Using a Human-Centered Design Lens to Examine Community Accountability Programs to Improve Quality of Maternal Health Care in India
- Although there are some specific challenges to applying an HCD lens to community accountability work, in general, it can be a valuable framework to use in designing and implementing accountability programs. More assessment will be required to fully understand the connection between implementing specific HCD phases and steps and the extent to which doing so increases the success of using community accountability to achieve outcomes.
- Using HCD tools such as activities, games, and interview and discussion guides can facilitate targeted, in-depth investigations of specific topics to guide the development of community accountability programs. Using these tools can help program implementers find the right balance between lengthy and deep examinations of a community and shorter or more circumscribed approaches to identifying MHQoC challenges.
- Rapid prototyping is a central component of HCD that comes from manufacturing practices. This concept is easier to apply when developing and testing specific community accountability tools, such as mobile phone-based apps or electronic applications. However, community accountability rarely involves just one specific product, but usually encompasses a series of processes and products. Thus, implementers must adapt the concept of rapid prototyping for this use case.
- It is important to define and measure success from both a design perspective and a public health perspective. MHQoC strategy grantees have largely recognized this need, tracking both process-oriented measures such as health officials’ responsiveness to accountability measures and outcome measures such as changes in maternal morbidity and mortality.
In India, the National Rural Health Mission (NRHM) seeks to communitize health, reflecting the global health community’s focus on democratizing health care and giving people a say in the health care available and delivered to them. The NRHM particularly calls out community-based monitoring as an approach to empower health care consumers, or patients, to advocate for access to needed services and quality care. Additional community accountability mechanisms have emerged, such as help lines, reviews of maternal deaths, and other legal strategies. The John D. and Catherine T. MacArthur Foundation’s maternal health quality of care (MHQoC) strategy in India has supported a variety of these community accountability mechanisms. This brief draws on an adapted version of the human-centered design (HCD) framework to examine approaches taken by MHQoC community accountability grants and discuss the lessons learned from applying this framework to assessing grant activities.