Project Mwana consists of a mobile service that delivers HIV lab results in real time to rural clinics and a messaging platform between clinics and Community Health Workers to ensure the results are communicated directly to mothers. It has reduced the time to deliver critical information from four weeks to a few minutes.

Project Mwana is now serving as a demonstration project for a new approach to collaborative design to enhance the use of real-time data within UNICEF.

UNICEF manages one of the largest and most complex supply chains in the world, delivering 60% of the world’s vaccines. But how do they know if their programs are truly reaching the neediest in the most underserved communities in the world? And how can they gather sufficient feedback to determine if these programs are delivering meaningful outcomes? Most UNICEF programs are designed centrally, by the Program Division in New York City. Typical measurement and evaluation activities can take years to capture results and outcomes, making the data practically useless in helping the organization target resources and adjust program design to suit local needs.

A small design team has pioneered a set of solutions that incorporate low-cost mobile technologies to improve the quality of service delivery and provide a missing layer of real-time feedback to measure results. Based on the success of these programs the team is swamped with requests for help and support from country offices. But countries are often looking for shrink-wrapped solutions, when these systems need to be tailored in meaningful ways to local needs and participants.

The team began a project to change this mindset and develop a new strategy for engaging with stakeholders at a country level. They had built up a great deal of experience working with country offices over the last few years, but needed to translate that experience into a broader model for engaging with local communities. The purpose of this model was to help country-level programs in areas like health and education to shift from a supply-oriented to a demand-oriented mindset so that they can better engage with new initiatives. They must resist the urge to see these programs as a way to automate data collection. It is tempting to design programs based purely on the data that you want to gather to measure outcomes.

The power of mobile technologies is personal and social in nature. Along with that power comes a responsibility to engage and support a dialogue between participants at multiple levels. This requires a set of methods and tools to engage users and understand their motivations and needs. UNICEF doesn't have a model for incorporating that kind of feedback into their program design. The team believed that a human-centered design process was critical to introduce to the broader organization. If UNICEF can improve its ability to drive regular use and engagement through mobile technologies, then they can generate the sort of real-time data that is critical to their long-term strategy.

The team worked on a number levels to define this strategy:

• engaging directly in pilot projects with UNICEF stakeholders to understand how they operate at a country level

• conducting workshops to take key stakeholders from nine different African countries through the process of designing mobile services from the end-user’s perspective

• developing and publishing a design framework that has been distributed widely throughout the organization.

The pilot project focused on the HIV crisis in East Africa. UNICEF wanted to improve infant diagnosis and treatment in rural areas that sit far outside the reach of infrastructure. This was the first opportunity to deliver a program on a national scale that, if successful, could be replicated around the world, but they wanted to ensure that the solution was tailored to the real needs and expectations of the communities involved and that the lessons could be integrated into a broader strategy and communicated back to the rest of the organization.

The team got immersed in the lives and routines of Community Health Workers (CHWs) and gave them phones to test out early prototypes for delivering HIV results directly from clinics via SMS, which revealed a number of key insights. Because CHWs receive little feedback, they wanted a feature that let all the CHWs see how many results each worker was delivering. The CHWs also requested an open channel to ask questions via SMS. Finally each CHW gets thanked via SMS whenever they report results, which is a great example of a feature that would not been created without a user-centered design process

The experience in Zambia demonstrated the importance of early involvement and rapid prototyping to create a service that community members want to use, which represents a shift in thinking for UNICEF. They generally start with a fixed idea of what they want to measure and look to mobile services to automate the data collection process, often adding complexity and redundancy to the daily tasks of front-line workers. This model considers the needs of the users first and looks at how mobile services can make their work more efficient and meaningful.

The team used this model in a series of collaborative workshops to introduce officials from a nine countries to the design process. The sessions were highly structured, with hands-on design activities to help identify opportunities to better support user needs through mobile services. Participants mapped out and performed services to better understand the kind of feedback that is meaningful to participants at each level in the system. It was critical for senior stakeholders to see real-time data as a reflection of the human experience and not simply cells in a spreadsheet. Based on the success of these workshops, a handbook was made to guide country offices through the design process so that they can better plan, design and integrate mobile services into their strategy moving forward.

This project delivers value by helping UNICEF better achieve its humanitarian and development goals in communities around the world, particularly those with the least access to resources. The current programming process is top-down, driven by central decision-making with outdated reporting mechanisms that take years to deliver meaningful data. The UNICEF innovation team has been working to change that approach on a small scale, partnering with local offices primarily in the health arena to pilot participatory and inclusive solutions. The goal of our partnership is to drive adoption of this approach across the organization, delivering value on a number of different levels:

- Demand for participant and community-led design approaches from UNICEF country offices.

- Increased access and improved outcomes among users of these services.

- Increased ability to measure the impact of these services and iterate on their design.

- Increased willingness by governments to adopt and roll out these services on a national scale.

- Increased capacity to support and enhance these services with local software development talent.

The clearest example of our ability to achieve these goals has been in Zambia where we collaborated on a program to increase access to lifesaving HIV information for mothers and children. This program has reduced the amount of time it takes mothers to receive this information by 57% while dramatically increasing the number of post-natal visits. The program is currently in the process of a national rollout in Zambia and is being replicated by UNICEF teams in Malawi and Sierre Leone.

This project is part of a long-term commitment to expand the role of design in the development sector. The partnership was highly iterative as we adapted to changing conditions both on the ground, as we worked together to develop mobile health solutions in East Africa, and organizationally, as we brought together an increasingly diverse cross-section of stakeholders within UNICEF. Unsurprisingly, there were a number of shifts along the way:

1. Shift in Mindset: UNICEF typically approaches programs in a top-down manner maintaining a great deal of control over the process for collecting data and resulting in programs that are a significant burden on the people they are trying to support, such as Community Healthworkers. The first major change was to from a data collection to a service mindset, in which their programs must deliver as much value to the participants as they do to the larger organization.

2. Community Engagement: The second shift had to do with the rapidly expanding reach of the project as we extended further into the community to ensure that health outcomes were achieved. This necessitated a fundamentally different design approach in which solutions for problems like birth registry had to be pared down to their simplest form.

3. Organizational Mandate: Top officials within UNICEF are demanding that the organization find ways to leverage “Real Time Data” to measure the effectiveness of their programs much more rapidly. To support this directive we generalized the solutions developed for Project Mwana into a model for the entire organization.