Do we dare to disrupt traditional public health approaches? “Innovation” has become an integral buzzword across all sectors, often used in abstraction, yet is fundamental to finding new approaches to the problems we face.
One school of innovation, Human-Centered Design (described in this blog post), has risen to prominence because of its potential to help us understand the hidden motivations and incentives that drive the behavior of our consumers—it allows us to question traditional approaches, question our assumptions, and arrive at a solution that is better aligned with our end user.
The past hundred years have seen incredible strides in global health, from remarkable decreases in maternal and child mortality to eradication of certain diseases through vaccination. However, there remain challenges in public health that we have been unable to surmount. Family planning is a classic “wicked problem” that public health workers have struggled to address. For years, private, non-profit organizations and public sector have invested significant resources to increase uptake of family planning. The initial focus was on increasing awareness through a knowledge, attitudes and practice approach, and focusing on system change to build capacity for family planning services. Decades later, we now see very high knowledge and acceptance of family planning as well as greatly improved delivery systems. However, there are frequent instances where discontinuation rates of family planning users are quite high, sometimes in excess of 60%. Looking at this challenge through a business lens, any product with 60% of its clients deserting would find it challenging to stay afloat.
The natural question arises—why? It is worse to see a woman discontinuing contraception use than not starting use at all. She had the motivation to go to a health facility, actually start taking the method, and yet she went home and stopped. This pattern of behavior indicates a larger issue with the product or the system that we have been unable to identify. The associated negative word of mouth and the influence of the women who discontinue may have significant impacts in a community.
We have been asking questions in the field, but we are often getting our answers from health practitioners and administrators and not from the users themselves. We get much of our understanding from the DHS surveys, which asks women why they discontinued. They are provided with a list of possible reasons to choose from and rarely choose to provide a detailed reason of their own. The two most common reasons for discontinuation, “health” and “side-effects,” do not provide researchers with a great understanding of their motivations. This guided approach to research is at odds with HCD, which emphasizes leaving behind any assumptions about users’ motivations and focusing on user-driven research.
We also may not be asking the right questions. HCD promotes a better understanding of the user in order to get the underlying problem statement, giving us the opportunity to define our questions so that they get at the heart of the problem.
Organizations have already seen the potential to develop pilots using HCD. It focuses on a deep dive into the practices of the community so that you can design a solution coming from a rich empathy for their particular situation. HCD starts small so that you can prototype and test solutions until you can figure out how the population is influenced by the specific messaging you have developed and where you can focus your messaging. You first have to start in a small community, find solutions that are appropriate to that community, and then you can see how it is applicable to other communities and if it can be scaled. You can find an introduction to design thinking here and here.
Although this approach requires an intensive commitment of time and resources, it has great potential to develop situationally appropriate, tailored interventions that are completely user-driven with greater user buy-in and commitment. The time has come to use innovative approaches to get at human motivation so that we can gain traction in these traditionally unsolvable public health issues.