Program Advisory for Maternal Health

In many parts of the world, social and institutional barriers prevent vulnerable people from accessing critical, life-saving care. Millions of preventable deaths occur every year, perhaps most tragically amongst mothers and infants less than one month old.

Concern Worldwide had undertaken initial research to identify these barriers, with a focus on marginalized populations and unheard voices. The organization identified a number of complex challenges, including the significant chasms between formal and informal health care providers. In the target contexts, women use informal providers almost exclusively, both because of cultural precedence and because of limited access to formal care. The poor quality of care offered by overworked health care providers, blockages by “gatekeepers to health” with beliefs at odds with modern medicine, and the physical distance to health services were also key challenges.

To address these issues, Concern solicited ideas from target beneficiaries through open-call competitions in three initial focus countries: India, Malawi, and Sierra Leone. While the winning suggestions showed promise, they required further validation, design, and refinement to ensure they could achieve their potential. Concern engaged Reboot’s support to iterate and incubate the ideas, in consultation with both local beneficiaries and global experts, to develop actionable, programmatic concepts.

Our systems-based approach reached “experts” at both ends of the spectrum—from local stakeholders and intended beneficiaries to globally recognized experts in health care, behavior, and other fields. By bringing in a relevant range of perspectives and experiences, as well as lessons learned from other contexts, these consultations continually informed the process as we refined and developed ideas through multiple rapid iterations.

Select services for this project included:

• Design Research

  We conducted design research to understand each country’s sociopolitical context as well as individuals’ experiences with their health care systems. Further, we facilitated consultations with subject matter experts in healthcare, design, social franchise, informatics, and other relevant fields to ensure program designs and implementation plans would be informed by lessons learned in other global contexts.

• Program Advisory

  We refined existing concepts and developed new ideas using the diverse inputs and multidisciplinary perspectives gathered through design research. As part of the ideation process, we consulted closely with Concern and potential implementing organizations in each country, making sure we were creating sustainable operational models that would leverage each partner’s strengths and expertise.

• Communications Design

  As the conversation included a diversity of voices, there was a clear need for communications materials that could introduce the complex and multidisciplinary concepts to diverse stakeholders with different levels of experience, expertise, and literacy. We created clear materials that facilitated productive discussion, including visual aids for end-user beneficiaries with low literacy.

The partnership resulted in ten innovations that address the continuum of challenges impeding access to health services, compromising quality of care, and hampering meaningful health impact for mothers and infants. Beginning with the ideas solicited from end-users themselves, we ripened concepts into customized solutions rooted in the needs and realities of each local context and informed by the insights of leading experts in health and other domains. Our designs addressed not only what might improve healthcare access, but also how each intervention may do so, with tailored operational models for each unique context.

Four of these programs have since been implemented and evaluated. One, a toll-free case management hotline in rural Malawi, was shown to increase women’s effective use of formal health care services. It also reduced the burden on health facility staff by permitting caregivers to avoid costly and time-consuming trips to the facility for minor issues. Similarly, in India, an initiative that encouraged men to become activists for maternal health enabled greater participation by women and infants in critical health-seeking activities, such as antenatal care checks or immunization visits.

Drawing lessons from these and other early pilots, individual projects, and activities, the entire suite of concepts has been adapted and improved. Concern has since expanded the initiative to Kenya and Ghana, and several of the proposed concepts are currently being implemented with UNICEF and the Ministries of Health in the respective countries.