Friday, June 14, 2013

Introducing Human Centered Design into policy-making in Nicaragua

“Boring...” That was my first reaction after spending the night at a ‘casa materna’ in rural Nicaragua. There wasn’t much for the other women – who had come to access the regional capital’s superior maternal health services – to do. There was a lot of sitting around. Most women were too shy to talk to one another. Others just missed their homes.

I felt guilty at my reaction. These maternal houses were, after all, superb facilities that help rural women have free pre-natal exams and deliver their babies in a safe environment. Was it unfair to talk about boredom when money is scarce? Shouldn’t these women be content to just have these services? From a Human Centered Design perspective, the answer is simply no.

At UNICEF Nicaragua, we have introduced ‘design thinking’ into policy-making. The concept invites us to look at public services as designers. To focus on the experience of service users as a departure point for improving these same services, and therefore their impact on people. So when we teamed up with the government at the Northern Autonomous Atlantic Region (RAAN) in Nicaragua to develop a regional policy for children, we seized on the opportunity to use this innovative approach to support the rights of kids in the region.

Design thinking requires empathy, so we started our work by going to the people. The work kicked off with two weeks of intense field work in 7 indigenous territories and 23 communities. Equipped with a design research framework (i.e. ethnographic and journalistic tools, photos, videos) developed by Reboot, an NY-based social enterprise specializing in governance, the team set off to capture what people really care about. We talked to more than a hundred residents of the region about their aspirations, priorities and concerns for their children. There were no pre-cooked solutions waiting to be vetted. The goal was simply to observe and understand.

“We didn’t understand the methodology at first, but it soon became dynamic, active and proactive,” confessed Fernando Pomares, Technical Advisor for the Regional Council in the RAAN. Mr. Pomares further explained that the technique allowed him to deeply understand the opinions and problems of people in a concrete way.

Making sense of this wealth of information wasn’t easy. A series of co-creation workshops and additional investigation followed to synthesize over 500 direct and indirect observations. Post-it notes and drawings covered the walls of our office. They told the stories of children, single-mothers, parents, and grandmothers, most of them from indigenous or afro-descendant backgrounds. The regional policy started to have a face, a name, a context.

To deepen our understanding of the experience of parents and children in the region, we also ran service trials. It was during the latter that I spent the night at the maternal house. The other 15 government officials also spent the week carrying heavy backpacks to simulate pregnancy, filing for child support services, registering children, attending classes in good and bad schools, participating in after-school activities - not as observers - but as actual service users, as rights holders.

“We lived with people, were in their places where things were going on,” explained Guadalupe Alvarez Kitler, Director of the Women, Children and Family Secretary of the RAAN. The important part, according to Ms. Kitler, was understanding the perspective of children and mothers, what happens during school hours, in the hospital.

The work is far from over. But thinking like a designer and a policy-maker has been a rich experience. It has brought together government officials beyond party lines, created empathy towards service users, and increased understanding of context (and what the policy can in fact deliver and what’s just wishful thinking). Most importantly, it showed us that improving the experience of services doesn’t have to be costly. Government officials in Nicaragua are already envisioning casas maternas as spas experiences by creating linkages with the hotel industry. The private sector has long understood the centrality of creating positive experiences to attract and keep loyal customers. For the public sector, happy ‘customers’ means stepping closer to fulfilling their rights. And there’s nothing boring about that.

Focal Points:
Natalia Adler,
Rinko Kinoshita
UNICEF Nicaragua,