Five years ago, I led Frog on a journey to the hardest-hit region in the HIV crisis—South Africa. I am not talking about the South Africa of safaris and vineyards. I am not even talking about the celebrated townships like Soweto. This journey started in KwaZulu-Natal, where HIV prevalence is estimated at 30–40% of the population. What did we think we could contribute to this crisis from our studios in New York and Milan? It was a classic case of design hubris.Our work on Project Masiluleke was profiled this week on the Smithsonian Channel in association with the Cooper-Hewitt’s Design with the Other 90%—appropriate timing given that today is World AIDS day. The show provided a moment of reflection. Working with incredible partners like iTeach, Praekelt Foundation, and Pop!Tech , over the last five years our project to leverage mobile-phone technology to raise AIDS-services awareness has reached 700,000 people. But have we made a real impact?
The most significant accomplishment to date has been the launch of a mobile messaging service that reaches 1–2 million low-income South Africans a day through an innovative distribution mechanism pioneered by Praekelt. This service has proved to be an effective laboratory for experimenting with different messages, languages, and incentives to see which are the most effective in driving awareness. I recently found out that the raw data from this program is being used to teach statistics at the Yale School of Management, which also published a rich case study profiling the project.
Since day one, this service has tripled the volume of calls into the National AIDS Helpline through links embedded in each message. But what do we do with the people who call in? Design in the social sector often consists of campaigns and awareness activities, but it rarely does more than that. Five years later, awareness alone would feel insufficient. In today’s model of design for social impact, communications is a small part of the answer.
Since we launched the messaging service in 2008, the hard work has really just begun. How do we link increased awareness to services that can meaningfully change behavior and improve outcomes? These services need to support a variety of touch points that are all accessible from ultralow-cost mobile phones, including:
• Boosting call center capacity and effectiveness,
• Creating open forums to ask questions and get answers from experts and the community,
• Offering a simpler and more convenient way to get tested,
• Integrating follow-up and reminder systems.
The good news is that our partners have programs running in each of these areas that are showing real promise. Although the programs have been piloted at different scales and on different timelines, in each case there is real data to indicate positive engagement and the potential for meaningful health outcomes. Still, it will take some time to get there.
In the meantime, the biggest success so far has been the collaboration itself. We have watched partners like iTeach bring design to the very center of what they do. We have worked together to help them transform community outreach workers into skilled design researchers. iTeach now runs rigorous usability tests on everything from traditional healer-referral forms to the HIV self-test that we have designed and developed together, diverting frontline staff from critical care to design activities. Design is no longer an option for iTeach—it is an imperative.
We face many challenges in bringing each of these programs online at scale, particularly self-testing. As we continue to pursue this goal, we must also step outside of the path we have defined for ourselves. I am continually reminded of some of the earliest user research that we conducted in KwaZulu-Natal. Again and again, in these discussions the participants indicated, without being explicit, that the risk of contracting HIV was not even among their top five concerns, falling way behind food, jobs, and safety.I recently participated in an offsite discussion organized by Patricia Mechael of the mHealth Alliance at Greentree in Long Island. It was a privilege to spend time with mHealth experts from organizations like USAID, GSMA, Gates, Rockefeller, and others. The key takeaway was how fragmented the landscape of health interventions really is. AIDS, Malaria, and TB programs all depend on the same fragile health-delivery system. We must think about community health in a more integrated manner. Frog is working with UNICEF as part of our Mobile Mandate program to do just that. We are also working with organizations like Movirtu to explore innovative ways to open up mobile services to an even broader population so that clinics can provide every patient with a private means to access their health information from any mobile phone anywhere in the world.
Each of these partnerships provides one more building block toward a more comprehensive solution to the global health deficit. The trick is to make sure that the pieces fit together in a way that truly works for the people who are directly affected. I can’t think of a better challenge for designers who want to have an impact on this crisis.