Health Center By Phone
Clients: Village Reach Malawi, the Malawi Ministry of Health and Airtel
Location: Malawi
Duration
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Design: 5 Months
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Impact: Ongoing, as this project has become a well-adopted national service owned and operated by the Malawi Ministry of Health
My Role
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UX Research & Design
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Project Management
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UX/UI Development
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Prototyping
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Usability Testing
Press: The African
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Brief
In Malawi, reducing the rates of maternal, child and infant mortality means democratizing health care for remote communities. Accessibility is vital, and the previous call centre system in place was frustrating to use and disliked by clients and health care professionals alike. Once we built the trust necessary for community uptake, we were able to define the goals for an improved system and perform extensive user testing in order to get to our final deliverable: the Chipatala cha pa Foni (CCPF). The CCPF is a toll-free health hotline that connects rural community members to trained practitioners to provide healthcare information and referrals over the phone. It also allows users to sign up for voice reminders regarding maternal and child health topics. When I finished with the project, over 80% of calls made to the hotline were resolved through the hotline.
DISCOVER
User & Stakeholder Research and Analysis
The first stage in this process was to pitch project stakeholders the idea of adopting a human-centred design approach for tackling the issues at hand. Once we came to an agreement on this, I put the approach into practice to identify user needs and develop a set of final detailed requirements which would fulfill obligations and excite stakeholders about accomplishing their goals. Our CTO and I started by travelling to the Village Reach’s headquarters in Seattle in order to discuss the budget and high-level requirements with the management team before I went to Malawi to meet with Airtel and the Ministry of Health to understand infrastructure needs and overall goals of in-country stakeholders.
Once I was able to define the needs of the system and its users, I facilitated a workshop with users reviewing current user processes and changes they would like to see.
Key Take Aways
From this research, there were a few key takeaways:
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The biggest challenge related to the adoption of the new system was reliability, as the current system was unreliable and thus had garnered a bad reputation with nurses and users alike.
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Nurses wanted better call management practices, including updated call flows, ways to direct people related to their circumstances, strategies to process high call volumes and insights into statistics.
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Interactive voice response would increase the capacity of nurses, while also helping to best support those calling in.
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The best-case scenario would allow for flexibility in the system, to enable additions and changes in the way the system worked for the unforeseeable future. That way, this product could grow and expand alongside the needs of the community.
Define, Ideate & Test
After the discovery phase, I worked with a designer colleague to scope out the work and design potential user interfaces. We worked primarily with 30 nurses during this software design process in order to test the information architecture of the data being collected. We investigated different options during the prototyping phase, and I facilitated a workshop with representatives from each stakeholder group in order to further iterate upon the product and generate ideas and requirements for improvements.
A primary requirement of the system, which required significant co-design, was creating the call flows that a caller would experience when calling the call center. This was challenging due to the complexity of health cases the call center was looking to support, the number of stakeholders who needed to be consulted, and the technical limitations of the infrastructure available.
Throughout this process, our Malawi Country Manager and I also liaised with mobile network operator Airtel in order to form the appropriate agreements that would allow this to be a reusable and sustainable product.
Deliver
Once the designs, architecture diagrams and documentation were developed and delivered, a three-month long period of beta testing began. During this time, our in-country team tracked the successes and shortcomings of the product and provided this primary information for me to create the necessary designs for the final round of iteration. This included optimizing the design, fixing any points of unreliability and improving the call flows.
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The result of this final product was a popular national health service. By August of 2018, the hotline was answering around 3,000 calls per month and 80% of cases were resolved using the hotline. Overall, the CCPF is saving people time and money, and is relieving stress from health care workers across the country.
Reflection
As the lead designer and project manager for this five-person development team, I enhanced my practical skills related to Agile Development, and learned about the importance of trust and buy-in from users. I worked with my team to understand the mistrust held by nurses and see it as its own challenge that we needed to solve, which allowed for collaboration with the stakeholders and software development team to satisfy concerns. Prioritizing the nurses during this user testing phase was extremely important, as it empowered them to have influence in what was being designed.
From a design perspective, I now understand more than ever that a reliable infrastructure is just as important as something that looks good. This is often overlooked during design processes, and as a team leader I now know to see this as a challenge within the scope of design.
