Building better healthcare from the bottom up

In my work designing medical devices, when I ask health workers about the major challenges they face, the most common reaction is surprise. Rarely are they asked this. Their answers also surprise me. Yes, the usual responses are there: lack of equipment or supplies, power outages, poor pay. But so was morale. As a 30-something, bespectacled doctor at a dusty rural community clinic put it to me: “I’m overworked. I haven’t received my pay in two months. I don’t have any medicines or gauze. My wife has no one to talk to here.”

Health ministries and global health experts talk a great deal about finding the right incentives to change behaviour to improve healthcare. Yet, from a design – and human – perspective, I wonder if we need to flip this thinking on its head. A good solution needs little or no convincing of its value. Instead of starting to develop innovations in the laboratory and then convincing people to use them, why not start with the user and work backwards to the laboratory?

All too often, a perceived problem is part of a larger one – like a lack of morale – which needs to be tackled if the solution is going to have any lasting impact. We can take this one step further and test the value of a solution on the market: instead of donating medical devices, why not design devices to meet the needs and price points of users – and sell them?

The need for user-centric, or “bottom-up,” approaches in addressing sticky health issues is critical. Too often, health problems are prioritized using only data, and innovations are developed without user engagement. User-centric design can be messy and time-consuming if you are used to working in an office. Understanding users means being in hospitals, in clinics, in delivery rooms, and understanding markets, day-to-day operations, motivations and constraints. But at the same time, almost all of the medical professionals that I’ve met are passionate about their work and have no trouble articulating their needs.

It was from an Indian doctor that D-Rev, the organization I lead, first learned about the need to find an effective treatment for severe jaundice. Our fieldwork in over 200 hospitals and clinics confirmed a broad need in the developing world. One nurse at a hospital in central Uganda showed my colleague how she placed her jaundiced newborns in the sun because she had no phototherapy device.  More than 10% of these babies suffered brain damage or died from lack of adequate treatment. The irony is that hyperbilirubinemia (or severe jaundice), although easy to treat with blue light phototherapy and a common problem, has traditionally not been seen as a major neonatal health threat within the global health community. The reason: it has been difficult collecting the data needed to prove it is a problem. Our work at D-Rev starts with users, so we designed a state-of-the-art phototherapy device, Brilliance, which specifically targets urban hospitals in low-income regions.  It costs 1/8th of the price of comparable devices, and reaches facilities that, in most cases, have never previously had effective phototherapy.

Technology, like phototherapy, can be a beguiling solution to large-scale problems. The best innovations, and the ones most likely to make a real difference, start thinking about how a product will be delivered even when it is still in the design phase. How does the product get from the factory to the user? Why would they use it? What motivates them to keep using it?

Several years ago I attended a meeting where a new way to keep vaccines cold was presented to doctors from Sub-Saharan Africa. The technology was brilliant: the scientists had developed a free-standing cooler that could maintain a specified temperature range for three to five times the length of time possible with existing coolers. But the equipment was what I call fussy: the cooler was large and awkwardly shaped, not something that could be strapped to a motorcycle or piki-piki (motorized bike). It used long chilling cylinders that needed to be frozen periodically, yet they looked too large for any freezer except a top-opening horizontal deep freezer, like the kind you find in an American basement. A special tool was required to load and extract the vaccines from the cooler. The doctors were impressed with the remote temperature monitoring via cell phone, but no one, except me, inquired about the cooler’s price. The scientists didn’t know; they hadn’t considered cost in their design process.

In global health, we don’t think of charging money as working in favour of patients’ needs, but it can do so for many products. A product that is sold must be user-centric; it must meet users’ needs and market requirements, including affordability. Products that are valued are products that are used and have impact.  Poorly designed products don’t sell.  And in short, charging money holds designers and implementers – instead of overworked medical staff and patients living in poverty – to account. Moreover, selling a product offers a path to scale, with minimal ongoing donor funds.

The world is confounded by difficult problems in healthcare that are ripe for innovative solutions. At the same time, the information most needed for these solutions to have a real and lasting impact is readily available – from the users. To start, they need to be asked: How can we solve X? What is your experience with Y? Instead of focusing on asking people in developing countries to change their behaviour, those of us who work in healthcare should sit up and listen to what they have to say.

Read the Technology Pioneers 2014 report.

Author: Krista Donaldson is the Chief Executive Officer of D-Rev, a 2014 World Economic Forum Technology Pioneer.

Image: Women who have recently given birth rest in a clinic in central India REUTERS/Vivek Prakash.