World-leading behaviour change to save lives
Every day, around the world, people die from preventable illnesses.
How many lives could be saved by working with them to change their behaviour?
Whether it is sleeping under mosquito nets in malaria-ravaged communities, storing drinking water safely in regions prone to Zika virus or using self-testing kits in places with high HIV rates, attempts to change harmful human behaviours into helpful ones have proven stubbornly difficult.
That’s where Breakthrough ACTION comes in.
WHAT IS BREAKTHROUGH ACTION?
Breakthrough ACTION is a 5-year, $300 million mission to address those challenges using a world-first alliance of human-centred design, strategic communication, behavioural economics, marketing science, digital health and community mobilisation and engagement.
It is the flagship social and behaviour change program for the world’s largest public funder of international development, USAID. And it’s a hugely-ambitious initiative that spans 25 countries across the globe.
ThinkPlace is the global human-centered design lead for this project, which is led by Johns Hopkins Center for Communication Programs and features a consortium of partners. This unprecedented collaboration is driving change that will save lives and create better health outcomes across Africa, Central America, the Caribbean and Asia.
For ThinkPlace, this project represented an opportunity to apply the stages of design thinking (research, ideate, prototype, reiterate, test, measure, apply) on an unprecedented scale to an intractable set of problems.
Beginning with co-design workshops at each site we set shared intent, creating pathways for stakeholders and users to participate and shape prototypes.
These early-stage prototypes are then aggressively tested and revised in real-world settings across a series of design sprints.
RAPID FIELD PROTOTYPING
Working with our partners we have created a new way of running the design process – Rapid Field Prototyping -- to fully integrate the communities involved: designing, testing and iterating solutions from within their midst.
We have brought our expertise in behavioural insights, behaviour change and communication design to the project, allowing communities to co-create change in real-time.
In complex systems it can be risky to go too far down a design path before testing how an intervention sits in a system. Rapid Field Prototyping begins with an intense period of ideation and research but moves quickly to early prototyping (often within 48 hours).
This allows us to test a broad range of imperfect and experimental responses with humans in the system; in the kinds of challenging environments thrown up by developing countries. Prototypes are often made from cardboard or modelling clay. We make changes to them in real-time in a rolling fashion.
By engaging community members in the processes of research, making and testing we are helping to build local capacity so that the interventions we craft together can be implemented, scaled and retained over time.
Human centredness is at the heart of this project. Each intervention that ThinkPlace has designed begins with spending significant time on the ground in local communities, talking with people about how they live, what motivates them and what blockers exist that prevent them adopting healthier behaviours.
We are currently in year two of the five-year project and already we are seeing impact from our work in places such as Nigeria, Zambia, Jamaica and Guyana.
Nigeria accounts for 13 per cent of all child deaths worldwide. In just this one Breakthrough ACTION site our work (around child health and nutrition) is having a profound impact.
Over a 2.5-week period in Nigeria, we conducted over 290 interviews in homes, workplaces, health facilities and more. These were synthesised into 10 key insights around maternal child health and nutrition that will now form the basis for interventions to be prototyped and tested.
Elsewhere in Nigeria, we have developed designs to increase health seeking behaviour for signs and symptoms of tuberculosis – reducing the stigma associated with being tested and treated. Pilots of these initiatives are currently being rolled out at scale.
In Zambia we have implemented interventions that have reduced barriers to adoption of six key behaviours (family planning among adolescents, accessing HIV testing, condom use, optimal complementary feeding for children under two years, timely care-seeking for children under five and insecticide-treaded net use for malaria prevention).
Working with the community we co-designed 40 innovations for tackling HIV prevention, maternal and child health, family planning, malaria and nutrition, prototyped 8 and then refined to 4 after testing.
Using persuasive techniques from advertising we created the Umbrella Campaign, based on what Zambian families see as precious in their lives and using social media to sway ingrained behaviours around reproductive health, contraception and disease prevention.
In Jamaica we have designed integrated initiatives to increase safe storage of water to minimise the risk of Zika and other mosquito borne diseases.
Our initial research showed many people had little idea about how to prevent Zika, by changing methods for storing water and thereby removing mosquito breeding sites. That has changed.
Our partner, Jamaica’s Health Ministry says: “This was one of the highest quality projects we have seen. What you produced was impressive. You have given us much to work with, not just with the solution but with the methodology used and your approach.”
In Guyana we have created interventions that will improve community access to malaria testing and treatment services in remote regions of the country.
Across all these projects we have facilitated a co-design approach which brings together various agencies and non-government organisations to collaborate in ways that have not been possible previously.
DESIGN FOR LASTING CHANGE
ThinkPlace has helped develop the Breakthrough ACTION Social and Behaviour Change FlowChart. The flowchart incorporates elements of the design thinking process along with methodologies from behavioural economics, community engagement, marketing science and strategic communication for a world-first hybrid approach.
Collaborating in this hybrid way, harnessing the expertise of Breakthrough ACTION consortium partners, allows us to create new methods and maximise impact at scale.
Breakthrough ACTION largely works in locations and communities where human-centred design and co-design are unfamiliar. The project is building new capabilities that will endure.
In-country partnerships are allowing innovations that are created, implemented and scaled. Partnerships are built so that in-country organisations can continue to drive change after current interventions expire.
The processes we have brought to this project are helping to create a systematic but innovative wave of change across numerous countries. While many local differences exist, we are seeing the emergence of an integrated and broadly-applicable methodology that spans national borders and connects on a human level.
Many of the world-first interventions that make up this program have broad potential to be applied elsewhere and scaled up. Breakthrough ACTION will have a direct impact on the lives of real people, but it is also a sandbox for innovation and experimentation.
By deploying a hybrid solution that draws on many methods and approaches we are showing that innovation for impact is not always about new technology. Methods that bring together the right people and put them in position to design and implement change for their own communities can be far more powerful than a fully-technical solution.