Module 2: Define a Global Health Challenge

STAGE 1: Identify Problems

The recognition of an existing need or problem is the first step of design creation. Whether this occurs through personal observation or guidance from existing literature or identified challenges, a need emerges for which all subsequent research and development strives to meet.

Much of the process of personal observation involves collecting stories, gathering inspiration, and engaging people in the field to understand what people need or want. In this stage of learning, it is important to remain receptive to the real opinions of your constituents. Here, through qualitative research methods, the goal is to reach a deeper understanding of the needs, barriers, and constraints of the context in which you desire to work, to gain empathy, and to reframe health challenges from the constituents’ point of view.

Problems in global or public health may also be identified with the help of existing analyses or reports from research institutes and aid organizations. For instance, the World Health Organization (WHO) maintains data and statistics on the most pressing global health concerns, and releases an annual world health report. Federal governments may similarly publish information on the state of disease and disability within countries; at the local level, public or private hospitals may reveal the most common diseases encountered among their catchment populations. Such formal publications may provide guidance on which specific global health challenges to tackle.

If innovators are working within defined limits subject to the focus of a particular laboratory, research institution, or manufacturer, this stage may not apply. However, there is still value in recognizing the significance of the global health challenge at hand, and this motivation for the desired technology will carry through for the remainder of the design process.

Stage 2: Research the Problem

After identifying the global health challenge to tackle, it is necessary to gather as much information as possible on the extent of the problem. During this process, it is valuable to consult current literature, experts, and perspectives from the field. The range of pertinent information includes but is not limited to: underlying causes, social/political/economic/cultural impacts, associated challenges, and existing technologies or programs in place to address the health challenge. A thorough understanding of existing knowledge helps to unveil relevant issues, avoid pitfalls, and prevent repetition of error.

Without a comprehensive background review of the global health challenge at hand, innovators run the risk of creating inappropriate designs that ultimately hinder the effectiveness of technological intervention. The World Health Organization (WHO) has recognized that current devices which have been inappropriate to the context or intended setting have been due to a “lack of needs assessment, appropriate design, robust infrastructure, spare parts when devices break down, consumables… a lack of information for procurement and maintenance, and trained healthcare staff.”(1)

In this stage of exploration, it is also appropriate to identify how such problems are currently best managed, both in developed and developing countries. Clinical guidelines for standard care often define the protocols necessary for delivery of care, and subsequently indicate what technologies are involved in the management of disease.(2) Often, technologies used in developed countries are too costly, complex, or cumbersome to disseminate to developing countries, thereby creating a gap in global health innovation. If this is the case, knowledge of existing methods or devices may provide a blueprint for later stages of the design process. Alternatively, if there are no adequate technologies for a particular challenge, it may be useful to consider current solutions or ideas being implemented in comparable areas of care.

Suggested areas of research on the problem at hand include:

• Constraints or Limitations

  • Technical

  • Economic

  • Social

  • Cultural

• Existing Solutions

  • To the Problem

  • To Relevant Problems

• Potential Setbacks

Stage 3: Narrow the Objective

While the process itself is generative and inspires vast potential to innovate, the design of effective technology should follow a challenge that is broad enough to craft unexpected connections and narrow enough to stay manageable. The design and innovation firm IDEO suggests starting with the intention to “create,” “define,” or “adapt,” or begin the question of “How can…” in order to best frame the design challenge in human terms, not by technology, product, or service.(3)

As such, establish a specific objective by crafting a problem statement for the global health challenge. The problem statement should focus the project to fulfill the goals that the innovation is trying to accomplish. This step also helps to clarify expectations for the innovation team, directing the remainder of development and implementation phases to keep the end-goal intact.

Stage 4: Establish Design Criteria

The research and exploration stage should have identified various needs and specifications for the intended technology. In this stage, the innovator acknowledges such needs and is able to prioritize them according to significance. By clearly delineating design factors, it will be possible to measure the technology’s success objectively.

It is important that the design criteria be specific. In methodology used by KickStart, an organization that utilizes a systematic approach to design and distribute appropriate interventions to alleviate poverty, design criteria are identified with very clear intentions. For instance, if a product must be “income generating,” KickStart specifies that “every tool must have a profitable business model attached to it.” If the product should create a “return on investment,” the goal is for “anyone who purchases a KickStart tool [to] be able to fully recoup his or her investment in six months or less.” Other examples can be found on KickStart’s website, and are used for directing the design of their products, which are intended “to help [people] make enough money to lift their [families] out of poverty.”(4)

The World Health Organization suggests various criteria for the design of technology for rural, low-resource settings. These include: robust reliability, ergonomic layout, modular serviceability, “procurability” (of parts), “repairability” (by local technicians), affordability, portability, power-sparing, and the use of little to no disposables.(5)

While criteria must be specific, they must also be measurable in order to determine if a technology is successful in later stages of evaluation. The requirement for measurable design criteria is not necessarily restricted to quantitative outputs. For example, one criterion of the technology might assess the cultural acceptability of components or procedures. Measuring “cultural acceptability” may occur through a quantitative rating system (values of 1 to 5), according to a method that relates cultural acceptability to consumer uptake as measured by time. In this example, a value of 1 may indicate that the technology is “accepted” by consumers for only a short period of time (1 day to 1 week), while a value of 5 may indicate acceptance for a longer period of time (up to 5 years). While the rates and values may be determined by typical or ideal standards, this system still ensures that selected criteria are measurable. Regardless of the quantitative or qualitative nature of measurement, it is best to standardize ratings to a common scale (for instance, values of 1 to 5), which will help with later evaluation.

Other examples of measurable design criteria include:

• Accuracy of intervention in prevention, diagnosis, or treatment – measured by comparison to existing standards of care (value of measurement error)

• Economic feasibility – measured by cost

• Durability – measured by resistance to testable environmental conditions

• Sustainability – measured by energy sufficiency, or long-term economic affordability

• Ease of use – measured by approval from sample survey

• Adherence to quality and safety standards – measured by approval from regulatory institutions

Other ideal characteristics of specific interventions include:(6)

• Diagnostics: Provides quick and easy-to-interpret results

• Vaccines: Requires few doses, confers lifelong immunity

• Drugs: Not easy for pathogens to become resistant to, requires small doses over a limited period

• Delivery devices: Not invasive

Create a Design Criteria Table to help organize the needs and specifications of innovation in this stage. See table below, using example measurable design criteria:

Stage 5: Create a Plan or Timeline

With a defined global health challenge, it is helpful to create a design and implementation timeline to track progress toward a chosen goal effectively. An established timeline can also help arrange the step-wise solutions to the design pipeline. For instance, IDEO suggests a map of solutions according to incremental (building on existing ideas with familiar users), evolutionary (expanding into new ideas or users while holding other variables constant), or revolutionary (addressing both new ideas and new users) iterations. Earlier iterations may be incremental, while later developments may be more revolutionary.(7) A major challenge for innovators is getting trapped unnecessarily in any phase of the design process. Thus, the goal is to initiate a plan that will motivate continuous advancement toward effective technology delivery.

Footnotes

(1) World Health Organization. “Medical Devices: Managing the Mismatch.” Geneva: WHO Press, 2010.

(2) Ibid.

(3) IDEO. “Human-Centered Design Toolkit, 2nd Edition.”https://www.ideo.com/post/design-kit.

(4) KickStart. “Our Products.”http://kickstart.org/.

(5) World Health Organization. “Medical Devices: Managing the Mismatch.” Geneva: WHO Press, 2010.

(6) Skolnik, Richard L. Essentials of Global Health. Sudbury, MA: Jones and Bartlett, 2008.

(7) IDEO. “Human-Centered Design Toolkit, 2nd Edition.” https://www.ideo.com/post/design-kit.