View
1.370
Download
0
Category
Preview:
DESCRIPTION
Roberta Tassi, frog's Senior Design Researcher in Milan, shares her thoughts on system thinking for large scale impact.
Citation preview
System thinking for large scale impact
ROBERTA TASSI
WIAD 2014 15 febbraio
DESIGN FOR
EVERYDAY LIFE
sys·tema set of connected things or parts forming a complex whole.For example a set of things working together as parts of a mechanism or an interconnecting network.
understanding#empathy #data #patterns
modeling#synthesis #structure #visualization
translating#guide #shape #link
the vast majority of the seven million children who die every year never see a doctor
community health workersare the “last mile” in healthcare and one of the the biggest untapped resources in global health.
how to design a comprehensive and systemic solution to empower Community Health Workers at a global scale?
design researchunderstanding CHW aspirations, workflow and needsWe relied on a Human-Centered Design process to shape solutions for CHWs that are based on a deep understanding of their real-world needs.
01
UGANDABefore CHWs, having medicines to treat malaria available right in the village was a daydream.
CHW SUPERVISOR
4 DISTRICTS, 37 INTERVIEWS
Backpack Plus Design Research
Backpack Plus Design Research
The main challenge is sensitizing people to look for health services to timely treat their illnesses.
CHW (ASC) SENEGAL3 DISTRICTS, 26 INTERVIEWS
Backpack Plus Design Research
Backpack Plus Design Research
system thinkingmapping and modeling CHW programsThe Backpack PLUS framework is a CHW-centric model that identifies all the essential physical, digital and service-level components required to empower and activate CHWs along their journey.
02
CARE
COMMUNITY HEALTH SYSTEM
SERVICES
TOOLS
CHW
TRUST
CARE
SUPPORT
REPORT
CARE
Backpack Plus Framework
INDIVIDUALCOMMUNITY
ASSESS & TREAT
EDUCATE
RESPECT
TRUST
SUPERVISOR HEALTH CENTER DISTRICT
SUPPLIES
REPORT
COACH
SUPPORT
REPORT
REPORT
INSTRUCT
SUPPLIER
TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDINGRECRUITING UPGRADING
CHW
DIAGNOSTICS TOOLS ENABLERSCOMMODITIES
ASSESS TREAT EDUCATE REPORT
Backpack Plus Framework
Backpack Plus Framework
ADVANCED MODULES
BASIC SET
DIAGNOSTICSCOMMODITIES TOOLS ENABLERS
ACT AMOXICILLIN
CHLORHEXIDINE
PARACETAMOL
RDT
RESPIRATORY TIMER
MUAC
ORS & ZINC
GLOVES
ALCOHOL PADS ALCOHOL
SCISSORS
SOAP
BANDAGES
SYRINGE
TRASH BIN NOTEBOOKTHERMOMETER
TRANSPORTATION(bike, motorbike,...)
UNIFORM
HOUSE SIGNAGE
ADVANCED ED.MATERIALS
FEEEDBACKSCORECARD
HOUSEHOLDREGISTER
HEALTH PROMOTIONMESSAGES
MISOPROSTOL IPT
JOB AIDS ED. MATERIALS
VISIT REGISTERREFERRAL FORMS
STOCK REGISTER
RAIN BOOTS RAIN COAT
TORCH, LIGHTPENCILS, PENS
SOLAR CHARGER MOBILE PHONE
VITAMIN Amother
VITAMIN Achildren
PILLS CONDOMS PREGNANCY TEST
INJECTABLE
RUTF SCALE
HIV TEST
DEWORMING(Albendazole)
MAMA KIT
1 | P
REG
NA
NC
Y &
NEW
BO
RN
CA
RE
2 | F
AM
ILY
PLA
NN
ING
3 | M
ALN
UT
RIT
ION
4 | H
IV5,
6,7
| AD
VAN
CED
SET
S8
| MA
MA
KIT
BA
SIC
SET
TOOLS
JOB AIDS ED. MATERIALS
VISIT REGISTERREFERRAL FORMS
STOCK REGISTER
Backpack Plus Framework
ACTORS INVOLVED
DESIGN PRINCIPLES
SERVICE ELEMENTS
ON DEMAND RESUPPLY (supervisor)
Ensure continuity by selecting people who are long-term members of the community (resident, married).
Leverage existing influential roles that are already present in the community.
Manage age limits (min but also max age).
Embrace flexibility to adapt the criteria to specific regions (i.e. nomadic areas, low-literacy,...).
SELECTION CRITERIA
PUBLIC ANNOUNCEMENTS
REGULARREFRESHER
CHWLIST
Define reference recruiting criteria
RECRUITING TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDING UPGRADING
Create modular training plans to enable incremental learning and differentiate competences.
Teach fundamentals of time/budget management.
Provide analog and mHealth services that can be access by CHWs also at the end of the training period.
Create a moment at the end of each training session to certify and/or celebrate the new competences aquired by CHWs.
Set up routine refresher training sessions to ensure a continuous learning experience.
Support a continuous learning process
Provide standard protocols with reference materials that guide the assessment through a series of steps.
Create strong consistency and cross-references across job aids, diagnostics, commodities and informational materials.
Include visuals that help understanding and sharing the process also with the patients.
Improve guidance through integrated tools
Provide standard instructions for dosages with supporting reference materials.
Create strong consistency and cross-references across job aids, diagnostics, commodities and information.
Support referral at a system level (i.e. referred patients are given priority at the clinic).
Strenghten follow-up visits through protocols and reminders.
Provide clear instructions & follow-up
Facilitate education processes through rich media (visuals, audio, video).
Optimize content and materials to address different situations (1:1, households, group sessions).
Stimulate an active engagement of the community.
Provide tools to facilitate education
Facilitate consistent data tracking through clear recording standards and protocols.
Enable data sharing across different stakeholders by armonizing tools and optimizing transmission of information.
Enable data mining by facilitating aggregation of information across tools.
Give value to the collected information by giving it back to CHWs and their communities.
Improve data collection and mining
Establish clear roles of a supervisor and relationship to the CHW (e.g. how often they see each other).
Ensure a continuous support and supervision through meetings at defined intervals (e.g. weekly meeting).
Include role-modeling through joint visits with supervisors.
Include spot checks of the supervisor with the community.
Enable the collection of a clear basic set of data that supports the supervisor with performance management.
Enable the supervisor to set real incentives in case of good performance.
Set clear roles and responsabil-ities
Address restocking by using data to make effective forecasts.
Maximize resupply efficiency by communicating availability of stocks.
Bring the supplies as close as possible to CHWs by leveraging existing resources (shops, private supply chains, etc.).
Facilitate transportation (either by reimbursement or by providing logistical support).
Optimize access and system efficiency
Enhance the community perception of the role of CHWs through branded materials.
Give visibility to the CHW-enabled outcomes inside the community.
Celebrate & reward the work of CHWs
Establish a clear career path based on personal inclinations and impact.
Provide incremental training to enrich and evolve competences.
Establish a clear career path
SUPERVISOR
STANDARDPROTOCOLS
REFERENCE MATERIALS
VISITTRACKING
STOCK TRACKING
HOUSEHOLDTRACKING
BASIC MODULEON EDUCATION
SPECIAL MODULES(e.g. RDT)
CHW CERTIFICATION
BASIC MODULEON ICCM
REFERENCEMATERIALS
MOBILIZATION FOR SPECIAL EVENTS
BEHAVIOR CHANGE DEMONSTRATIONS
STANDARDPROTOCOLS
REFERRAL PROTOCOLS
REFERRAL TRACKING
REFERENCE MATERIALS
ONE-TO-ONE REVIEWS
SPORT PERFORMANCE CHECK
GROUPREVIEWS
‘LEAVE-BEHIND’INSTRUCTIONS
EDUCATIONALGAMES
RESUPPLY BY CONSUMPTION
ADDITIONAL TRAINING MODULES
GRATIFICATION BY BRANDED KIT
REIMBURSEMENTS(e.g. TRANPORT)
INCENTIVES THROUGH GADGETS
FACILITATION BYBASIC ENABLERS
CARRIERPATH
PERFORMANCE BASED REPORT
ASSESS TREAT EDUCATE REPORT
BA
SIC
CO
MP
ON
ENTS
AD
VAN
CED
CO
MP
ON
ENTS
IND
IVID
UA
LC
OM
MU
NIT
YS
UP
ERV
ISO
R C
LIN
ICD
IST
RIC
TS
UP
PLI
ERD
ESIG
N P
RIN
CIP
LES
Establish clear roles of a
relationship to the CHW (e.g. how often they see
Ensure a continuous support and supervision through meetings at defined intervals (e.g.
Set clear roles and responsabil-
Address restocking by using data to make effective forecasts.
Maximize resupply efficiency by communicating availability of stocks.
Bring the supplies as close as possible to CHWs by leveraging
Optimize access and system efficiency
Enhance the community perception of the role of CHWs through branded materials.
Give visibility to the CHW-enabled outcomes inside the community.
Celebrate & reward the work of CHWs
Establish a clear career path based on personal inclinations and impact.
Provide incremental training to enrich and evolve competences.
Establish a clear career path
Backpack Plus Framework
TRAINING SERVICE DELIVERY REVIEWING RESUPPLY REWARDINGRECRUITING UPGRADING
INDIVIDUALCOMMUNITY
CHP
SUPERVISOR SUPPLIERHEALTH CENTER
SUPPLIES
ASSESS& TREAT
TRUST
REPORT
COACH
REPORT
DIAGNOSTICS TOOLS ENABLERSCOMMODITIES
SUPPORT
ASSESS TREAT EDUCATE REPORT
HEALTH RELATED GOODS
SERVICES
LG BRANCH
INDIVIDUAL CHWCOMMUNITY
SUPERVISOR
SUPPLIES
ENGAGE
INFORM
COACH
REPORT SUPPORT
REPORT
REPORT
SUPPORT
SUPPLIERHEALTH CENTER DISTRICT
MAPPING OTHER PROVIDERS
MAPPING OTHER USERS
MAPPING PRIVATE OPPORTUNITIES
Backpack Plus Framework
product and service designfrom research insights to holistic solutionsStarting from core CHW needs highlighted during field research we identified opportunities to improve the quality of the solutions they are provided. Integrating physical tools and mobile-enabled services into one cohesive experience will positively impact community health outcomes.
03
Current tools and process meant to support CHWs are fragmented, often affecting effectiveness and undermining motivation.
“The job aid is our Bible”CHW (UGANDA)
Backpack Plus Research Insight
Backpack Plus Toolkit
From a disconnected set of diagnostic tools and medical commodities to a well-orchestrated experience that improves CHW effectiveness.
Backpack Plus Toolkit
Storage and carrying solutions for tools and commodities aren’t flexible enough and do not support CHW workflows.
“The bag I was given is big and bulky, I never need to carry that much.”CHW (UGANDA)
Backpack Plus Research Insight
Backpack Plus Toolkit
From generic storage and carrying solutions to a system designed to easily adapt to evolving CHW needs.
Backpack Plus Toolkit
Data that is currently generated by CHWs and other actors in the system is not consistent and seldom turned into useful information.
“The data collected here is always incomplete.”DISTRICT MANAGER (SENEGAL)
Backpack Plus Research Insight
From one-way data flows to closed and effective feedback loops that provide real-time access to essential information.
Backpack Plus Toolkit
CHWs are asked to cover an ever-increasing variety of health domains, not always properly supported by training and adequate tools.
“New training means that they are investing in us!”CHW (SENEGAL)
Backpack Plus Research Insight
Backpack Plus Toolkit From irregular training sessions to a continuous learning model that targets CHWs but also accounts for the need to educate their communities.
Current incentive programs -monetary or otherwise- often fall short of being perceived as making the difference in the lives of CHWs.
“These people put in their own money to do their job!”CLINICAL OFFICER (UGANDA)
Backpack Plus Research Insight
Backpack Plus Toolkit
From fragmented incentive programs to a clear hierarchy of roles, responsibilities, benefits and opportunities for growth over time.
Fragmented or inefficient supply chains can result in perceived lack of CHW support, and undermine the level of trust they need to be effective.
“Why should I walk to the clinic if then they don’t have medicines?”CHW (SENEGAL)
Backpack Plus Research Insight
Backpack Plus Toolkit From closed ecosystems to integrated public and private sector initiatives aimed at better supporting CHWs and Supervisors.
Backpack Plus Toolkit
Backpack Plus Toolkit
Backpack Plus Toolkit
Backpack Plus Toolkit
Pneumonia
FROM 2 TO 11 MONTHS
Diarrhoea
FROM 2 MONTHS TO 5 YEARS
ACTLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.
Malaria
FROM 4 MONTHS TO 3 YEARS
07712345678
07712345678
ORSLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.
AmoxicillinLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.
07712345678
ParacetamolLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nibh euismod tincidunt ut laoreet dolore magna aliquam erat volutpat.
07712345678
Diarrhoea
FROM 2 MONTHS TO 5 YEARS
ZincLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh.
ChlorhexidineLorem ipsum dolor sit amet, consectetuer adipiscing elit, sed diam nonummy nibh.
Neonatal care
NEW BORN
Fever
FROM 0 TO 5 YEARS
TYPOGRAPHY
COLOR PALETTE
ICONS
Noto Sans Bold
Noto Sans Bold ItalicNoto Sans Regular
MAIN TEXT
SECONDARY TEXT
MAIN DISEASES GENERIC DISEASE
Backpack Plus Emblem
Backpack Plus Emblem
Backpack Plus System
FrameworkA reference framework to gather best practices, assess gaps and align partners to scale up existing and future CHW initiatives.
Toolkit EmblemA systemic set of physical and digital tools to empower CHWs and improve the quality of the healthcare services they provide.
A symbol for Backpack PLUS that could be used by the public health community for advocacy and large scale fundraising.
Backpack Plus What’s next
T h a n k s
Recommended