Apr 26, 2014

Show Me the Evidence!

Human-centered design, co-creation, and community participation are some of the sexiest terms used in the social sector today. The increase in usage of these terms signifies the social sector's discontent with designing products and services for rather than with the financially poor in developing countries. These terms succinctly illustrate the fundamental ideals of TulaLens, and I've incorporated them into my vocabulary. However, I'm not a fan of drowning in buzz word soup for the sake of it. So, let's take a minute to deconstruct the purpose of partnering with the financially poor.

We generally think of co-creation as a form of respecting the people whose lives we are trying to improve. When organizations partner with the financially poor and deeply listen to them, they acknowledge that people can bring wisdom and intelligence to a discussion despite their financial circumstances. Beyond the values-based argument, there is evidence that shows improved outcomes due to co-creation (I'll speak to the health sector for now because this is TulaLens's initial focus). Thankfully, when I was preparing to pitch TulaLens for the first time last month, the folks at the Global Health & Innovation Conference at Yale asked me to show them this evidence.

I started digging around to demonstrate that partnering with the poor is about values, and also about improved health outcomes due to improved design of health products and services. I came across two types of evidence - anecdotal and empirical. Jacaranda Health in Kenya, for example, has anecdotally shown us the power of engaging in the human-centered design process. They are working with clinical staff to find solutions to improve the nutrition of clients in the maternal health program. I've also come across empirical evidence. The Australian Journal of Primary Health looked at 37 studies focusing on rural health in developing countries. The review showed that community participation in design of health products and services can increase uptake of services and improve health outcomes. One of these studies looked at the effect of participation in women's groups on birth outcomes in Nepal. The results were impressive. A trained female facilitator held 9 meetings each month with women in the community to identify health issues in newborns and devise solutions. The neonatal mortality in this group compared to the group that did not attend meetings was 26.2 per 1000 versus 36.9 per 1000. Other aspects of health also drastically improved in the group that participated in the design of health services including maternal mortality rates, antenatal care uptake, and delivery at an institution.

Rigorous studies that are currently underway to assess the impact of community participation on health outcomes include a study on Participation and Accountability in Healthcare Provision in Uganda and Child Protection Knowledge and Information Network in Sierra Leonne.

I encourage startups and existing organizations to think about the power of partnering with the communities they work with early on. Partnerships go beyond brief interactions. They involve organizations embedding themselves into communities, and often spending years to understand people's needs. These partnerships bring dignity to communities and show that the poor are truly equal partners in the creation process. As Stuart Hart aptly said,"We should think of the poor not just as producers or consumers, but as partners." Partnerships also lead to better design, and improved outcomes. In addition, the evidence shows us and will continue to show us that putting the power of the design process back into the hands of people who use the design can lead to more culturally appropriate and effective products and services.