YLabs Executive Director Rebecca Hope and Senior Designer Theo Gibbs were interviewed for the Yale School of Management’s Impact and Innovation podcast. Hosted by Dr. Teresa Chahine, the podcast examines the latest trends and pitfalls in social innovation, funding, and impact. In this episode, our team sat down to discuss designing for health, the difference between market research and co-design, and how good design can shift patterns of power.

Dr. Teresa Chahine: Tell me more about what ‘design’ means - because people are talking about it so much in social entrepreneurship these days. Is it something new, or is it just a new way of describing something that social entrepreneurs have always done?

Rebecca Hope: For us, design is nothing new in health, but I think the latest era of design is being used to really elevate people's needs - and for us young people specifically - to be able to create products and services that really have value, that are contextually appropriate, and that align with what people really need and want. 

I come from a public health and clinical background, which tends to be very supply driven. People need services - so we build hospitals. People need mosquito nets - so we put mosquito nets out there. But typically, this is done without really thinking about desirability in the same way that the private sector does.

When I came into the world of design, I started to see the value of beauty and desirability in goods and services for public health. 

Design also brings a really nice structure for engaging people that are actually going to use these products and services, ie. your users, and involving them in the co-creation process.

Theo Gibbs: My background is in design and innovation strategy, and I think that at its core, design is interested in what people need, what they dream of, and what do they desire. We tap into that. 

At YLabs, where all of our design projects focus on health, it's been fascinating to see how public health professionals seem to feel like, ‘I already have the solution and I know what people need and I’m just going to put it out there,’ rather than thinking about what the user actually wants. And sure, maybe it is the right product or service because it responds to the fundamental necessities of someone's health or livelihood. But there is contextualization and changes that need to be made in order to make a product or service not only something that fulfills people's basic needs, but that also fulfills their dreams. 

TC: Does that make things more expensive? When we look at some consumer products, the ones with the nicest design are always more expensive - just because they have a nicer design. Does that play in to public health or is there an opportunity to design for affordability? 

RH: Yes. Designing for affordability is what we have to do if we want things to be impactful and scalable. The value that the design process brings to public health is the idea of testing things through a rough prototype first. Right now, typical programs are created with huge, multi-million dollar grants intended to strengthen health systems or roll out better maternal and child health services - but these materials, activities, or products and are created in places like New York, Boston, DC, or London.

The products or communication services are based on assumptions or best guesses - and then rolled out in a twenty million dollar campaign without ever really having tested the intervention with the 14-year-old girl in Kampala that it’s intended to be for.

The design process mitigates this risk by testing products and services through rough prototyping. When we are designing a solution, we know that 50-60 percent of our ideas will get thrown out, or they’ll get redone - a lot! This can be hard, but this way we learn what is working and what is not working very quickly. We’re not going to launch a two year project and then realize it’s not working after an evaluation. For us - that’s too long. We can’t wait that long to get it right, especially for young people. 

Shifting patterns of power through design

TC: That makes sense, so it’s about investing time in the design process and making that the starting point, instead of saying, ‘Here’s the intervention, now we're gonna go implement it.’ And at the same time, making that investment and that time for design shorter so that it can be more affordable and you can just have more rapid iterations of getting customer feedback.

Speaking of customer feedback, we hear this word ‘co-creation’ all the time in social entrepreneurship. ‘We co-designed with the community and we co-created with the customer…’ One push back my students always say is ‘Aren’t you just using them as customers anyways?’ What’s the difference between you and any random, private, brand that designs around its customers? Do your end users pay for the products and solutions that you design? Is that your aspiration? How is what you do different from when the private sector does it? What does co-creating mean to you? 

TG: What differentiates our design process from private sector product research and user testing really comes down to power and empowerment. 

In my personal design ethic, I’m not just trying to create beautiful products and elegant services - I’m trying to shift patterns of power. Co-creation, when done well, is about shifting the power dynamic in the room. It’s about shifting the power around who gets to say what gets rolled out, or what goes to the market or what goes out into the community. 

Instead of an extractive kind of ethos - extracting insights, extracting information, extracting preferences - it's more about having a regenerative relationship where the co-creation process doesn’t just extract information but actually puts skills and ideas back into the community that you’re designing with. For me personally, that's what I strive to do and I think that I see that reflected in the work that YLabs is doing as well. 

TC: So in one scenario, the end user is really just going to pay for the product and become a consumer at the end of the day. In another scenario, you might be designing a hospital or a school that the government is paying for, and you’re helping them co-design to give the end user more power and more voice. Can you give me examples of how that power occurs in these two different types of scenarios?

RH: I can speak to shifting power to youth as designers and concretely what that would look like. When we start a project and have folks on the ground, we are solution agnostic. We do a lot of research before we begin a project, but we also come in with an open mind. From day one, we are hiring and training young people on our approach so that they by the end of the design sprint they are the ones who are leading sessions and speaking to young people in their communities. 

They are part of the decision making process. One great example is Mireille Sekamana, a young leader in Rwanda, who was actively working on reproductive health, access to family planning, and sex education for young people. She was recruited to be a part of design research for one of our projects, CyberRwanda, and she’s now been with us for two years!

We’re hoping that through our work, we’re developing a generation of young designers who can do this work, because there aren’t currently a lot of opportunities to learn those skill sets in a lot of the communities that we work in. This is how we want to operate. It’s not just about having people come to a focus group and then thank them for their time, give them some incentive and just say ‘bye.’ They are part of this journey, and they should be helping to make decisions and drive solutions forward. 

TC: It sounds like it’s also about social mobility and their opportunity to benefit economically from whatever is being designed, right? Not just being asked to pay for it. 

RH: We work in two separate ways; often times governments or large international NGOs are rolling out large scale programs with youth in mind and they hire us since we specialize in youth. The other way is that we actively work with young people trying to identify their priority challenges. Then, we figure out how we can catalyze funding to work on the priorities that young people uncover for us. 

It may be that where we land is a revenue generating model. We’re very open minded about what that looks like and obviously looking very carefully at the willingness to pay. One thing that we are looking at is HIV self testing kits. This is a new product that is rolling out, but the price point is currently very high and so there’s some investment in bringing that price down. 

Right now, we understand that we need to design for affordability, meet young people where they are at, and try to balance how we meet the need that’s there with the product. It may be a five year journey until we get to a place where the product comes down in price, but right now it might mean looking at subsidized models. We have to be flexible and responsive, and that's where I think the power of design and being nimble, flexible, and able to pivot can help when you’re looking to design for affordability. 

Create enabling environments for young people

TC: I love that. Okay, last question: what do you think is one of the hardest things about designing in the context of youth, health, and affordability? There's so many specific constraints, other than if you’re just designing an electronic product for a consumer, right?

TG: One example I'll draw from is the project I'm working on right now, Beyond Bias. We're looking to empower young people to have their voice heard within health systems that are supposed to serve them well, but often don’t. We needed to create mechanisms for gathering feedback from young people and then find out how that feedback could actually get back to the health care providers and the government agencies that are supposed to run those facilities. 

But gathering feedback form low literacy populations is really difficult, especially from young people. For example, in two of the countries where the project is taking place, Burkina Faso and Pakistan, young women in particular have very high non-literacy rates. Both in text literacy and tech literacy and comfort with digital products. 

So, when you’re thinking about a scalable feedback mechanism, we usually go towards digital technologies to capture feedback that can be processed and visualized - but often those systems exclude the people who are most vulnerable to being left out by those health systems in the first place. That's a challenge that we’ve been trying to tackle; how do we develop a feedback mechanism - a literal tool that can go back into the clinic - that is accessible to non- literate young people who maybe have never interacted with a cell phone or a touchscreen tablet before.

There are micro elements, like the colors and the design that need to be considered. But there are also structural elements that need to be created. Young, non-literate women need to feel like they have institutional permission to interact with that device, or else they won’t use it and we won’t get the feedback that we need. So in this case, the design is really about considering the micro and the macro, or the system that the user is in, and asking, ‘How can we create enabling environments for young people?’

TC: This is so exciting, I can't thank you enough for being here today to share your work.