We believed in the potential of design to create more resonant, relevant, and integrated solutions to a wide range of challenges related to poverty and inequality. So we made the case to social-sector organizations that a design-led process could help them meet the needs of those they serve. The social sector already embraces an ethos of focusing on end users, but human-centered design, we argued, could unlock new possibilities for creative solutions to social problems.
Although there are many ways to describe human-centered design, perhaps the simplest is to focus on three, sometimes overlapping, phases of problem-solving: inspiration, ideation, and implementation. These phases build on each other, although they are not necessarily linear. In the inspiration stage, designers engage in immersive, participatory research with the ultimate users of a new product or service (whether a business or communities affected by the problem at hand) in order to surface insights about their needs, barriers, and aspirations. During ideation, we begin to develop concepts that respond to the needs uncovered during research and test them through various rounds of prototyping. Prototypes are tangible experiments conducted quickly, inexpensively, and on a small scale. We design them to help validate (or invalidate) potential solutions, as well as to uncover unforeseen challenges with implementation.
Finally, during the implementation phase, we refine solutions that showed promise during testing as we build the delivery model, technology, tools, and processes needed to ensure long-term success.
Over the past decade, this design-led approach to social innovation has gone from a relatively nascent practice championed by a few organizations to a rich ecosystem of practitioners, academics, and adopters around the world. At IDEO.org, we’ve had the opportunity to use design to address a vast array of challenges—from working with mobile-network operators in South Asia and East Africa to create digital financial services that advance women’s financial inclusion to partnering with institutions to address racial inequities in health care.
Design organizations around the globe are now working on a range of social challenges. The MASS Design Group is establishing first-rate hospitals and a medical campus in one of the poorest districts of Rwanda, D-Rev is developing affordable prosthetics for low-resource environments, and the Vihara Innovation Network is operating a human-centered design practice in rural Bihar, India. And communities of practice that bring together practitioners, funders, and designers such as the global health collective Design for Health and HCD Exchange, which focuses on adolescent sexual reproductive health in sub-Saharan Africa and South Asia have emerged to connect practitioners, funders, and organizations looking to apply design in their worlds.
This surge in interest in the social sector also inspired us, in 2009, to create Design Kit (originally published as HCD Toolkit), a suite of tools and courses hosted with Acumen Academy to help social-impact organizations adopt design methods in their own work. Since then, we’ve seen more than one million users access these tools from countries around the world.
But as the practice of design has become more mainstream, the approach has also generated a fair amount of criticism. Objections have focused chiefly on the up-front costs of design and its potential to produce unscalable, bespoke solutions without sufficient evidence underpinning the intervention. Early cases in our own portfolio of work, including the Diva Centres, fed into these concerns.
While the initial sites of the Diva Centres showed results in reaching adolescent girls and doubling the proportion of adolescent clients selecting a long-acting contraceptive method, we saw that the model would struggle to expand beyond the pilot. Our design process had focused too narrowly on creating an engaging and effective user experience for teens and providers, without grounding it in the wider health ecosystem. Because the stand-alone centers weren’t integrated with existing service-delivery channels, they were prohibitively expensive and complicated to scale.
In the years since the Diva Centres were piloted, MSI Zambia has worked with Spring Impact, a consultancy that helps organizations scale social-impact solutions, to integrate the model into public-health facilities. The partnership has adopted lessons from the pilot program and developed a more iterative and embedded program model that is still in use today. But we could have avoided some of these adaptation efforts by supplementing our design process. A more intensive, up-front mapping of the surrounding health-care ecosystem and a deeper assessment of our implementing partners’ capacity would have enabled us to design a more cost-effective and scalable intervention from the start.
In a subsequent design project with MSI Burkina Faso in 2017, our team put these lessons into practice. We worked closely with MSI’s local staff to understand the service delivery ecosystem and the organization’s capacity constraints from the start. The resulting program we designed together, La Famille Idéale, augmented and built upon that foundation. This more rigorous approach to the design process enabled us to rapidly adapt the program for implementation in other countries across the Sahel region. These practices are a standard part of our design process today but were not firmly cemented when we began the Diva Centre project a few years earlier.
Evolving the Practice of Design
While cases like the Diva Centres helped popularize human-centered design in the social sector, they also highlighted opportunities for the practice to progress in addressing complex social problems. Challenges in health, education, migration, and economic inclusion are often described as “wicked problems,” because they are difficult to define, involve multiple interconnected actors, and likely require more than one intervention. While design can be an effective tool for developing novel and successful interventions, many design efforts are not effectively structured to tackle these problems, because inflexible funding, time scales, and ways of working inherited from the private sector limit them.
In recent years, many human-centered designers have structured initiatives in new ways to meet these complex social challenges. One example of this approach is the Adolescents 360 (A360) program, which also focused on supporting more young women to make decisions about their reproductive health but, thanks to lessons learned from Divas, took a more multidisciplinary, adaptive, and ultimately scalable approach.
A360, led by global health nonprofit PSI and funded by the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation (CIFF), seeks to reframe how girls ages 15 to 19 perceive, value, and access modern contraception across Tanzania, Ethiopia, and Nigeria. The project, which launched in 2016, has several advantages over previous design-led initiatives for adolescent health. It was formed by a transdisciplinary network of partners that integrates human-centered design with expertise from public health, adolescent developmental science, cultural anthropology, and social marketing. This combined approach aims to produce youth-friendly solutions that are poised to scale. IDEO.org was the human-centered design partner within the consortium.
The A360 program would need to build off a rich market analysis and evidence-based theory of change to have a shot at meeting its goals. To ground the design process, A360 conducted a rigorous review of relevant academic literature and evidence before beginning user research. It sought to serve a whopping 60,000 to 70,000 girls in rural Ethiopia alone within three years. The market analysis helped us target our qualitative design research and ideation with a greater awareness of the contextual factors affecting girls’ lives and choices.
A360 also recruited, trained, and worked alongside on-the-ground experts: Young women and men from local communities in Ethiopia joined our team as researchers and co-designers throughout the process.
And the network of partners wasn’t the only thing that differentiated A360’s design process from its predecessors’. The consortium set up the program as a multiphase, 15-month project recognizing that a longer process was required than had been available for the Diva Centres that allowed for multiple cycles of exploration, prototyping, refinement, measurement, and optimization, hand in hand with PSI, to ensure that our solution not only succeeded in the pilot phase but also had a clear pathway to scale.
As the qualitative design research for A360 in Ethiopia began, the process didn’t look substantially different from that of the Diva Centres or other previous projects. Ethnographic research provided insights about young people’s behavior that signaled opportunities for innovative design. It quickly became clear that strict social norms tightly govern girls’ movement and access to services in these extremely rural communities. Any viable solution would need to build support for contraception among young women’s immediate network of influencers, including elders in the community and in most cases husbands. We found from speaking to young men and women that they were more open to new ideas and possibilities for the future immediately after marriage when the prospect of planning their lives together was most relevant.
With this insight in hand, the team prototyped different ways of broaching the topic of contraception that seized this moment as an entry point for expanding girls’ access to services. The team tested several concepts, including a financial planning pop-up at the local market, a marriage counseling session, and a cost calculator to support couples in determining the resources they would need to plan for the families they wanted. The cost calculator resonated most among test users, who expressed anxiety about their financial future. This observation (among others) gradually reshaped the framing of the proposed service from a conversation about family planning (taboo in the local context) to one about financial planning, in which contraception and birth spacing became tools introduced later to support young couples in achieving their goals for financial security. These prototypes were gradually refined into a cohesive, holistic program called Smart Start that is being implemented across Ethiopia today.
Smart Start frames contraception as the leeway necessary to save up for a home before a firstborn, as the difference between comfortably raising one child and making ends meet with two, and as a decision couples can navigate together. To enable young men and women to participate effectively in these sessions, despite low literacy, the design team explored many ways of communicating these financial trade-offs in simple, accessible terms. Eventually, this search led to the discovery that bags of teff—the country’s staple crop—could act as a universally understood proxy for money.
Smart Start sends health-care workers to meet couples where they are. The delivery model leverages and augments the country’s network of health extension workers (HEWs), which routinely sends trained health-care providers to rural communities to deliver frontline health-care services. Through Smart Start, these HEWs are trained to lead counseling sessions with couples that begin with a conversation about life goals designed to help young married girls and their partners consider how their long-term visions will be more attainable if they delay their first pregnancy and space out subsequent births. HEWs are equipped with engaging visual materials and interactive exercises that help couples think through the costs of raising a child, and present contraception as a tool that can help them align their financial and reproductive plans. And before counseling begins, community meetings are held, where local leaders and elders discuss the importance of setting up young couples with the tools they need to build a better future. This step gives these couples sanction to explore an otherwise taboo conversation.
A360 also partnered designers with an adolescent developmental scientist to develop communication tools tailored to young people’s stages of cognitive and hormonal development. Health counselors reported that the thoughtful messaging helped increase understanding and connection with young clients who were previously difficult to reach. After one conversation with a Smart Start counselor, girls can easily memorize the information and then share it with parents and other community gatekeepers, helping them to understand the logic behind choosing to delay pregnancy.
Since Smart Start’s pilot, more than 30,000 adolescent girls have adopted modern contraception through the program. PSI’s results exceeded expectations and convinced Ethiopian health ministers to visit the pilot and learn more. The A360 model was created with built-in systems that would produce evidence that the Ministry of Health deemed compelling. These systems included careful program monitoring, led by PSI country teams, and independent process and outcome evaluations led by measurement partners Itad and the London School of Hygiene & Tropical Medicine. The conversion was remarkable. Based on these results, the ministry has committed to expand the Smart Start program across the country, with $10.5 million from the Children’s Investment Fund Foundation. The program will be embedded in the country’s primary health-care system and will support more than one million girls by the end of 2024.
The adoption and integration of Smart Start into the national government health-care system is one of several critical metrics of success: It demonstrates the potential for scalability, financial feasibility, and long-term operational sustainability. Most important, it also shows that the program works for the young people it was designed for.
Three Actions for Better Design
The lessons learned from Smart Start and other similarly ambitious design programs over the past several years have helped inform an era of social-impact design that is increasingly rigorous, experimental, and collaborative. The field has made tremendous progress. But as we look toward the next 10 years, our practice must continue to evolve in several essential ways.
Invest in the infrastructure and evidence required to scale. While many social-impact design efforts over the past decade have demonstrated innovation in tackling social challenges, far fewer have demonstrated change at scale. Like the Diva Centres, early case studies of design for social innovation focused on creating demonstration cases and more engaging user experiences, but often lacked the necessary ingredients to create large-scale change.
In many instances, this deficiency springs from a failure to design the “back of house” organizational infrastructure required to bring bold new products or services to life. Across the board, leading social-impact designers including us for many years failed to recognize and solve for the significant operational and mindset shifts required for an organization to deliver effectively a new and innovative intervention. This blind spot leads to solutions that are vulnerable to challenges of an organization’s operational capacity, capabilities, and funding. Preparing an implementation plan, business model, role descriptions, and measurement frameworks can help overcome these barriers and steward a solution to success, but they are not widely integrated into the practice of social-impact design across the sector.
Consider, for example, Kuja Kuja, a real-time customer feedback platform that enables refugees to rate their satisfaction with the services NGOs deliver. The platform idea belongs to Alight (formerly the American Refugee Committee), which sought to reimagine the ways in which humanitarian organizations improve and take responsibility for their services and to shift the role of refugees from beneficiaries to customers. Today, staff at Alight HQ can see photos of service points, read individual testimonials, and gather qualitative information before making decisions. Kuja Kuja has collected more than one million data points in six countries.
But getting the service off the ground was only a small part of what we had to design and deliver. Creating the tools and conditions to foster organizational change presented the major design challenge. We had to answer questions such as: How can we build a trustworthy brand, given the power dynamics at play between refugees and NGOs? How can the feedback from the Kuja Kuja platform improve daily operations at the camp? How will this system work when network connectivity goes out? How will we recruit and train local teams to do this work? Developing elegant training materials was as important as getting the digital interactions right, and laid the groundwork for Kuja Kuja to scale quickly. It expanded to five countries two years after piloting in a single refugee settlement in Uganda.
Getting a solution to market is only the first step. Designers must also plan for phases of intentional learning, optimization, and refinement beyond the pilot and build measurement systems into their design solutions to produce the evidence needed for scaling. The Smart Start program in Ethiopia illustrates this approach. It has scaled deliberately and incrementally from live prototype to pilots to regional expansion. This journey included additional phases of design as the program expanded to iterate, optimize, and improve the cost-effectiveness of the model at each phase of growth. For example, one year after the initial pilot, PSI and IDEO.org used a six-week design sprint to reduce costs and lighten the workload for HEWs that implement the model, so that the Ministry of Health, which plans to integrate it into the national health system, could adopt it more easily. Success will depend on ensuring not only that the experience offered to young couples continues to be positive, but also that any adaptations to the delivery model feel meaningful and efficient for the HEWs who need to execute it.3 Formalizing optimization as a distinct phase of design can help implementing organizations move more confidently from pilot to replications and scale.
This patient, phased approach to scaling innovation also requires new approaches to funding. Scaling a well-designed and proven intervention still requires a significant investment usually from the public sector or philanthropy. In the past several years, we’ve seen the rise of systems-change philanthropy, which aims to join the forces of individuals, organizations, and institutions to address the root causes of social problems. New, ambitious investment vehicles designed to support such philanthropy through initiatives such as Co-Impact, the MacArthur Foundation’s 100&Change program, the Global Innovation Fund, and The Audacious Project have arisen to satisfy this demand. But many design-led interventions have yet to successfully capitalize on this funding because of the evidence gap many well-designed solutions face. They have yet to scale and have not been properly evaluated by third parties.
As human-centered design has gained popularity as a tool for developing new delivery models, the social sector has invested significantly in evaluations to collect evidence about the methodology itself, but much less in outcome evaluations for design-led solutions. In order to build the case to replicate and scale such solutions, design firms need to collect the evidence necessary to demonstrate whether the solutions have generated the desired outcomes. Firms need to partner with experts and embed detailed frameworks for measurement and learning in all services and products they design as they are implemented. Without this commitment, many transformative, human-centered solutions will be unnecessarily limited in reach.
Build community ownership. We must also invest in the people we serve, by yielding power to them in the design process. Human-centered design has always been a collaborative process, in which designers, subject-matter experts, and communities themselves are all engaged in finding and developing solutions. But as design continues to take root in the social sector, these exchanges must shift from mere consultation to co-creation, in which those who will ultimately benefit from and/or deliver a solution can shape the outcome at each stage of the design process. When the stakes of design change (to improve people’s health, livelihood, or well-being), our process must follow suit ensuring that communities have a voice and a hand in bringing possibilities to life.
This approach requires us to design the conditions for co-creation. We must build a space that enables those with lived experience of the issue at hand to participate fully. “Good design makes space for those without formal training to shape and control the project itself,” says George Aye, of the social-impact design firm Greater Good Studio. “We must design the conditions where the constituents own the change we’re asking them to make.” 4
We had good intentions for the Diva Centres. We conducted participatory research with teen girls in the program’s target population. We created daily diaries and other tools to help them articulate their needs, goals, and barriers. We also tested concepts with them to see what resonated. But as we refined those concepts toward a final solution, the closeness of our interaction faded, and the young women who helped inspire the Diva Centres had a diminished role during the later phases of the process. As a result, some of the final program materials contained depictions that didn’t reflect the girls they were created for and needed to be modified after implementation had begun.
Later on, when we worked with MSI to design an adaptation of the Divas program for a rural audience, MSI’s field team in Zambia took the lead. Building on the lessons learned from that initial phase of work, MSI staff led design activities with girls and their families directly, working with our designers to visualize potential directions for the brand and materials and ensuring that communities remained engaged throughout the process.
In the case of Smart Start, the program was intentionally co-designed from the beginning with young people and local PSI staff, who had personal experience of the challenge at hand. Together, we did several rounds of refinement on the program’s tools and communications materials. We ended up with visual representations of people and community that resonated, and used bags of grain as a proxy for money that everyone in the village could relate to their own household finances. Everything in the program’s outreach materials, from the color patterns used to the clothes worn in the illustrations, expresses the hyperlocal context.
Human-centered design has a role to play in shifting our communities toward a more equitable and regenerative future.
The success of Smart Start belies an important truth: The best design happens with communities, not for them. Consequently, we must always focus on creating the conditions for the people affected most directly by an issue to articulate the solutions they want and need, and use our skills as designers to help bring those initiatives to life. Organizations such as Creative Reaction Lab in St. Louis, the National Equity Project, and the K12 Lab at the Hasso Plattner Institute of Design at Stanford University (the d.school) are crafting new tools 5 and publishing resources (such as the Field Guide to Equity-Centered Community Design and the Liberatory Design Resource Collection) to help others practice more inclusive and equitable design processes. For example, they are training young people in underinvested communities to lead the design process and codifying practices and frameworks that recognize the role of power and historical context in the design process.
In recent years, new educational programs have also been established to support a more diverse cadre of young people in finding career pathways in design. Typically, design education has produced a field of practitioners that are disproportionately white, male, and privileged. By contrast, most social-sector design by virtue of its orientation toward social justice focuses on challenges that disproportionately affect women, people of color, and other historically marginalized groups. Today, programs such as Nairobi Design Institute in Kenya and Inneract Project in the United States are helping to narrow that gap, by providing training and support to designers with a much wider set of lived experiences to draw upon in imagining and creating new solutions. This more inclusive vision for design, with a plurality of perspectives at the table, will undoubtedly yield better results especially within the social sector.
Embrace radical collaboration focused on systemic change. The major social problems we face today are grounded in systemic issues that demand serious reengineering from staggering income inequality to waste and exploitation in our global food system to inequitable and overstretched health-care systems around the world. Human-centered design has a role to play in shifting our communities toward a more equitable and regenerative future, but it will look quite different from the social innovation that has come before. Instead of focusing on designing individual products and services in response to discrete briefs, designers must adopt a more systemic lens and intentionally coordinate multiple interventions with multiple actors to create more enduring change.
We’ve been on this journey with our own portfolio of reproductive-health work. In global development, we know that when young people can control whether and when to have children, rates of unintended pregnancies and maternal mortality decrease dramatically. Delaying pregnancy can also enable girls to finish secondary school and pursue further education and work opportunities before starting a family and thereby gives them more agency in shaping the future they want. Since 2014, IDEO.org has worked with partners in more than 10 countries to expand young women’s access to relevant, accessible reproductive-health care. Together, the resulting programs have led to more than 400,000 young women adopting a contraceptive method of their choice.
But from a girl’s perspective, the relevant issues are not so simple. Barriers in other parts of girls’ and women’s lives, such as lack of opportunities to earn income and a limited sense of personal agency and empowerment, often prevent them from benefiting fully from the promise of contraception. While the social sector is frequently divided into actors that address these issues individually, girls themselves experience them holistically. For a teenage girl, access to contraception and choices about sex and relationships are intrinsically linked to the other areas of her life. Creating systemic change in the opportunities young women have to shape their lives will require coordinated efforts within and beyond access to reproductive-health care. This, in turn, demands that many types of actors, from NGOs and foundations to private-sector companies, community activists, and adolescent girls themselves, work together.
Today’s social sector is not set up for this type of collective problem-solving; its incentive structures demand narrow outcomes at scale and revolve around competition for funding. To transcend these limitations, we must find new ways to enable radical collaboration and new vehicles for change.
One approach we’re trying is the Billion Girls CoLab. The CoLab brings together cross-sectoral cohorts of organizations to work together on a range of issues that affect young women’s health, well-being, and economic opportunities. Together with adolescent girls as partners, these organizations work to identify shared problems and test new solutions through collaborative design sprints. We kicked off the CoLab in January 2020 with a “make-a-thon,” or collaborative design workshop, in Nairobi, Kenya. It produced 10 wide-ranging prototypes for new girl-centered services that address a wide range of issues, from body positivity and menstrual health to helping girls find employment opportunities.
The Billion Girls CoLab is still in its early days, but its promise is exciting. Its goal is to take the field of systems change, which has often been the domain of academia, and make it actionable by creating spaces that break sector silos, promote more holistic designs, and transfer power into the hands of users in this case, adolescent girls. This type of design requires a significant shift in the role of designers, from solution creators to system architects; bringing together the right mix of organizations and stakeholders; and creating the conditions and tools to facilitate productive, inclusive collaboration. This shift also invites private- and public-sector actors to pool learnings, share resources, and orchestrate change in a more coordinated and collaborative manner. A multisector initiative of this magnitude, although complex, can unlock much more significant, systemic change, where the creativity and ingenuity of the design process is most needed.
“Systems change all the time,” says Dave Kim, program officer on financial services for the poor at the Bill & Melinda Gates Foundation. “It is only when we apply a design lens one that leaps across disciplines while remaining grounded in human insights that we can tilt the change to a system that is a bit more just and joyful.”
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SOURCES/AUTHORS
Jocelyn Wyatt, Co-founder and CEO of IDEO.org, a non-profit design studio whose mission is to create a more just and inclusive world.
Tim Brown, Chair of Global Design and Innovation firm IDEO and vice-chair of kyu.
Shauna Carey, Managing Director at IDEO.org.
