Eating an elephant : Designing for Health and Human Rights outcomes

They say when eating an elephant, take one bite at a time. When it comes to attempts to address socio-economic challenges affecting Africa — healthcare, access to information, human rights, social justice, democracy, agriculture, information technology, etc — we find that there is dissonance between the various actors in the development space. On one hand, you have a community of enthusiastic African organizations working to address these challenges. This community includes social entrepreneurs, tech start-ups and non-governmental organizations, which often lack the tools and support structures to ensure they are efficient, effective and keep innovating with the contextualized needs of the target population at the core of their work in order to scale and have meaningful impact. These are the makings of a design elephant.

So the human centered design project between the iHub UX Lab -which was absorbed into the single unit — and the Open Society Foundation was born and I was co-responsible for carrying out the year long project.

I undertook to employ and test design-thinking approaches for human rights and health outcomes. Broadly, it sought to improve the livelihoods of marginalized populations in Kenya, particularly health outcomes and legal representation. The majority of the targeted demographic included bar hostesses and sex workers across Nairobi, though other groups whom struggle more generally with access to healthcare and legal representation.

From a description of the target users, you can already tell this was not an easy undertaking especially because this is at surface level a taboo subject, especially in Africa. It raises legal, moral, ethical, trust and other questions that traditional channels and methodologies have found difficult to engage. Health and human rights questions and dialogues among marginalized populations have long been difficult or perhaps deemed ‘not important’. I was scared, unsure, soldiered on.

It’s in these uncomfortable spaces that I believe human centered design plays a critical role, not only because it is fosters communication and collaboration, but also because it is chiefly based on empathy and rooted in an understanding of the users, problems and context were in.

The envisioned and potential end products of which some are digital products and others not, were :

  • Better organizational process(es);
  • A communication/feedback system between target populations and service providers;
  • Better advocacy strategies for civic and government involvement.

We spent weeks in research across Kenya talking with sex workers, health workers, partner organizations offering services to the target population, government bodies including the police, legal advocates and a host of stakeholders to understand (among others): Who really are we designing for? what are their day to day lives like? What are the most pressing challenges as experienced by individuals and organizations? What are the different relationships in this system and where do they breakdown and why? How can we help the organizations achieve their mandate more effectively?

They talked about the challenges they face in accessing affordable health care and receiving fair treatment. The societal stigmatization and living with no voice or one that is barely heard. Health workers talked of challenges in staffing ample competent caregivers, creating awareness, accessing information and training for themselves.

All the data collected (and it was a whole lot) was incredibly rich food for ideation and prototyping. It was tough, it was instructive and shed brought new light to the work of designing in underserved communities. Much can be said about this work and I will detail specific insights and outcomes in a separate piece but for now, here are some of the key top-level lessons I took away from this experience:

Embrace non-prescription

“It’s not ‘us versus them’ or even ‘us on behalf of them.’ For a design thinker it has to be ‘us with them’”

– Tim Brown, CEO and President of IDEO

Forget about your prescriptions to begin with, the design mindset should be aimed at first discovery then solutions. By prescribing what technology and solutions we think are best, we may miss out on rich opportunities to create meaningful impact in the long term and solving a need people actually have and want solved.

Design, in its truest form, removes our personal biases and creates room for a new dimension where dialogues can happen that traditional mind-spaces fall short.

Empathize

I was entirely surprised at the trust & raw honesty of the sex workers, health workers, police, lawyers I spoke to about their lives and work. In addition to interviews, ethnography, as a tool for immersion, I used diary studies where participants’ data is self-reported as answers to questions touching on their lives, work, technology, habits and journeys interacting with different tools and channels etc.

In his book Change by design: How design thinking transforms organizations and inspires innovation, Tim Brown describes empathy as key to connecting with our audiences intruder to arrive at insights that allow us to create products and services that improve lives.

Empathy at the very least, is truly humbling. Realize we are designing for people who are more than a statistic and want to be heard, to be truly heard. We learn the contexts in which people exist and thrive, mental models and are inspired to create value.

Open up safe spaces

Create trust and safe, open spaces where people can share their experiences. I did this by primarily by meeting people where they are in familiar friendly settings. Sometimes just being aware of the sensitivities, cultural differences and barriers begins to give insight into what may create an atmosphere of fear and how to deal with it.

In addition, actively engaging with stakeholders and involving them in the design process. When people are involved in the process, they come up with truly innovative ideas about what solutions would alleviate their pain points. We often played games, assured people of confidence, reiterated our purpose and intention as well as told and laughed at random stories as well..never hurts.

With organizations especially where one has no exposure to it, it is helpful to identify and define strategic purpose of HCD, highlight success stories, metrics on how the process can help overcome challenges and increase impact.

Make it, break it, Iterate

“The best way to get a good idea is to get a lot of ideas.” 
 — Linus Pauling, Nobel Prize Chemist

And oh did we have plenty ideas -so many sometimes it’s a brain melting exercise to pin them down.

With the insights derived from research we went through a rigorous context-focus ideation process to arrive at potential solutions and made prototypes out of the most viable. We were wrong often, thank goodness for a culture that truly embraced failure and learning from it through communication and collaboration. By continuous iteration on solution ideas with stakeholders involved, it was possible to validate learnings and adapt as necessary. Iterative prototyping also creates by in for eventual solutions as people are involved through the evolution of what could be a critical piece of their lives.

— —

The learning, experience, difficulty, awareness, creativity and all around development as a designer and human being gained from this project are all together difficult to describe. Overall, have seen and I believe we’ll continue to see mind shifts in approaching some of these complex systems and problems, toward wholistic building around the needs of the community and thoughtfully measuring the impact of their approach.

These are simple lessons I carry with me in my design consulting work in product design whether in social spaces or not.

Inspired. Humbled. Engaged.