User-Centric Mobile Design for Development: It's all about the People!

Posted by KatrinVerclas on Apr 26, 2010

During the last FailFaire (well, actually the first one to date) we were reminded by a guest rather sternly that NGOs often forget who their users are and, more importantly, what the needs of these users are. When we, collectively as a field, implement mobile deployments with constituents or groups, do we tend to forget user needs and capabilities, getting too enchanted with the tech (and ourselves) and then fail when, not surprisingly, there isn't any uptake?  We have seen many a project fail for precisely this reason. Our grouchy attendee had a point even if he did not deliver it very gracefully.

To this end, we are reposting here a recent report from Zambia. Project Mwana is UNICEF Innovation project that is "working with the Zambian Ministry of Health, UNICEF Zambia, the Malawi Ministry of Health, UNICEF Malawi and many implementing and technical partners to find appropriate, scalable and impactful ways that mobile technologies can strengthen health services for mothers and infants in rural health clinics."

The implementation blog is here. It does a great job outlining some key issues in regard to planning for and then implementing mobile solutions in-country, and well worth a thorough read. These posts were written by Cory Zue from Dimagi and Nancy Ringel. 

One team is heading to the city of Ndola, which is the 3rd largest city in Zambia and the industrial hub of the mining operations in the country.  There we will be working out of the Arthur Davidson Children's Hospital, which contains one of the three labs in Zambia with PCR machines. The PCR machines are able to break down the DNA of anti-bodies in blood samples and determine whether an infant has HIV or just the mother which is critical to being able to save the infants life. We are going to be working on automatically sending the results from the database they are stored in, to RapidSMS, which can in turn send them on to cell phones in the facilities where the samples were collected.
The other team is heading to Mansa, which is the provincial capital of the Luapula province. The journey to get there was reduced to nine hours from eleven, since the roads were repaired last year. Luckily the rains this year did not wash them out.  The team in Mansa is going to immediately start working with the Community Health Workers and Clinic workers on creating usable and useful systems for receiving the Early Infant Diagnosis (EID) results we are sending from the lab, as well as to contact mothers and caregivers and to notify the Ministry Of Health infrastructure of low stock. 

The Mwana team is committed to responsible development, and one of the most important parts of a project like this is ensuring that we involve as many stakeholders as possible, at all levels of planning.  We have had numerous meetings in Lusaka to make sure groups and individuals are informed about our project plans, and we are beginning the process of involving the rural communities of Luapula.  I have recently traveled to Mansa to start preparing clinics for our pilot launch, and the meetings with stakeholders are still going strong on the Lusaka side!  Since the goal is not to design a system FOR the citizens of Zambia, but to design a system WITH the citizens of Zambia, we feel it is important to involve all stakeholders and keep them fully informed.  This will help the project be more sustainable, so that once our dev team is gone the project will continue to grow and improve.

We have decided that of all the stakeholders, the most important people to involve will be the ones actually using the system- in this case, the clinic workers of Luapula Province.  As part of our project plan involves an iterative development scheme, we will be taking our product directly to the users (the staff of Luapula clinics) for input and advice after each iteration.  Making regular visits to clinics around Mansa district will ensure that we have direct user input, and that the clinic workers will have a concrete say in the system’s design.  We are constantly facing logistical challenges in implementing this strategy (i.e., finding out that designated clinics have no cell network, or that the clinics are far away on bad roads and will be difficult to visit regularly), but we have been able to come up with relevant solutions and take our difficulties in stride.  So far, so good!

We will be deploying our "final" product in clinics all around Luapula Province, many of which are the MNCH Pilot Initiative clinics designated by the Ministry of Health.  It will be exciting to see a technology project like this implemented in such a rural area, as pilot initiatives rarely reach out to such neglected populations.

There is a lot of excitement about moving into the real work we are here to do and getting to collaborate with the potential users and beneficiaries of the systems we are building.

It's always nerve racking showing your software to actual users for the first time, and SMS systems are no exception. Technically there's plenty to worry about. Did you connect the modem and make sure your server isn't going to hibernate or crash? Did you bootstrap the database properly with the demo data that you're going to use? Did that bugfix you made 30 minutes before the demo break anything else? All of these things can, and often do, go wrong.

However the larger issues are not technical, but programmatic. Is your system user-friendly? Is it practical? Is it even solving a real problem? Often times you'll build what you think is a simple, intuitive, and useful SMS system only to find that it's far too complicated, confusing, and actually solves the wrong problem entirely. So naturally it was with both excitement and trepidation that the team made our way to Mansa Central Clinic on Friday to get our first round of real user feedback.

At Mansa Central we met with Majory, a sharp and busy nurse. We tried to put her at ease as seven of us of us sat in an imposing circle of chairs, taking notes and hanging on her every word. As we explained the purpose of Results160 (to get early infant diagnosis test results from the central labs back to the clinics faster by sending them straight to the phones of the clinic workers via SMS) we were immediately reassured by her reaction. Yes, the results take a very long time to come back. Yes, it is a big problem, and frustrating for both the health workers and the mothers. Anything we could do to improve the speed of results delivery would be fantastic. Useful? Check.


Next we talked about phones. She told us that all the workers have personal phones that they keep on them at all times. Service is good where she works (this will unfortunately not always be the case in our clinics) and everyone is quite familiar with SMS. Practical? Check.

Finally it was time to demonstrate the system. Talking through carefully designed training materials, we showed her how the system would work, and explained to her how she could register and receive
test results for her clinic. We talked her through an imaginary workflow of being notified that new results were ready, responding with her secret security code, and receiving the results directly to
her phone.

Much to our surprise and delight, it went shockingly well. Many times in early-stage user testing, you're happy if the user has a single back-and-forth with the system successfully. However, Majory got through the entire workflow we'd planned with little guidance from the team. When she got stuck, she fell back to the training materials, and was able to figure out what to do next on her own. She was fast, efficient, and happy at the conclusion. So were we. Usable? Maybe.

The session went so well (and so quickly) that we decided to make a second stop at another nearby health facility: Buntungwa Clinic. There we met with two more clinic workers, Beatrice and Hildah, and went through the system again. Once again the feedback was extremely positive. Yes, they would love to get their test results sooner. Yes, everyone has a phone. Yes, everyone uses SMS. However, when it came to demo the system we had one small problem. Because we had only anticipated making a single stop, we had only setup the database to include one clinic with pending test results, and those results had just been collected by Majory at Mansa Central. We had no data and no way of adding data to the database remotely.

Enter agile user testing. Rather than have them SMS our carefully crafted system (which would not be able to send them results), we had them SMS one of the developer's phones. While we explained and introduced the system to them, the developer was frantically copying and pasting messages from his own previous interactions with the system in order to fake the responses.

Again, things went off great. They breezed through the session and had almost no issues, even offering insights as to where they thought small things could be improved.

We're not sure how representative the clinics we visited will be compared to sites in the more rural areas where we will also implement, however, the first round of testing was extremely encouraging for the whole team. There is nothing like seeing your system in use for the first time, and it is that much more exciting to see that you've built something that's actually practical, usable, and
may even solve an important problem.

Photo Courtesy Dimagi/Unicef Innovation


User-Centric Mobile Design for Development: It's all about the People! data sheet 3620 Views
Countries: Zambia

How can donors use the crowd to monitor projects?

This is a fascinating post and I'm interested to find out more about how mobile phones can be used to monitor the implementation of aid projects.

Specifically I'm keen to explore how donors can use the power of the crowd to ensure that aid reaches beneficiaries, and have posted an example of the type of problem donors typically face (e.g. getting 500,000 textbooks out to school). We'd be grateful for any tips on solutions.

Thanks for writing about the pilot in Zambia - it looks great! And I look forward to checking out your other posts.

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