Embracing Ambiguity to Deliver Pediatric Care in Rural Nepal

Our work with IDEO.org

IDEO.org’s Amplify program is a social innovation platform financed by DFID and organized around sourcing on-the-ground ideas to solve some of the world’s biggest challenges.

A problem could be something like this:

“How might we make low-income urban areas safer and more empowering for women and girls?”

Or this:

“How might parents in low-income communities ensure children thrive in their first five years?”

As a healthcare organization, this last prompt was right up our alley. So we applied.

We had an idea that was modeled around an intervention we were already implementing in the communities where we work. It is run by our community health team.

Meet Isha, Lal ji, and Bishal.

Group antenatal care and post-natal care programs are sessions held bi-monthly in rural communities, and facilitated by our community health workers and nurses. The module includes direct check-ups (including mobile Ultrasound services), consultations, and group discussions, all with the goal of educating and empowering expecting and new moms around the health of themselves and their newborn.

In order to be effective, rural healthcare demands a proactive approach. Our community health program is a manifestation of our commitment to that principle; we aim for community health integration within our broader delivery framework, which includes a hospital hub and health clinics, so we can reach the communities before problems become unsolvable, and bring care closer to home.

We wanted to add a third chapter to our group care sessions in order to reach out to new mothers and children.

Meet Group Pediatric Care.

The idea is this: Mothers with children under-five would assemble in their communities and learn about infant health, have their children screened for vitals by our community health nurses, relay to the nurses and community health workers any concerns they might have about their children, and finally have a space to talk to each other about child-rearing.

We would be using existing employees and resources, simply adding a new component onto our delivery framework.

The idea spawned engaging and constructive discussion on IDEO.org’s Amplify platform, and we won the challenge.

We received a grant to implement the idea. Just as importantly, we also got the opportunity to work with product designers from IDEO.org.

Meet Nathalie, Robin, and Dominic.

IDEO.org fills a vital void in intervention work — Design. And they do it with a capital “D.”

The same way a company researches, tests, and reiterates the design of its product — from chocolates to field tractors — to get the best return on investment for its customers, IDEO.org subscribes to the idea of researching, testing, and reiterating interventions to create maximum benefits for communities in resource-poor settings. They work with impact organizations in fields as varied as agriculture and healthcare, and come with a design approach that is so unique to nonprofits it might possibly seem absurd in the beginning—but so interesting it becomes an eye-opening and beneficial experience immediately.

It also helps they come bearing massive quantities of colorful post-its and felt-tip pens, along with uplifting humor and energy.

Their approach, called “human-centered design,” involves the same rigorous process of learning, applying, unlearning, and re-applying with which cell-phones today are designed to match human intuition. Their guiding mantra is to understand human and contextual behaviors. Problems stem out from the interaction of people and the environment around them. The solutions are also housed in this same intersection.

To get to the heart of the matter, the IDEO.org team insisted we “embrace ambiguity.”

That, along with “prototype” and “download” all sounded a little too vague at first.

Sometimes one of us would nod in agreement with Nathalie with a barely concealed expression of amusement, and she would brighten up as if she knew exactly what we were thinking about.

“We get that a lot,” she would say, beaming. Her confidence in the process was not misplaced, though. Embracing ambiguity has pointed us to the most concrete directions.

Setting out to learn from the communities without presumptions gives us nuggets of insights, like the fact that a baby’s care extends beyond the mother, and that children often cared for siblings and neighbors’ babies with ease.

Moreover, mothers often mentioned being unable to implement best healthcare practices for their babies — even when they knew what it was. For instance, they already knew that breastfeeding is important.

So the question became this: What function should Group Pediatrics serve apart from re-iterating on these facts?

From Robin:

From many interviews with mothers and community health workers, we got the sense that [the mothers] really do want to learn more. They want to go to checkups and ask questions and learn to do better. And they have to come to these sessions despite their incredibly busy schedules. So how do we integrate content that is powerful and will actually cause behavior change, with the idea of a break and something designed for them?

To test this out, our teams organized a pediatrics fair.

The fair, with its inherent form of stalls and stops, integrated many prototypes into one. There was a space where an iPad played videos about healthy child-rearing practices. There was another stall to sit down and make necklaces out of colorful little beads. Another station ran private checkups and consultation sessions with a community health nurse to answer a mother’s questions and concerns. Another stop was a group consultation and discussion forum. Yet another, and one of the most popular, was a game of “Health Jeopardy” with questions around essential child-rearing practices.

This turned out to be a success, and confirmed our suspicions that for better pediatric practices, it was crucial to reduce a mother’s stress. It comforted us with the notion that mothers actually like going to sessions all at once with their friends in tow.

The ultimate program that we are launching has internalized and given form to all of these learning, insights, and successes. It will put forward Possible’s community health workers, who walk through the healthcare system at its every tier—from home to hospital—as leaders, coordinators, and executors.

It will be further reiterated as our data-system grows from the Electronic Health Record at our hospital-hub (from which we identify new mothers), to every household in the community. And most important of all, it will be integrated into the government’s system given our persistence in pushing for agreements with the local government like this:

This means that the idea for this program is now to pilot a program that presents the opportunity for adoption at scale by the government, giving it a chance at what we like to call the holy-grail of intervention work: Permanence.