WIAD: Design For Everyday Life

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System thinking for large scale impact ROBERTA TASSI WIAD 2014 15 febbraio DESIGN FOR EVERYDAY LIFE
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Roberta Tassi, frog's Senior Design Researcher in Milan, shares her thoughts on system thinking for large scale impact.

Transcript of WIAD: Design For Everyday Life

Page 1: WIAD: Design For Everyday Life

System thinking for large scale impact

ROBERTA TASSI

WIAD 2014 15 febbraio

DESIGN FOR

EVERYDAY LIFE

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sys·tema set of connected things or parts forming a complex whole.For example a set of things working together as parts of a mechanism or an interconnecting network.

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understanding#empathy #data #patterns

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modeling#synthesis #structure #visualization

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translating#guide #shape #link

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the vast majority of the seven million children who die every year never see a doctor

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community health workersare the “last mile” in healthcare and one of the the biggest untapped resources in global health.

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how to design a comprehensive and systemic solution to empower Community Health Workers at a global scale?

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design researchunderstanding CHW aspirations, workflow and needsWe relied on a Human-Centered Design process to shape solutions for CHWs that are based on a deep understanding of their real-world needs.

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UGANDABefore CHWs, having medicines to treat malaria available right in the village was a daydream.

CHW SUPERVISOR

4 DISTRICTS, 37 INTERVIEWS

Backpack Plus Design Research

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Backpack Plus Design Research

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The main challenge is sensitizing people to look for health services to timely treat their illnesses.

CHW (ASC) SENEGAL3 DISTRICTS, 26 INTERVIEWS

Backpack Plus Design Research

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Backpack Plus Design Research

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system thinkingmapping and modeling CHW programsThe Backpack PLUS framework is a CHW-centric model that identifies all the essential physical, digital and service-level components required to empower and activate CHWs along their journey.

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CARE

COMMUNITY HEALTH SYSTEM

SERVICES

TOOLS

CHW

TRUST

CARE

SUPPORT

REPORT

CARE

Backpack Plus Framework

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INDIVIDUALCOMMUNITY

ASSESS & TREAT

EDUCATE

RESPECT

TRUST

SUPERVISOR HEALTH CENTER DISTRICT

SUPPLIES

REPORT

COACH

SUPPORT

REPORT

REPORT

INSTRUCT

SUPPLIER

TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDINGRECRUITING UPGRADING

CHW

DIAGNOSTICS TOOLS ENABLERSCOMMODITIES

ASSESS TREAT EDUCATE REPORT

Backpack Plus Framework

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Backpack Plus Framework

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ADVANCED MODULES

BASIC SET

DIAGNOSTICSCOMMODITIES TOOLS ENABLERS

ACT AMOXICILLIN

CHLORHEXIDINE

PARACETAMOL

RDT

RESPIRATORY TIMER

MUAC

ORS & ZINC

GLOVES

ALCOHOL PADS ALCOHOL

SCISSORS

SOAP

BANDAGES

SYRINGE

TRASH BIN NOTEBOOKTHERMOMETER

TRANSPORTATION(bike, motorbike,...)

UNIFORM

HOUSE SIGNAGE

ADVANCED ED.MATERIALS

FEEEDBACKSCORECARD

HOUSEHOLDREGISTER

HEALTH PROMOTIONMESSAGES

MISOPROSTOL IPT

JOB AIDS ED. MATERIALS

VISIT REGISTERREFERRAL FORMS

STOCK REGISTER

RAIN BOOTS RAIN COAT

TORCH, LIGHTPENCILS, PENS

SOLAR CHARGER MOBILE PHONE

VITAMIN Amother

VITAMIN Achildren

PILLS CONDOMS PREGNANCY TEST

INJECTABLE

RUTF SCALE

HIV TEST

DEWORMING(Albendazole)

MAMA KIT

1 | P

REG

NA

NC

Y &

NEW

BO

RN

CA

RE

2 | F

AM

ILY

PLA

NN

ING

3 | M

ALN

UT

RIT

ION

4 | H

IV5,

6,7

| AD

VAN

CED

SET

S8

| MA

MA

KIT

BA

SIC

SET

TOOLS

JOB AIDS ED. MATERIALS

VISIT REGISTERREFERRAL FORMS

STOCK REGISTER

Backpack Plus Framework

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ACTORS INVOLVED

DESIGN PRINCIPLES

SERVICE ELEMENTS

ON DEMAND RESUPPLY (supervisor)

Ensure continuity by selecting people who are long-term members of the community (resident, married).

Leverage existing influential roles that are already present in the community.

Manage age limits (min but also max age).

Embrace flexibility to adapt the criteria to specific regions (i.e. nomadic areas, low-literacy,...).

SELECTION CRITERIA

PUBLIC ANNOUNCEMENTS

REGULARREFRESHER

CHWLIST

Define reference recruiting criteria

RECRUITING TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDING UPGRADING

Create modular training plans to enable incremental learning and differentiate competences.

Teach fundamentals of time/budget management.

Provide analog and mHealth services that can be access by CHWs also at the end of the training period.

Create a moment at the end of each training session to certify and/or celebrate the new competences aquired by CHWs.

Set up routine refresher training sessions to ensure a continuous learning experience.

Support a continuous learning process

Provide standard protocols with reference materials that guide the assessment through a series of steps.

Create strong consistency and cross-references across job aids, diagnostics, commodities and informational materials.

Include visuals that help understanding and sharing the process also with the patients.

Improve guidance through integrated tools

Provide standard instructions for dosages with supporting reference materials.

Create strong consistency and cross-references across job aids, diagnostics, commodities and information.

Support referral at a system level (i.e. referred patients are given priority at the clinic).

Strenghten follow-up visits through protocols and reminders.

Provide clear instructions & follow-up

Facilitate education processes through rich media (visuals, audio, video).

Optimize content and materials to address different situations (1:1, households, group sessions).

Stimulate an active engagement of the community.

Provide tools to facilitate education

Facilitate consistent data tracking through clear recording standards and protocols.

Enable data sharing across different stakeholders by armonizing tools and optimizing transmission of information.

Enable data mining by facilitating aggregation of information across tools.

Give value to the collected information by giving it back to CHWs and their communities.

Improve data collection and mining

Establish clear roles of a supervisor and relationship to the CHW (e.g. how often they see each other).

Ensure a continuous support and supervision through meetings at defined intervals (e.g. weekly meeting).

Include role-modeling through joint visits with supervisors.

Include spot checks of the supervisor with the community.

Enable the collection of a clear basic set of data that supports the supervisor with performance management.

Enable the supervisor to set real incentives in case of good performance.

Set clear roles and responsabil-ities

Address restocking by using data to make effective forecasts.

Maximize resupply efficiency by communicating availability of stocks.

Bring the supplies as close as possible to CHWs by leveraging existing resources (shops, private supply chains, etc.).

Facilitate transportation (either by reimbursement or by providing logistical support).

Optimize access and system efficiency

Enhance the community perception of the role of CHWs through branded materials.

Give visibility to the CHW-enabled outcomes inside the community.

Celebrate & reward the work of CHWs

Establish a clear career path based on personal inclinations and impact.

Provide incremental training to enrich and evolve competences.

Establish a clear career path

SUPERVISOR

STANDARDPROTOCOLS

REFERENCE MATERIALS

VISITTRACKING

STOCK TRACKING

HOUSEHOLDTRACKING

BASIC MODULEON EDUCATION

SPECIAL MODULES(e.g. RDT)

CHW CERTIFICATION

BASIC MODULEON ICCM

REFERENCEMATERIALS

MOBILIZATION FOR SPECIAL EVENTS

BEHAVIOR CHANGE DEMONSTRATIONS

STANDARDPROTOCOLS

REFERRAL PROTOCOLS

REFERRAL TRACKING

REFERENCE MATERIALS

ONE-TO-ONE REVIEWS

SPORT PERFORMANCE CHECK

GROUPREVIEWS

‘LEAVE-BEHIND’INSTRUCTIONS

EDUCATIONALGAMES

RESUPPLY BY CONSUMPTION

ADDITIONAL TRAINING MODULES

GRATIFICATION BY BRANDED KIT

REIMBURSEMENTS(e.g. TRANPORT)

INCENTIVES THROUGH GADGETS

FACILITATION BYBASIC ENABLERS

CARRIERPATH

PERFORMANCE BASED REPORT

ASSESS TREAT EDUCATE REPORT

BA

SIC

CO

MP

ON

ENTS

AD

VAN

CED

CO

MP

ON

ENTS

IND

IVID

UA

LC

OM

MU

NIT

YS

UP

ERV

ISO

R C

LIN

ICD

IST

RIC

TS

UP

PLI

ERD

ESIG

N P

RIN

CIP

LES

Establish clear roles of a

relationship to the CHW (e.g. how often they see

Ensure a continuous support and supervision through meetings at defined intervals (e.g.

Set clear roles and responsabil-

Address restocking by using data to make effective forecasts.

Maximize resupply efficiency by communicating availability of stocks.

Bring the supplies as close as possible to CHWs by leveraging

Optimize access and system efficiency

Enhance the community perception of the role of CHWs through branded materials.

Give visibility to the CHW-enabled outcomes inside the community.

Celebrate & reward the work of CHWs

Establish a clear career path based on personal inclinations and impact.

Provide incremental training to enrich and evolve competences.

Establish a clear career path

Backpack Plus Framework

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TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDINGRECRUITING UPGRADING

INDIVIDUALCOMMUNITY

CHP

SUPERVISOR SUPPLIERHEALTH CENTER

SUPPLIES

ASSESS& TREAT

TRUST

REPORT

COACH

REPORT

DIAGNOSTICS TOOLS ENABLERSCOMMODITIES

SUPPORT

ASSESS TREAT EDUCATE REPORT

HEALTH RELATED GOODS

SERVICES

LG BRANCH

INDIVIDUAL CHWCOMMUNITY

SUPERVISOR

SUPPLIES

ENGAGE

INFORM

COACH

REPORT SUPPORT

REPORT

REPORT

SUPPORT

SUPPLIERHEALTH CENTER DISTRICT

MAPPING OTHER PROVIDERS

MAPPING OTHER USERS

MAPPING PRIVATE OPPORTUNITIES

Backpack Plus Framework

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product and service designfrom research insights to holistic solutionsStarting from core CHW needs highlighted during field research we identified opportunities to improve the quality of the solutions they are provided. Integrating physical tools and mobile-enabled services into one cohesive experience will positively impact community health outcomes.

03

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Current tools and process meant to support CHWs are fragmented, often affecting effectiveness and undermining motivation.

“The job aid is our Bible”CHW (UGANDA)

Backpack Plus Research Insight

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Backpack Plus Toolkit

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From a disconnected set of diagnostic tools and medical commodities to a well-orchestrated experience that improves CHW effectiveness.

Backpack Plus Toolkit

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Storage and carrying solutions for tools and commodities aren’t flexible enough and do not support CHW workflows.

“The bag I was given is big and bulky, I never need to carry that much.”CHW (UGANDA)

Backpack Plus Research Insight

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Backpack Plus Toolkit

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From generic storage and carrying solutions to a system designed to easily adapt to evolving CHW needs.

Backpack Plus Toolkit

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Data that is currently generated by CHWs and other actors in the system is not consistent and seldom turned into useful information.

“The data collected here is always incomplete.”DISTRICT MANAGER (SENEGAL)

Backpack Plus Research Insight

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From one-way data flows to closed and effective feedback loops that provide real-time access to essential information.

Backpack Plus Toolkit

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CHWs are asked to cover an ever-increasing variety of health domains, not always properly supported by training and adequate tools.

“New training means that they are investing in us!”CHW (SENEGAL)

Backpack Plus Research Insight

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Backpack Plus Toolkit From irregular training sessions to a continuous learning model that targets CHWs but also accounts for the need to educate their communities.

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Current incentive programs -monetary or otherwise- often fall short of being perceived as making the difference in the lives of CHWs.

“These people put in their own money to do their job!”CLINICAL OFFICER (UGANDA)

Backpack Plus Research Insight

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Backpack Plus Toolkit

From fragmented incentive programs to a clear hierarchy of roles, responsibilities, benefits and opportunities for growth over time.

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Fragmented or inefficient supply chains can result in perceived lack of CHW support, and undermine the level of trust they need to be effective.

“Why should I walk to the clinic if then they don’t have medicines?”CHW (SENEGAL)

Backpack Plus Research Insight

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Backpack Plus Toolkit From closed ecosystems to integrated public and private sector initiatives aimed at better supporting CHWs and Supervisors.

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Backpack Plus Toolkit

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Backpack Plus Toolkit

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Backpack Plus Toolkit

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Backpack Plus Toolkit

Pneumonia

FROM 2 TO 11 MONTHS

Diarrhoea

FROM 2 MONTHS TO 5 YEARS

ACTLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.

Malaria

FROM 4 MONTHS TO 3 YEARS

07712345678

07712345678

ORSLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.

AmoxicillinLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.

07712345678

ParacetamolLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.

07712345678

Diarrhoea

FROM 2 MONTHS TO 5 YEARS

ZincLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh.

ChlorhexidineLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh.

Neonatal care

NEW BORN

Fever

FROM 0 TO 5 YEARS

TYPOGRAPHY

COLOR PALETTE

ICONS

Noto Sans Bold

Noto Sans Bold ItalicNoto Sans Regular

MAIN TEXT

SECONDARY TEXT

MAIN DISEASES GENERIC DISEASE

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Backpack Plus Emblem

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Backpack Plus Emblem

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Backpack Plus System

FrameworkA reference framework to gather best practices, assess gaps and align partners to scale up existing and future CHW initiatives.

Toolkit EmblemA systemic set of physical and digital tools to empower CHWs and improve the quality of the healthcare services they provide.

A symbol for Backpack PLUS that could be used by the public health community for advocacy and large scale fundraising.

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Backpack Plus What’s next

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T h a n k s