Human-centered design (HCD) is a way of thinking that places the people you're trying to serve at the center of the design and implementation process. HCD was developed in the private sector to integrate business and technology around human needs. While these methods and principles have been applied for decades in global health, HCD is now being increasingly applied in more targeted and deliberate ways to the health sector and for good reasons.

Global health faces significant hurdles that stem from the complexity of navigating and coordinating health programs in a variety of settings, the difficulty of promoting different health behaviors, the barriers in scaling compelling solutions, and the challenge of measuring impact.

HCD is well suited to tackle these issues in the health sector by actively engaging program beneficiaries, providers, and other key health stakeholders throughout the program development process to ensure that their needs and expectations inform design decisions and lead to better and more lasting health outcomes.

A defining characteristic of the HCD process is that it prioritizes talking to and collaborating with the people who are most likely to be affected by the development of a new health intervention or program. The process seeks to better understand a health challenge from the human perspective, including how it looks and feels to real people and how it applies to the environment and context in which they live.

This understanding then informs the iterative development of concepts designed to address the health challenge along with strategies for gathering feedback from individuals and communities along the way. The HCD process is often most visible in the methods used, which can include observations, interviews, collaborative workshops, rapid prototyping, and individual and community engagement sessions.

To learn more about HCD and some of the ways it's being applied to the Bureau's work, please visit: www.engagehcd.com or contact USAID's Center for Accelerating Innovation and Impact (CII).

Driving Demand for Chlorhexidine through a Human-centered Approach

Source: Karen Kasmauski/USAID's flagship Maternal and Child Survival Program

Since 1990, the number of neonatal deaths has decreased more than 40 percent; even still, in 2015, 2.7 million babies died within the first 28 days of life. To accelerate progress in reducing neonatal deaths, it is essential to introduce and scale cost-effective interventions.

One such intervention is chlorhexidine, an antiseptic applied to the umbilical cord. When used in high-risk settings on the first day of life, chlorhexidine has shown a 23 percent reduction in neonatal mortality. Chlorhexidine costs less than $0.25 per dose, is simple to use, requires minimal training, and is easy to manufacture.

Yet, in many high-risk settings, chlorhexidine is not widely used as many expectant mothers and nurses are unaware that it exists. Significant efforts around demand generation are needed to raise awareness of this life-saving commodity and ensure sustainability of programming.

USAID partnered with Dalberg's Design Impact Group, the Chlorhexidine Working Group, and USAID's flagship Maternal and Child Survival Program to design a demand generation toolkit to develop tools and drive demand for chlorhexidine.

In designing the toolkit, 1,000+ hours were spent working in local communities in Nigeria (a country in the midst of its own chlorhexidine scale-up efforts); 100+ hours of interviews occurred; and 5 ideation workshops took place. Concept prototypes were developed during each stage then were tested in communities and expert interviews. Based on feedback from testing, prototypes were updated and tested again.

Through this iterative process, the final demand generation toolkit was developed. The toolkit is designed for countries and communities introducing and scaling chlorhexidine. It has two parts: a guide that provides details about the concepts and how they can be adapted and used; and an asset library that includes editable templates and images. The toolkit is free and open source.

Project EMOTION: Creating HIV Prevention Products that Fit into Women's Lives

The "V" branding for oral PrEP is meant to mimic the style of women's makeup products, with bright colors and easy-to-use packaging. Photo credit: Project EMOTION/CONRAD

USAID's Office of HIV/AIDS project, Enhancing Microbicide Uptake in High-risk End Users (Project EMOTION [PDF, 573K]), incorporates human-centered design into HIV product development and service delivery to increase women's use and protection. Project EMOTION harnesses the power of good product design in order to increase uptake of and adherence to oral pre-exposure prophylaxis (PrEP), a daily pill to prevent HIV acquisition, among high-risk young South African women.

To inform product design, Project EMOTION conducted qualitative interviews and focus groups with young South African women to understand what types of product packaging worked best for them. Initially, researchers thought plain and inconspicuous PrEP packaging would be the most accepted by the women in their focus groups. Based on women's feedback, they learned that plain packaging stood out starkly among the other brightly colored products women commonly have on their bathroom counters or nightstands. In effect, plain packaging made a woman's use of PrEP more obvious to a partner, decreasing the likelihood of her using PrEP altogether. Based on this human-centered design research, the need for a brightly colored, functional and empowering PrEP brand and packaging was clear.

The "V" branding for oral PrEP is meant to mimic the style of women's makeup products, with bright colors and easy-to-use packaging. Photo credit: Project EMOTION/CONRAD

Currently, Project EMOTION [PDF, 573K] is preparing to test its human-centered design-based PrEP branding, known as "V," to see if a product designed to seamlessly fit into women's lives will increase adherence with taking the oral PrEP medication consistently. In the study, women will either receive standard oral PrEP tablets in accordance with the current World Health Organization and South Africa Department of Health guidelines for oral PrEP (same tablets) with branding created using human-centered design. Project EMOTION's hypothesis is that this branded product, reinforced by changes in label design and inserts, a social support network and different approaches to provider training, will create an end-user-centered experience that can increase correct and consistent use of oral PrEP. By significantly raising adherence above that of women on the current standard of care for oral PrEP, this user-focused approach can help protect a higher proportion of vulnerable women against HIV, which is critical to controlling the HIV/AIDS epidemic globally.

Project EMOTION is an international research consortium made up of multiple USAID partners, led by CONRAD in collaboration with IDEO, Abt Associates, RTI International, CAPRISA and Matchboxology.

Putting Innovators in the Shoes of Ebola Healthcare Workers

Source: ENGAGE HCD

In response to the 2013-15 Ebola outbreak in West Africa, USAID partnered with the White House Office of Science and Technology Policy, the U.S. Centers for Disease Control and Prevention, and the U.S. Department of Defense to launch Fighting Ebola: A Grand Challenge for Development in late 2014.

The Challenge called on the global community to share new solutions to help healthcare workers provide better care to their patients. After a rigorous review process of more than 1,500 applications, 14 potentially game-changing solutions were selected that address a range of gaps in the global response capacity including personal protective equipment, improved care settings, decontamination, healthcare worker tools, and information communication technology.

This Challenge provided human-centered design support to seven promising solutions from the Fighting Ebola Grand Challenge portfolio. Each innovator was at a different stage of product development and faced a wide range of challenges as they sought to bring their innovations to market. The innovators worked to identify their unique set of needs and develop individualized design support along the HCD process.

A few examples of supporting activities provided to innovators included: gathering user feedback, product iteration and refinement, systems mapping, product introduction and market assessment strategies, pilot strategy, and stakeholder workshops. Much of the design support was guided by engagement with healthcare workers on the ground in Guinea, Liberia, and Sierra Leone. This Grand Challenge also set the stage for addressing future infectious disease outbreaks.

GLOBAL HEALTH VOICES

Podcast

David Milestone and Robert Fabricant discuss Human-centered Design for Health on the USAID Global Health podcast.
Download a transcript of this podcast [PDF, 90KB].

David Milestone, Acting Director, USAID's Center for Accelerating Innovation and Impact

Robert Fabricant, co-Founder of Dalberg Design Impact Group (DIG) and Partner at Dalberg Global Development Advisors