The value of design in global public health

The past three decades have witnessed a remarkable evolution of design. The concept has gone from a relatively niche practice to a buzzword gracing the publications of respected thought leaders and outlets such as Forbes and Harvard Business Review. Today, design has been embraced by leading global companies such as Apple, Disney, and Johnson & Johnson (see sidebar “First things first: What is design?”) and taught in classrooms at MIT, Stanford, and other top universities.

Successful incorporation of human-centered design in products and services has created huge value for companies. According to McKinsey’s 2018 The business value of design report, which tracked the design practices of 300 publicly listed companies, those with top-quartile design scores had 32 percent higher revenue growth and 56 percent higher growth in total shareholder returns than comparable peers during the same five-year period.

This pattern of performance holds true across sectors, including banking, consumer packaged goods, and healthcare. The reason for this is simple: rather than imposing preconceived assumptions about the customer when creating products and services, a successful design-based approach starts with understanding the customer’s needs and harnessing cross-functional perspectives to identify areas of opportunity. Design is inherently iterative and analytical in nature; with each cycle, the goal is to improve the user experience in a defined and measurable way.

Design can be similarly powerful in global health, where the user and stakeholder groups are numerous—ranging from patients to providers to suppliers to policy makers—with complex and sometimes hidden needs, preferences, and constraints. Harnessing design means focusing on better understanding individuals’ needs and motivations, translating these insights into tangible ideas, and iteratively testing and refining prototypes before rolling out a fully baked solution. By taking these steps, global health leaders can bring huge value to public health projects, programs, and organizations—and, of course, to the millions of people and communities they serve.

The value of design in public health

“Human-centered design. Meeting people where they are and really taking their needs and feedback into account. When you let people participate in the design process, you find that they often have ingenious ideas about what would really help them.”1

Melinda Gates, cochair, the Bill & Melinda Gates Foundation

Design can help craft a standout user experience and contribute to greater awareness, use, and adherence to interventions—including both products and services—that save lives and promote well-being. However, many public health leaders are not fully aware of the value and potential of design. When applied appropriately, design can add value to global health organizations in three ways: addressing the right problem by uncovering users’ deep-rooted needs and challenges, building ownership from the start by engaging a broad set of stakeholders, and finding the right solution by being willing to fail fast.

Addressing the right problem by uncovering users’ deep-rooted needs and challenges

To start, design can help leaders understand users’ immediate needs. Consider, for example, the elements that contribute to a pregnant woman’s ability to secure prenatal care. These might consist of the money to pay for it, access to transportation, permission to visit the clinic, and appointments that do not take too much time away from the workday. These underlying, often auxiliary issues can materially influence the development of effective prenatal care solutions.

For example, a West African country’s state ministry of health wanted to increase the usage of essential health commodities (such as clinical supplies and medicines) to improve maternal, newborn, and child health in the country. With the support of the United States Agency for International Development (USAID), a project was initiated to apply design in three states. The project developed new solutions that addressed supply-chain issues, improving availability and encouraging broad use. Through applying methodologies for the “understand” and “translate” steps of the design process in close collaboration with more than 200 health-system stakeholders—including mothers and healthcare workers—the stakeholders collectively agreed that a broad set of demand-side barriers needed to be brought into focus. These barriers included awareness about correct usage, cultural and social beliefs, and affordability. These challenges prevented patients and healthcare workers from using the medicines even if they were available. The team then pivoted to generate and prototype both the demand-side and supply-side solutions that would spur the adoption of essential commodities—including community awareness programs, health-worker training, and community-driven accountability—in addition to a more streamlined supply chain.

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Building ownership from the start by engaging a broad set of stakeholders

By involving a broad variety of stakeholders and end users throughout the entire process, the design team ensures the solutions reflect the collective lived experience. In addition, such involvement creates ownership to carry forward the implementation once the design team leaves.

Design can add value to global health in three ways: addressing the right problem by uncovering users’ deep-rooted needs and challenges, building ownership from the start by engaging a broad set of stakeholders, and finding the right solution by being willing to fail fast.

For example, in the case of the West African commodities project, the design team convened more than 200 stakeholders to identify the most critical improvements needed, and they generated more than 300 potential solutions. The same group of mothers, physicians, clinical staff, community representatives, and suppliers then worked in several rounds to refine the ideas into 12 solutions, which were then prototyped. Finally, the full team came together to develop implementation plans for the most promising solutions. This interactive and engaging process allowed team members to identify and educate one another on constraints likely to arise during implementation and brainstorm solutions to mitigate them. It also encouraged a high degree of ownership among the stakeholders, who soon after started the implementation process and carried it forward.

Finding the right solution by being willing to fail fast

Leaders can lean on quick cycles of experimentation to uncover issues that may derail potential solutions early in the process, thus allowing teams to refine or abandon them before investing too much time, energy, and resources. As an added benefit, this approach increases confidence that chosen approaches will be accepted by their intended users at and long after launch.

In the West African example, three regions needed to improve the transportation of medicines that require cold storage. Early on, the design team explored multiple solutions and tested the feasibility of each method using very simple prototypes. Within one week of testing with stakeholders from the communities, it became clear that a solution for one region wasn’t necessarily the right response in another. As a result, one region adapted its existing supply-chain infrastructure while another established a relationship with a private-sector distributor.

Where design could be applied in global health

“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.”2

David Milestone, former acting director of USAID’s Center for Accelerating Innovation and Impact

As a problem-solving approach, design can be applied at the project, program, and organization levels (exhibit). For our purposes, “projects” refer to time-bound initiatives focused on specific health products or services, “programs” refer to multiyear and systems-level health programs, and “organizations” refer to broader organizations within the global health ecosystem.

Design can be targeted at different levels to drive value in global health.

Across these applications, it is important to remember that design is just one approach among many. Realizing the value of the approach means understanding when to use design exclusively and, perhaps more importantly, when to integrate it with other methods. For example, project leaders might first generate insights from design-led interviews and observations—a small sample size. They might go on to test these hypotheses via a large-sample, traditional survey to build a more comprehensive picture.

Project level

Currently, the most common and straightforward deployment of design within global health is at the individual project level where teams can use the approach to develop a specific concept (whether a product or service), support its introduction, or both—for example, to harness user or customer insights to increase uptake (see sidebar “Case study: Developing a new infant jaundice treatment device”). A growing number of global health organizations have experienced success with this type of design engagement.

Program level

Beyond the scope of an individual project, the design approach can also be used to improve the effectiveness of broader programs (see sidebar “Case study: Improving the design of care delivery for community-level health services in Mali”). These are typically multiyear health programs that encompass all or part of a larger system—for example, a health supply chain or primary healthcare system. While projects are often standalone efforts bound by a set goal and defined timeline, programs require continuous improvement over a sustained period and can benefit from design at various stages. At the program development stage, design can help fine-tune focus areas by incorporating a more comprehensive understanding of users’ needs, preferences, and constraints. During implementation and scale-up, design approaches and tools can help leaders create program interventions that are not only aligned with user needs but also actively chosen and sought out by users. Thus, these solutions are often broadly adopted by end users, providers, and other stakeholders.

Organization level

Design practices can be infused into broader strategy, culture, and processes so that user orientation becomes a more significant part of an organization’s fabric. Successful deployment at this level means that decisions—whether they are strategic, operational, or organizational—are made with users in mind. Within healthcare organizations, users include the beneficiaries of a solution or offering (such as patients, community members, clinic staff, and doctors) as well as all the health system stakeholders (such as providers, purchasers, distributors, and regulators) involved in realizing its intended impact. At the organization level, embracing design to focus on a complex user group encourages new modes of collaboration across functions, making internal teams more agile and innovative (see sidebar “Case study: Embedding design into strategy development at an innovative global public health organization”).

How inclusive design can reconnect people with government

How inclusive design can reconnect people with government

Many community-based, nongovernmental health organizations have used principles similar to design for decades. Larger institutions are also starting to adopt the approach. According to Design for Health—a coalition of global health organizations, donors, and designers committed to amplifying impact in global health through design—more than 35 major global health projects have “used design as an essential component.”3 Additionally, multilateral organizations such as UNICEF have begun building out internal design capabilities, and leading donors such as USAID and the Bill & Melinda Gates Foundation have invested in expanding the use of design in global health.

As the growing number of design success stories in global health present an exciting opportunity to expand its use even further, there is a need for a conscious and deliberate effort to debate and adopt the best practices of applying design within the complexities of global health delivery systems. It is not enough to adopt the design process; rather the entire organization has to accept the design mind-set and put in place cross-functional talent and effective ways to encourage collaboration between them.

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