Stakeholders may be more motivated by supply-side concerns and less motivated by demand-side issues given the contextual dynamics and high degree of uncertainty.

VALUE: Design translates data and insights into visual materials and rich storytelling to convey end-user context in a compelling and inspirational manner that engages and motivates decision-makers.

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2. MISSED OPPORTUNITIES

PROBLEM STATEMENT: It can be difficult to leverage private sector and other alternate pathways to scale and impact.

VALUE: Design opens up new pathways to scale by applying creative thinking to reframe problems and envision alternative scenarios for how markets might shift and evolve over time.

3. SILOED DECISION-MAKERS

PROBLEM STATEMENT: Programmatic silos with narrow views of user context may lead to missed opportunities to tap synergies and increase impact across portfolios.

VALUE: Design provides a holistic understanding of user needs and behaviors to bridge program silos and support more integrated programmatic outcomes that maximize the impact of individual investments across under-resourced health systems.

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4. FRAGMENTED APPROACH

PROBLEM STATEMENT: Due to silos, technical experts struggle to bridge different disciplines and areas of expertise to tackle systemic problems.

VALUE: Design supports a multidisciplinary approach to problem solving that can surface new perspectives and connect disparate insights across complex health systems.

 
 
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3. HARD TO REACH POPULATIONS

PROBLEM STATEMENT: Improvements are seen in certain communities but the lives of the hardest to reach are not impacted, preventing us from achieving the SDG’s.

VALUE: Design offers ways to define strategies focused on equity by, more efficiently and effectively, increasing understanding of hard to reach communities and uncovering long-standing barriers to quality service delivery.

1. LACK OF LOCAL OWNERSHIP

PROBLEM STATEMENT: Lack of ownership by local institutions, stakeholders, and communities leads to rapid fall off after the initial rollout.

VALUE: Design encourages local stakeholders to share and influence programs early, and throughout, by emphasizing observation, user experience, and storytelling as ways to maximize opportunities for their participation and ownership over decisions that affect them.

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2. INEQUITABLE OUTCOMES

PROBLEM STATEMENT: Solutions that do not represent the point of view of affected communities lead to inequitable results.

VALUE: Design brokers directly involve communities in the solutions aimed to help them by voicing and making sure all parties are heard equally throughout the processes of observation, learned experience, story telling, and participatory facilitation.

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4. LACK OF MUTUAL TRUST

PROBLEM STATEMENT: Lack of trust limits longer-term value that can be achieved through local partnership models.

VALUE: Design shifts the mindset of stakeholders who are “intervention-focused” or “system-focused” by encouraging them to maximize shared decision-making through mutual understanding, respect, partnership, and trust.

 
 
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FULL LIST OF SOURCES

Conversations with a broad range of global health practitioners and collaborators informed this resource. The following articles and documents were included in this analysis:

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Traditional Socio-Behavioral Research (SBR) and Human-centered Design (HCD), Similarities, Unique Contributions and Synergies By Elizabeth E. Tolley, PhD, FHI 360

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HCD In Global Health & Development, Guidance To Maximize Impact And Mitigate Risk, Prepared by AVAC for the Bill & Melinda Gates Foundation

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HCD Exchange Tanzania, CIFF, Hewlett Foundation, the Bill & Melinda Gates Foundation

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Human-centered Design In Global Health: A Scoping Review Of Applications And Contexts, PLOS One

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In search of alternatives: the value of design for international development, Unpublished doctoral dissertation, Andrawes, L., (Forthcoming 2019), Institute for Global Prosperity, University College London

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Human Centered Design Strategic Plan, Prepared by Dalberg Design for the Bill & Melinda Gates Foundation

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Download the 'Value of Design resource here:

 
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Compromises to achieve this value…

While design can amplify impact in global health programming, it is not a silver bullet or magic wand. To incorporate design into global health programming and vice versa, both designers and global health practitioners need to compromise on the methodologies that feel familiar to them. It is important for these compromises to be understood and discussed at the outset of a project to establish a dialogue and trust. Many projects have successfully navigated these potential tension points -- the project library contains a sample.

 
  • Design typically starts by looking at the needs and behaviors of end users in a holistic, system-based manner. Their insights often intersect multiple sectors such as education, economic growth, and gender dynamics. While global health practitioners recognize and work toward the systemic nature of global health challenges, resources are often directed at specific vertical health challenges, such as HIV or malaria. The constraints that global health practitioners face need to be recognized by designers (and vice versa).

 

  • By its nature, the design process necessitates flexibility and uncertainty. Until its final stages, outcomes of the design process remain undefined given their reliance on divergence and convergence. To that end, designers and global health practitioners need to understand and discuss how to scope and plan projects at the outset and they should set mechanisms in place that document the evolution of their thinking during a project. Through the course of a project, designers iterate on ideas and concepts based on user inputs but these inputs need to be well documented and traceable in order to evaluate how decisions were made. Having these mechanisms in place helps in navigating the tension points that typically arise during the course of a challenging project.
  • Global health relies on a hypothesis-driven approach in which an evidence base is generated to develop and refine interventions. Interventions are then studied further through additional data collection and analysis. The design process, however, adopts a flexible approach that allows for pivots, iterations, and rapid prototyping. While global health is outcome-driven, seeking solutions that are backed by rigorous data, design places equal value on both intuition and experimentation. Following the design of interventions, an evidence base can be collected to measure, evaluate, and refine interventions. This is similar to the hypothesis-driven approach of global health programming.
  • During the initial stages of the design process, designers benefit by engaging with the existing evidence base before embarking on the design research phase. This helps in calibrating the breadth and depth of information to be collected during the research phase. When the existing evidence base is scarce, design can adopt a more rigorous data collection process. Data gathered by designers during such research exercises might be different in nature from that typically collected in global health but it can still act as an equally valuable evidence base.

 

 

The resources contained in this website were developed, in part, to address these potential challenges and bring together a community that draws from both design and global health experts.

Working together, we can create conditions to amplify the impact of our respective work.