WIAD: Design For Everyday Life
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WIAD: 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.

Roberta Tassi, frog's Senior Design Researcher in Milan, shares her thoughts on system thinking for large scale impact.

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  • 1. System thinking for large scale impact ROBERTA TASSI WIAD 2014 15 febbraio DESIGN FOR EVERYDAY LIFE
  • 2. sys·tem a 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.
  • 3. understanding #empathy #data #patterns
  • 4. modeling #synthesis #structure #visualization
  • 5. translating #guide #shape #link
  • 6. the vast majority of the seven million children who die every year never see a doctor
  • 7. community health workers are the “last mile” in healthcare and one of the the biggest untapped resources in global health.
  • 8. how to design a comprehensive and systemic solution to empower Community Health Workers at a global scale?
  • 9. design research understanding CHW aspirations, workflow and needs We relied on a Human-Centered Design process to shape solutions for CHWs that are based on a deep understanding of their real-world needs. 01
  • 10. UGANDA Before CHWs, having medicines to treat malaria available right in the village was a daydream. CHW SUPERVISOR 4 DISTRICTS, 37 INTERVIEWS Backpack Plus Design Research
  • 11. Backpack Plus Design Research
  • 12. The main challenge is sensitizing people to look for health services to timely treat their illnesses. CHW (ASC) SENEGAL 3 DISTRICTS, 26 INTERVIEWS Backpack Plus Design Research
  • 13. Backpack Plus Design Research
  • 14. system thinking mapping and modeling CHW programs The 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. 02
  • 15. CARE COMMUNITY HEALTH SYSTEM SERVICES TOOLS CHW TRUST CARE SUPPORT REPORT CARE Backpack Plus Framework
  • 16. 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
  • 17. Backpack Plus Framework
  • 18. 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 FEEEDBACK SCORECARD HOUSEHOLD REGISTER HEALTH PROMOTION MESSAGES MISOPROSTOL IPT JOB AIDS ED. MATERIALS VISIT REGISTERREFERRAL FORMS STOCK REGISTER RAIN BOOTS RAIN COAT TORCH, LIGHTPENCILS, PENS SOLAR CHARGER MOBILE PHONE VITAMIN A mother VITAMIN A children PILLS CONDOMS PREGNANCY TEST INJECTABLE RUTF SCALE HIV TEST DEWORMING (Albendazole) MAMA KIT 1|PREGNANCY&NEWBORNCARE2|FAMILYPLANNING3|MALNUTRITION4|HIV5,6,7|ADVANCEDSETS8|MAMAKITBASICSET TOOLS JOB AIDS ED. MATERIALS VISIT REGISTERREFERRAL FORMS STOCK REGISTER Backpack Plus Framework
  • 19. 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 REGULAR REFRESHER CHW LIST 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 STANDARD PROTOCOLS REFERENCE MATERIALS VISIT TRACKING STOCK TRACKING HOUSEHOLD TRACKING BASIC MODULE ON EDUCATION SPECIAL MODULES (e.g. RDT) CHW CERTIFICATION BASIC MODULE ON ICCM REFERENCE MATERIALS MOBILIZATION FOR SPECIAL EVENTS BEHAVIOR CHANGE DEMONSTRATIONS STANDARD PROTOCOLS REFERRAL PROTOCOLS REFERRAL TRACKING REFERENCE MATERIALS ONE-TO-ONE REVIEWS SPORT PERFORMANCE CHECK GROUP REVIEWS ‘LEAVE-BEHIND’ INSTRUCTIONS EDUCATIONAL GAMES RESUPPLY BY CONSUMPTION ADDITIONAL TRAINING MODULES GRATIFICATION BY BRANDED KIT REIMBURSEMENTS (e.g. TRANPORT) INCENTIVES THROUGH GADGETS FACILITATION BY BASIC ENABLERS CARRIER PATH PERFORMANCE BASED REPORT ASSESS TREAT EDUCATE REPORT BASICCOMPONENTSNENTSINDIVIDUALCOMMUNITYSUPERVISORCLINICDISTRICTSUPPLIERDESIGNPRINCIPLES 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
  • 20. 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
  • 21. product and service design from research insights to holistic solutions Starting 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
  • 22. 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
  • 23. Backpack Plus Toolkit
  • 24. From a disconnected set of diagnostic tools and medical commodities to a well-orchestrated experience that improves CHW effectiveness. Backpack Plus Toolkit
  • 25. 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
  • 26. Backpack Plus Toolkit
  • 27. From generic storage and carrying solutions to a system designed to easily adapt to evolving CHW needs. Backpack Plus Toolkit
  • 28. 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
  • 29. From one-way data flows to closed and effective feedback loops that provide real- time access to essential information. Backpack Plus Toolkit
  • 30. 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
  • 31. 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.
  • 32. 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
  • 33. Backpack Plus Toolkit From fragmented incentive programs to a clear hierarchy of roles, responsibilities, benefits and opportunities for growth over time.
  • 34. 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
  • 35. Backpack Plus Toolkit From closed ecosystems to integrated public and private sector initiatives aimed at better supporting CHWs and Supervisors.
  • 36. Backpack Plus Toolkit
  • 37. Backpack Plus Toolkit
  • 38. Backpack Plus Toolkit
  • 39. Backpack Plus Toolkit Pneumonia FROM 2 TO 11 MONTHS Diarrhoea FROM 2 MONTHS TO 5 YEARS ACT Lorem 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 ORS Lorem ipsum dolor sit ame diam nonummy nibh euism magna aliquam erat volutp Amoxicillin Lorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat. 07712345678 Paracetamol Lorem 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 Zinc Lorem ipsum dolor sit ame adipiscing elit, sed diam no Chlorhexi Lorem ipsum dolor sit amet, adipiscing elit, sed diam non Neonatal care NEW BORN Fever FROM 0 TO 5 YEARS TYPOGRAPHY COLOR PALETTE ICONS Noto Sans Bold Noto Sans Bold Italic Noto Sans Regular MAIN TEXT SECONDARY TEXT MAIN DISEASES GENERIC DISEASE
  • 40. Backpack Plus Emblem
  • 41. Backpack Plus Emblem
  • 42. Backpack Plus System Framework A reference framework to gather best practices, assess gaps and align partners to scale up existing and future CHW initiatives. Toolkit Emblem A 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.
  • 43. Backpack Plus What’s next
  • 44. T h a n k s