When it comes to global health, I’m an optimist. Or as the Gates Foundation might say, an impatient optimist. What does this mean for me? It means I believe we’re trending upward, but we can trend faster. I believe we’re within arm’s length of a new era of solutions, but we have to reach out our hands and grasp it. I see failures as lessons learned, mistakes as unavoidable byproducts of trying something new, challenges as opportunities. And I believe we’re at a critical moment in our history when we’re seeing technology change the lives of people all over the world at an unprecedented pace.
It’s been incredible to watch how the global health community has embraced digital technology in particular. Thanks to investments from the Gates Foundation, USAID and other donors, we’ve seen a revolution in global health invention and entrepreneurship that’s yielded hundreds of nascent digital platforms, mobile apps and other tools that aspire to improve and save the lives of millions of women and children. But as efforts like Saving Lives at Birth and others have demonstrated, it’s a long path to bringing a technology to market and reaching the people for whom the solution was designed. To maximize the probability of success (i.e., the ability of the innovation to have the desired impact), the process needs to begin with the end-user.
When I think about this “user-experience design” process in the context of my work – saving women’s lives during pregnancy and childbirth – I am struck by the obvious: that new digital technologies to improve maternal health must begin and end with the woman and/or her provider (our end users). But it’s not always enough to design a product that simply has the end user in mind; rather, if we have any hope of achieving scale and sustainability, women’s needs, routines, preferences and overall context must factor in right from the ideation stage.
To some, this is a challenge too great to confront; to my colleagues and me at Merck for Mothers, Merck’s 10-year initiative to help end maternal mortality, this is an opportunity.
Bringing down the nearly 300,000 maternal deaths that occur each year is a challenge that unfortunately has no magic bullet: it cannot be tackled with a shiny new device or pill. But technology can be a critical enabler and, in some settings, a game-changer, especially when its function is clearly defined and integrated. Recognizing this, Merck for Mothers wanted to discover the real “pain points” in our programs before identifying technology solutions. What’s preventing women from reaching high-quality care? What’s preventing providers from delivering high-quality care? What’s driving up costs and creating inefficiencies? Where are there major gaps in information? How can we empower women to be informed decision-makers about their care? After answering some of these questions, we are now investing in the development of digital innovations that address key user needs seen in the field.
One exciting technological bet we’re making is in the area of community accountability. Too often, the quality of care women receive during pregnancy and childbirth is of poor or variable quality, especially among low-income, uneducated women. And because they don’t know what type of care they should receive, women are not able to express their dissatisfaction and ask for something different. Consequently, without a demand from patients for better care, doctors, nurses and midwives may not worry about losing “customers” and have little incentive to improve their practices.
As a result, we’re harnessing the power of crowd-sourced user feedback to see if we can help improve the quality of care. Similar to platforms like Yelp and Trip Advisor, we’re quite literally putting decision-making knowledge and power into the hands of low-income, limited-literacy pregnant women in India. We’ve partnered with White Ribbon Alliance India (an advocacy organization) and Gram Vaani (a technology developer) to launch a phone-based system designed to 1) educate women on the components of quality maternal healthcare, 2) enable them to anonymously rate the care they receive and, in doing so, 3) better hold providers accountable for the quality of care they deliver.
Though in its infancy, the tool has already seen early success. Our pilot test in 20 villages of Jharkhand reached nearly 10,000 callers in just four months. We found that low-income women with limited literacy can successfully use the platform to learn and rate care quality, and that health providers and officials are receptive to receiving this feedback. Building on the pilot’s success, we hope to develop a model that can be scaled to reach more women, communities and providers in India and beyond.
This tool is just one example of the digital innovations we’re exploring at Merck for Mothers, but I’m proud to say that it wasn’t built in a laboratory or office building removed from its context. It is being refined everyday by the end users themselves, and, in turn, so is the maternal healthcare women receive. Sure, there’s always a chance that it fails (my fingers are permanently crossed that it won’t); but with that failure would come lessons that could guide our future efforts and those of the global health community – always with the end user steering the ship. We look forward to keeping the global health community abreast of our successes and our failures, knowing that, together, we can tap into this wave of technology for the benefit of the people who need it most.
At least that’s what the optimist in me believes.