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Keywords: Design Research, Human-Centered Design, Innovation, Humanitarian Aid

Quicksand co-founder Ayush Chauhan sat down recently with Ravi Gurumurthy, head of the International Rescue Committee’s strategy and innovation cell Airbel, to discuss the role of design thinking and innovation in the humanitarian sector. This post shares some of the highlights from that conversation.

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Ayush leading research activities at a healthcare center in rural Mali

Ayush: Thank you for agreeing to be a part of this interview. Before we start, could you introduce yourself and the innovation mandate that you are leading at the IRC.

Ravi: My name is Ravi Gurumurthy and I am the Vice President of Strategy and Innovation at the International Rescue Committee. The IRC has been around for about 80 years and works in crisis affected contexts in about 30 countries. Recently we’ve been setting up an R&D center, called the Airbel Center, which we formally launched last month.

A: Could you speak on the need for innovation both within the IRC and the wider humanitarian sector and what might have been the triggers for it?

R: This focus on innovation emerged out of the strategy that we developed three years ago. We looked at the evidence base for interventions in education, health, safety; all the outcomes that we tend to work on, and what became clear was that if you look across all the work that we and other organizations do, it falls into perhaps three categories. One category is where there is very little evidence of good, rigorously proven practice. For instance we know relatively little about improving adult skills, or governance, or reducing intimate partner violence.

Secondly there are areas where there is some good evidence in low-income, stable contexts. However, effect sizes are not large. If you take all the work we are doing with kids, who may start with reading skills at just about 10 words a minute, it’s not enough to transform their lives and get them up to 60 words a minute, which is what you need to be if you were functionally literate.

The third category are areas where there was very good evidence, very good interventions, such as cash transfers or vaccinations, but there were challenges in actually delivering those solutions in crisis affected places. We felt that while innovation was needed to develop new products and services to address the first two categories, you also needed innovations in the delivery system to be able to get those products and services to market.

IRC field staff working with mothers and children in Mali

A: Could you speak a little about how these efforts differ from what may have been traditionally tried in the humanitarian sector up until now?

R: In some ways the focus on innovation is not new for IRC in that all of our programs are constantly tinkering and improvising and finding ingenious work-arounds. Also, in the last decade, the organization has made a big investment in rigorous research. What differs from the past is that we’re trying to develop new ideas rather than necessarily just adapt and transplant existing ideas. I think all new ideas are actually an amalgam of existing and new ideas, but the focus on starting afresh rather than just adapting or grafting existing practice was slightly different.

Secondly, in that process of generating new ideas, a bigger focus has been on understanding the context and the clients that we serve, as well as trying to find analogies outside of our practice to get a different take on what we do.

The third area is around the criticism that sometimes we jump from an initial concept to large scale implementation and rigorous evaluation without going through prototyping and iteration to improve the solution. We’re trying to build in that cycle between the initial idea and the rigorous evaluation.

A: When we speak of innovation, and borrowing largely from its commercial applications, it often refers to breakthrough or disruptive success, but in the humanitarian field, as it is perhaps true of the development sector as well, a lot of these are long-standing, complex issues. What can innovation begin to mean in these settings and does it have to differentiate itself from how it is largely understood?

R: I think ‘disruption’ is a very overused word. When it was originally used it had a very specific meaning, so I prefer not to use that term. We sometimes talk about ‘breakthrough solutions’, and by that we mean two things: a significantly larger effect size than the current, best-proven practice, and the ability to go to scale because sometimes you find good interventions that require a lot of money and scarce skills and can’t actually be rolled out at scale. It’s definitely challenging to come up with breakthrough solutions. If you aim high, however, there’s a chance you can actually get good progress. Some of the solutions in our context could mean a massive change in outcomes.

Let me give you an example of something we’re working on at the moment. We’re looking at how you can take diagnosis and treatment of malnutrition from the clinic to villages, in people’s homes: can you enable the South Sudanese community health worker, who may not be able to read or count, to diagnose and treat malnutrition? Given that only 1-in-10 people are diagnosed with malnutrition and treated, a new delivery system that brought it closer to the villages could make quite a big difference in outcomes.

Prototypes of malnutrition identification and tracking tools

It’s definitely challenging to come up with breakthrough solutions. If you aim high, however, there’s a chance you can actually get good progress.

A: Quicksand has been engaged with the IRC over the past year, and in particular with the project that you just mentioned. It would be great to hear your point of view on the relevance of human-centered design or design thinking as an innovation methodology, and how that contrasts with some other methods or processes that the IRC may have considered.

R: What was good about that process [for the malnutrition project] is that you had an original idea from a technical advisor who had been in the field a lot and thought about making it easier for the community health workers to diagnose malnutrition with a simple arm measuring tape that had a color code rather than any numbers and on which direct markings could be made to check how malnourished the child is.

What was great about working with [Quicksand], was taking that idea and very quickly making it concrete. Getting feedback on that concept from people in the field meant that we could jettison that original idea and come up with two or three different ideas. As a result we’ve moved more quickly towards a viable solution instead of going  straight towards implementation. It has really accelerated our work in that area.

A: Do you identify certain gaps or fault lines between the ways of human-centered design or design thinking and fairly well developed and entrenched processes of a humanitarian organization like IRC?

R: In some ways many people in the organization are used to doing research, and many of the methods that [we] might use are not dissimilar from the methods you would use in qualitative research. Sometimes the difference is that instead of doing as many interviews as necessary to reach saturation points, you are doing interviews and observations with a view to finding inspiration, which is a slightly different purpose.

What’s been most challenging is the idea of prototyping and trying things at the smallest possible scale, often in a very low fidelity way, just with a view to improving the product or solution. That’s something that is different. There are ethical questions about how you do that without appearing like you’re experimenting on people. I think that’s one of the main questions that we’ll be grappling with over the next year.

IRC staff discussing the malnutrition tools during a workshop in Mali

A: One of the tensions that I felt was between the need for rigour, that often dictates the choice of research methods and processes at an evidence-driven firm like IRC, and the speed at which design tends to move. Do you think this tension is easily resolvable or are there ways in which IRC has tried to resolve it?

R: The real question is about having rigour at the right stage of the process. You always want the product or solution tested rigorously at some point with an impact evaluation so you can tell whether the intervention actually has an effect. It’s important to conduct impact evaluations only once the solution has reached a certain degree of maturity, with lighter touch feedback and measurement done when the solution is still being figured out and improved.

A: Coming to more specifically the engagement with Quicksand, could you speak about some of the ways in which our recent work together has informed new directions and outcomes for IRC?

R: The malnutrition work is a good example of where we’ve ended up with four tools that we are now taking forward in South Sudan to a feasibility trial, and which could be the basis for moving treatment of malnutrition into villages rather than clinics.

We’ve also worked with [Quicksand] on some work in education and how to improve the social and emotional learning of primary school children. What was interesting about the latter is we chose two quite different contexts – one was with kids in Niger who are constantly on the move because of Boko Haram, and then families that were in Nyarugusu Refugee Camp in Tanzania where an entire generation has grown up within the camp.

The education project was interesting because it was not starting with an idea that we were trying to prototype and improve. Instead, it was starting with a topic and a question that we didn’t have an answer to. We’ve now developed three concepts from that work that really speak to the different challenges in those contexts. How do you improve the teacher capability and motivation, how do you engage parents and make them educators of their children, and how do you harness the potential of older peers and youth to teach younger kids?

We’re now at the stage where we are getting feedback on those concepts and prototyping them in Tanzania in a very low fidelity, light-touch way with a view to refining the concepts further.

It’s important to conduct impact evaluations only once the solution has reached a certain degree of maturity, with lighter touch feedback and measurement done when the solution is still being figured out and improved.

Visiting a classroom as part of field research in Nyarugusu Refugee Camp in Tanzania

A:  Do you have a point of view on the effectiveness of HCD in a fairly open-ended mandate, as in the case of our education project together, as opposed to a more defined mandate like we had in malnutrition ?

R: In some ways the malnutrition case was helpful because it was very bounded as an issue and it was immediately relevant how design thinking could help. With the more open-ended and broad mandate, I think in the IRC we are trying to fuse input of different disciplines. In that context, strategy consultants are very good at structuring problems up front, prioritizing issues, and putting boundaries on things. We’re also trying to bring in a very strong understanding of the existing evidence base so we do not go in naive but review the evidence base. The design process arguably is better when you’ve got some clearer boundaries, which I think the researchers and consultants can probably do through upfront problem structuring and prioritizing of issues.

A health care worker in South Sudan interacting with a malnutrition tool prototype

A: My final question is around what the IRC is thinking in terms of strategies and activities at the innovation cell going forward? Could you give us a window into that?

R: A few things. One, we are thinking about different ways of generating ideas. We’ve spoken about the education work, which is trying to answer a big question, and where we spent 12 weeks intensively studying it: analyzing the evidence base, talking to users and practitioners, and running an ideation workshop. We’re also thinking about how we can generate the next example of the malnutrition intervention – how can we harvest ideas that are trapped in the minds of practitioners? And then the third example is how can we do this from a very grassroots perspective? Could we empower frontline staff to experiment and try things out rather than assuming that it always has to be an outside team?

One of the interesting things about human-centered design in our context is that we’re a company that understands our users. We’ve got local staff who really have great knowledge, and our question is how to capture that in processes better. The other thing that I’d highlight is that we’re thinking very seriously about pathways to scale. If I think about the critique of a lot of innovation work, it is that it gets stuck at the pilot phase and doesn’t move beyond that. We’re trying to think about the factors that we need to build in from the start to enable scale – such as cost efficiency, simplicity, being embedded within an existing delivery system et al, – and trying to factor that more prominently in our work.

A: Great. Thanks a lot Ravi. That was fantastic and a very useful recap of the work we’ve done together.

R: Great. Good talking to you.