Human-Centered Design in the Jungle
Nurses inspire, ideate, and implement better health care in remote Liberia
Lately a small team of locals and expats has been driving trucks and motorcycles to some of the most remote health clinics in the world. In southeast Liberia, 400 miles from the country’s nearest paved airstrip, they cross flooded rivers, squeeze through cuts in fallen bubinga trees, and bounce over rolling grassland.
The four-wheeling isn’t for fun; it’s part of a human-centered design initiative. Since 2015, Liberia has been rebuilding the country’s health system, which was devastated by a civil war that ended in 2003 and again by the Ebola epidemic that ended in 2015. But improvements in the remote clinics are a ways off. So Partners In Health staff and local nurses led an HCD program to improve health care in 19 of the facilities.
For two months beginning in April 2016, the team recorded baseline data — on how often nurses washed their hands during births, for example. Then they gathered county health officials, clinic staff, and locals who had been patients for a breakneck HCD session.
Members of the group interviewed each other and shared their experiences. Challenges were presented and agreed on. Sticky notes were deployed. And participants spent hours ideating potential solutions to a variety of challenges. An example? One reason why only 37 percent of clinicians wash their hands correctly seems to be old-fashioned heedlessness. What if they created a talking faucet, a small stereo recording at hand-washing stations that reminds staff, in the local dialect, of the importance of scrubbing in. The next day, they winnowed the list and after a bit of rapid prototyping, everyone dispersed, knowing that they would iterate or abandon their solutions in subsequent sessions every two months.
“One of the solutions could be a talking faucet”
How did it turn out? The results might not have led to IDEO-like system-wide changes, but between May and December 2016, at least, the improvements were more impressive than one might expect. The scolding faucet, for example, was passed over for a wall calendar with portraits celebrating the best handwashers of each month. And the number of clinicians who correctly washed their hands increased from 37 percent to 72 percent. To this day, “Handwashing Champion” calendars hang proudly in tiny, distant clinics like Gbloken and Rock Town and Kunokudi.