The Use of Design Thinking in MNCH Programs: A Case Study of the Essential Newborn Care Corps (ENCC) Pilot, Sierra Leone

This case study focuses on the use of design thinking in the Essential Newborn Care Corps (ENCC) pilot project that aimed to transform the role of traditional birth attendants (TBA) in Bo district, Sierra Leone, from community midwives to maternal newborn health promoters (MNHP) and test their potential to improve coverage of essential care for mothers and young children. Some of these MNHPs were also enrolled in a microfranchise social enterprise scheme and, in addition to conducting health promotion, sold basic goods to women at community level to build their own sustainable source of revenue.

The pilot was segmented into two intervention arms: one focused on MNHPs who were trained to conduct health promotion (HP arm) and a second on MNHPs who were also trained as health promoters but also sold goods as part of a microfranchise scheme (HP+ arm).

The design thinking case study research design used a mixed-methods, comparative case-study approach. JSI constructed research propositions to describe and explain the application and influence of design thinking in the ENCC pilot and focused our research using the constructs of fit, uptake, buy-in, ownership, and the effectiveness of the ENCC model. We refined these propositions over time and, as data emerged, constructed a theoretical pathway to illustrate the influence of design thinking on the ENCC intervention. The in-depth case study methodology was intentionally designed to be exploratory and analytical but not evaluative.

The Innovations for Maternal, Newborn, and Child Health (MNCH) Initiative (Innovations) developed and piloted innovative interventions to address common barriers to improving the effectiveness of basic MNCH health services in low-resource settings.

Central to the initiative’s overall strategy was experimentation and learning related to the application of “design thinking,” a form of inquiry that is applied in the conceptual stages of a planning process and subsequent stages of program or product development. A fundamental rationale for the use of design thinking is that it provides important insights into user experience, needs, and desires and helps to translate these insights into tailored interventions or products, increasing the likelihood of user adoption and reducing the risk of intervention failure. In spite of increased reports of the use of design thinking in developing-country settings, there is little systematically recorded evidence of the value of these approaches in the form of in-depth documentation or formal evaluations that link the application of design thinking to health program performance or health outcomes. Moreover, there are few validated metrics to assess the effect of design thinking. Nikki Davis and Anne LaFond, JSI Research & Training Institute, Inc. 2016.