Helping health workers and hard-to-reach communities interact better together: what works?

Summary:

Nepal has made huge leaps in improving maternal and child health in the last few decades. 50,000 Female Community Health Volunteers (FCHVs) have played a significant role in these improvements. In remote areas of Nepal, FCHVs play a vital role connecting people to, and sometimes providing, basic primary care; referring patients to clinical services and supporting families to adopt healthier practices. Although FCHVs are tasked with communicating about health, they often lack the skills or engaging communication tools to do this effectively. In three pilot districts, BBC Media Action worked in partnership with the Nepali government to design a simple and effective solution to support FCHVs in their communication with communities, utilizing technology they were already using in their day to day lives their mobile phones. The project used Human Centered Design and Design Thinking in order to root the solution within the needs of FCHVs and the communities they serve. The result is Mobile Chautari, launched in late 2019 and awaiting a quasi-experimental evaluation early next year. It is a facilitation tool where FCHVs play audio content, via their mobile phone, to communities, promoting discussion and supporting positive behavior change. Mobile Chautari uses creative audio to engage communities and upskills FCHVs to facilitate high quality interactions. Harnessing discussion and peer support, FCHVs use existing community meetings and a simple facilitation model to raise knowledge and understanding of key health issues as well as building trust, motivation and efficacy amongst communities to support them in making healthier choices.

Background/Objectives:

Maternal and child health outcomes in Nepal are improving but challenges remain, especially in more remote communities. FCHVs are often undervalued and lack the effective communication skills and tools to promote healthier behaviours. This project sought to design a user-friendly communication solution which would help FCHVs build trust and engagement with their communities. Learning that the majority of FCHVs have access to a basic mobile phone handset, the project sought to use behaviour change communication theory to design a low-cost and low-tech mHealth solution which would help to make FCHV and community interactions more structured and powerful.

Description of Intervention and/or Methods/Design:

To design an effective solution, the project linked the Theory of Change, Design Thinking and Human Centred Design processes together, grounding a technological solution within the needs of FCHVs themselves. Production, project, research and health experts made up the central team throughout the design process. The pilot intervention began with in-depth mapping of the context in Nepal, involving site visits, interviews with partners and consultation with the health and mHealth community. Following this, an in-depth piece of primary research was conducted with FCHVs and communities consisting of observations, in depth interviews and focus groups. These insights supported a project Theory of Change and the two concepts that emerged from the early design ideation sessions. The two concepts evolved and adapted to user feedback within rapid prototyping and user testing sessions before a single concept 'Mobile Chautari' was finalised with audio content, printed IEC cards and roll out training.

Results/Lessons Learned:

The pilot project is mid-phase and preliminary monitoring and evaluation results shall be presented in the summit presentation. To date however, key lessons which have emerged include: The importance of lead in and development times to produce an effective and high-quality solution in line with Human Centred Design principles. The need for multidisciplinary teams from different sectors including research, design, technology and theory in order to build effective prototypes to test, refine and learn from. The importance of centralising the key theme of 'Leaving no one behind' in design so that any solution is effective for all. This project selected a low-tech Interactive Voice Response (IVR) system because research showed that digital literacy and smart phone ownership were low amongst our end users and we designed a simple facilitation model that is suitable for literate and non-literate FCHVs.

Discussion/Implications for the Field:

Design of a meaningful, appropriate and sustainable solution takes time, multi-disciplinary engagement and a strong understanding of your target audience. How can we ensure we have space for this depth of design whilst managing time and budget pressures? There is a push for design projects to utilise high tech and exciting solutions, this project met with significant pressure to design an app, yet how do we balance this when our research says it's not compatible with leave-no-one-behind?

Abstract submitted by:

Josh Alcock - BBC Media Action
Yvonne MacPherson - BBC Media Action
Anna Godfrey - BBC Media Action