Case study: Service design for maternal care in rural Ethiopia
This article describes my experience as a Master thesis student in aCar Mobility team at the Technical University of Munich (TUM). For 6 months, I worked on an exciting project in cross-functional collaboration with 2 other Master students. Together we discovered healthcare challenges in Sub-Saharan Africa, interviewed locals and came up with a concept that would address the key problems.
The problem
In Ethiopia, 412 women per 100.000 live births die for pregnancy-related causes. At the same time, pregnancy is more than common — on average, every woman has 4 children. One of the key reasons is lack of preventive healthcare — attendance rates for maternal care during pregnancy are very low, especially in such rural areas. For example, only 37.4% of women receive all 4 recommended ante-natal visits.
There are numerous reasons for why women in Ethiopia don’t receive proper maternal care — and for my Master thesis, I aimed to discover as many of them as I could. One of the most critical reason is, however, large distance to hospitals which in rural context often has to be covered walking.
Existing problems in maternal care are strongly connected to many mobility challenges — which is why I conducted further research together with aCar Mobility team.
About aCar Mobility project
aCar Mobility is a research group at TUM university. Within the project, electric utility vehicle aCar (Africa Car) was developed that would address the specific mobility needs of rural population in Sub-Saharan Africa.
Agriculture and healthcare have until now been the main application fields for aCar in two project countries — Ethiopia and Côte d’Ivoire. My Master thesis focused on understanding stakeholder ecosystem and pain points within maternal care in rural Ethiopia as well as proposing the most desirable vehicle-based services to address such pain points. Vehicle-based services can refer to any services offered with or on the aCar vehicle.
Human-centered design for social innovation
In this study, I applied human-centered design in academic research environment. My motivation for applying such tools was mainly due to several reasons:
- access to healthcare in rural Ethiopia is a problem too complex and multi-faceted to be analyzed by more traditional academic research methods (e.g. correlation analysis);
- based in Germany, I could hardly gather relevant data about the local problems in Ethiopia using secondary data sources;
- I had little knowledge about the context and needed a deep dive into Ethiopian reality to understand it profoundly.
Additionally, there exists ample evidence that human-centered design is especially effective when applied to social innovation. For example, van der Bijl-Brouwer argued that design tools prove effective when it comes to solving complex societal challenges in the public sector. On their website, IDEO.org shares different impact stories of design tools application around the world, many of which impress by the magnitude of that impact.
My research process
To understand and improve the current process of receiving maternal care in rural Ethiopia, I conducted interviews with three different target respondents:
- expert interviews (to understand globally how maternal care works in Ethiopia);
- doctor interviews (to learn what resources are available in public rural clinics and what kind of services are currently offered);
- interviews with equipment and medicine providers in Sub-Saharan Africa (to analyze in detail the issue of medicine and equipment shortage in rural areas).
Based on the interviews and available secondary sources, I worked my way through several human-centered design tools which included value chain and user journey mapping, persona development and service blueprinting. Results of my research are presented in the next section.
Results
After interview analysis, numerous issues were revealed that prevent Ethiopian women from visiting a doctor during their pregnancy. The main categories are presented in a graph below, along with the number of quotes that belong to that category.
While many infrastructural and cultural reasons became clear, what really stood out was the problems of maternal care supply. For example, this category included long distance to hospitals, shortage of medicine and equipment in health institutions as well as lack of health professionals.
It turned out that the nearest hospital can be within 6 hours (!) walking from a woman’s home, the distance she has to cover while pregnant. Even if she does walk, rural hospitals usually only have 1 ultrasound device available, waiting times are long and free medicine is usually not in stock.
The image above presents one of the 4 stakeholder personas — that of a pregnant woman. Other 3 important actors were doctor, health extension worker (community-based health worker) and equipment and medicine supplier. After analyzing the needs of all the 4 stakeholders, I prioritized them and together with the team we brainstormed ideas for vehicle-based services that can meet the most critical needs.
Solution: Diagnostics on wheels
With the team, we came up with a list of services, the most valuable of which turned out to be diagnostics on wheels, or a mobile maternal clinic. Such a clinic would have a doctor on board and would be equipped with the basic mobile equipment for maternal care.
Women could see a doctor during pregnancy close to their homes — without having to walk for hours. Doctors and health extension workers could treat a wider audience of women who potentially can develop complications during delivery. Equipment and medicine manufacturers can have a new distribution channel — through the mobile clinic.
The image above conceptualizes mobile clinic services in a service blueprint. At every stage of pregnancy, women can find advice and diagnostics services in aCar mobile clinic. For a pregnant woman, the clinic solves the main issue with the current Ethiopian healthcare system — it de-centralizes healthcare services, therefore reducing the barrier for women to get such needed preventive care.
My research was completed at this stage but the findings will continue to be used by my teammates and the aCar Mobility project. I really want to hope that one day all women around the world can have safe pregnancies and healthy babies, and innovative mobility concepts will help us achieve it.
