Landscaping AI-assisted diagnostics for respiratory illness

Outsight was recently contracted by FIND, the global alliance for diagnostics, to help them scope the existing landscape of AI-assisted diagnostics for respiratory illness. The aim of this work was to help FIND identify platforms that could be appropriate for use in the Global South. There are specific challenges in these contexts, different to those in Europe or North America, which is where most of the solutions are developed. For example, different racial backgrounds show up differently on X-rays, and the level of background noise in crowded health structures can be higher. It is essential to test the ability of AI algorithms to cope with these contextual differences. To do so, FIND used context-appropriate datasets from these regions — that might not normally form the foundation of the AI dataset testing — to evaluate performance of these solutions for use in these types of contexts.

The Outsight team identified a long list of 75 digital solutions of interest from around the world. These solutions included a range of signal-input methods, including thorax image capture (X-rays, CT, MRI), auscultation, cough sounds and pulmonary function tests, and captured data with traditional medical devices, as well as smartphones. Of the 75, 25 of these solutions were taken forward to a short list (based on discussions with the FIND team), where detailed information was requested from the companies developing these solutions. This information was assessed and a final list of 11 solutions of particular interest was drawn up.

Moving forward with this work, the hope is that FIND will be able to use the information gathered to help shape their diagnostic strategy in various disease and technology areas.

About Outsight International

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Worth the risk? Humanitarian innovation's risk challenge

Any meaningful change comes with new risks. The merit of the change depends on the balance of benefits and risks that the change offers. Ideas that deliver essential value that cannot be obtained elsewhere may well easily justify the risks that are incurred. Deducting the risk against potential benefit can offer a way of visualising if an intervention can be justified or not. 

Humanitarian innovators have become increasingly aware of the risks associated with new creative processes, services and products. These risks are of concern when they are borne by already vulnerable people. In particular, technology change has the unintended potential to create widely distributed ripple effects that are often not immediately visible. Understanding these consequences can be daunting in their scope, as illustrated by the 2018 ICRC report “Doing No Harm in the Digital Era”, which catalogued over 100 pages of digital risks in the humanitarian context. The current humanitarian discourse is to do no harm. But is doing no harm possible when also innovating?

The Dilemma - Risk as a Barrier to Beneficial Change

The range of innovation risks is not limited to digital technologies. Drones, robotics, and even construction projects all inevitably create new risks when they change the status quo. Considering risks is an essential step in any proposed innovation, particularly one that affects people with limited resources or resilience. However, a too narrow focus on risk can bring even valuable change to a standstill.  

Whilst it is clearly wrong to needlessly expose people to risks and harm, it is also unreasonable to deny communities of potentially beneficial innovations that could substantially improve overall wellbeing.

The risks and benefits of an innovation should be assessed and measured using the same scale and common indicators as status quo programming, helping the innovators to compare, contrast and make an informed decision on whether this idea is taking acceptable risk. This is especially important as there can be a tendency to veto innovation proposals based on small risks due to perception biases. For example, risks are perceived as irrationally high when:

  1. The risk taken is involuntary.

  2. Prevalence and reach of the innovation increase to affect more people.

  3. An innovation is particularly novel.

Overall, this inherently tips the scale in favor of the status quo when dealing with innovations even though more good may be achieved through the means of innovation at equal or lesser risk as the status quo.

And what type of risk? Usually, we don’t go further in depth during risk assessments. Any sort of ‘harm’ closes the door and the idea is put ‘on hold’ indefinitely. ‘Risk’ as a general term is vague and abstract: harm needs to be considered on relative levels if it is life-threatening, financial, legal or if it is compromising the future plan of a specific person. This needs to be entered into the calculation before pausing a new idea. 

Within the humanitarian and development space also there is an added imperative to include financial risk within this calculation: money spent on an innovation that fails, could have been spent on proven methods such as vaccinations or supplies instead. This seems a legitimate points, but this is not the whole picture. As a new report from Elrha will detail, there are financial resources available to humanitarians, outside of an organisation’s operational budget i.e. through organisations like Grand Challenge Canada, foundations and impact investment grants. Through this, the level of financial risk can be mitigated. 

Finally, on how risk is assessed, we reach the problem of individual prestige. Identifying such risks in projects is a profession. Ensuring that there are people there to raise risks where they have been missed is undoubtedly important. However, such assessments often have a clear leaning towards detail, rather than the bigger picture and, as such, can lead to excessive scrutiny and stop a project in its tracks.

Comparing risk and benefit on the same scale

The relative weighing of benefit — or utility from a philosophical standpoint — is something that harks back to political philosophers of the past. John Stuart Mill – an ardent support of individual liberty — famously described the correct use of weighing utility as: 

"that actions are right in the proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness."

Mill is one of the founders of modern liberalism, widely regarded as underpinning many of the foundational principles of the current world governance. Therefore, why would we choose not to apply this principle in the case of humanitarian innovation when it’s good enough for the operation of modern democracy? 

Ultimately, the benefit and risk of two whole systems need to be compared. For example, the mortality rates for women undergoing childbirth in remote areas can be dramatically reduced through the use of drone deliveries of blood supplies.  The first system - unassisted childbirth - is the status quo, which has substantial unmitigated risks of death. The second system leverages the delivery of blood supplies by drone. This system offers strong medical benefits that are amplified by the lack of other effective alternatives. Yet, drones also come with concerns associated with safe operation in a shared airspace.  These whole systems need to be compared and contrasted with each other. 

If, as often happens, the questions around privacy or the risk of crashing a drone are seen in isolation, it’s easy to understand why permissions are difficult to obtain. Yet, if you’re to consider the possible gains of an overall system in terms of lives or disability-adjusted life year’s (DALYs), then the situation can look significantly different. 

When deciding on whether the risks of a clinical trial are acceptable, an Ethical Review Board will consider the possible improved patient outcomes in a relative manner. It seems odd this luxury is rarely extended to innovation projects, often dealing less directly with patients. Indeed, many innovation projects are deemed unacceptable because of a perceived risk to privacy or data management. Whilst this is a significantly less serious risk than the risk of side-effects in a clinical trial, it is given a disproportionately high prescience. 

Finally, when considering potential harms, it’s important to consider how we each operate within the social norms of our societies. Engaging with beneficiaries’ points of view is commonly accepted as best practice. Yet, there lies significant contradictions when considering the normative nature of humanitarian and development work. One classic example is identity and privacy. For those operating from Europe and North America, there is a tendency to see the right to privacy as fundamentally essential. Take the UK public’s resistance to identity cards, or the French law prohibiting the collection of ethnographic data for example. However, for many other regions, especially where having a recognised official identity can lead to greater access to social service provision, there is less concern for hiding personal details. Whilst this may be based on the levels of trust in government, the debate is far from definitive. Given the decolonisation of aid narrative in the humanitarian and development space, these cultural differences seem to rarely be accounted for. 

Using Systems to Support Responsible Innovation Tradeoffs

Discussions surrounding risk and harm need to be based on a broader view of the opportunity for change. This does not imply there is a blank check for change: a rigorous review of the benefits and harms alongside a consideration of alternative systems should be done for any proposed innovative change. 

A well-reasoned discussion can only be had with a big picture of both the current situation and an open mind to the proposed new combination of benefit and risk. The work that has already been done to identify potential sources of risk has laid a solid foundation on which to take this next step in analysis.  

It is now time to routinely embrace taking a more holistic view of status quo challenges and the alternative systems that are proposed to replace them. This whole systems view would not only allow a more balanced view of the value of change, it would also offer a broader range of alternatives for mitigating potential risks, or at the very least make them better understood to those involved.


About the authors and Outsight International

Dan McClure, Lucie Gueuning, Denise Soesilo, Monique Duggan, Louis Potter for Outsight International
Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

With data, responsibility: The Importance of Data Protection Impact Assessments (DPIAs) in aid

Is your organisational data sufficiently secure?

Is your organisational data sufficiently secure?

Aid agencies, public health bodies, and health innovators are harnessing the rapidly accelerating improvements in data capabilities to deliver better health and wellbeing outcomes for service users and beneficiaries. Increasingly, smaller organisations are empowered to gather, process, analyse, and act on larger databases with attractively small investments in time and capital. Ostensibly, the calculus is clear: if gathering large quantities of personal data that informs strengthened decision-making is becoming easier, it would be irresponsible for an organisation not to build databases with the intention of improving outcomes.

Yet, this era of year-on-year emergence of new, reality-changing tools has demonstrated an unavoidable truth: technology is never neutral. Technology used in aid contexts is usually developed far from where it is deployed, and can carry with it implicit biases that distort its utility and curb its benefits. Equally, improvements in technological capabilities in the hands of healthcare and aid providers can serve -at least initially- to further widen inequalities between those with access to innovative and those without. Often in aid, these inequalities manifest clearly along the dynamics of provider/recipient.

Technology is never neutral: it can magnify implicit biases and -if deployed irresponsibly- further entrench inequalities, particularly in aid settings

The ability to gather large sets of personal data are an acute example of this divide. Take, for example, healthcare and aid providers working in low-resource settings. If they choose to harness large personal data gathering and processing tools to build large datasets, comprised of personal information relating to local beneficiaries, they are at once equipped with technological potential that is likely inaccessible locally and additionally entrusted with highly sensitive material relating to many local individuals. It is incumbent for such actors at the privileged end of a power disparity to use their position with utmost responsibility.

Good data practice is not only an ethical responsibility - international regulation now makes it compulsory

This is where Data Protection becomes paramount. Many humanitarian actors now are subject to the European General Data Protection Regulations (GDPR). The donor community — including EU Humanitarian Aid — now require their partners to demonstrate good data practices, including the implementation of Data Protection Impact Assessments for projects that may process, store or share personal data. This includes names, photographs of people, and even CVs. Data ethics goes beyond the procedural programming of safeguards and several guidelines and frameworks exist that can help build projects and teams on solid ethical foundations.

We are ready to support you in implementing the most appropriate tools and frameworks to your operations: analysing your system in order to apply the most relevant adaptation without disturbing your day-to-day operations, in a smooth and efficient manner. With the growing complexity of the data-driven services offered and the risk of social exclusion inherent in opting out of various technologies, individuals are disadvantaged when asked to provide informed consent for their data to be collected and used. This gulf between uptake and understanding has been met by legal frameworks implemented by governments and intra-governmental organisations (such as the EU’s GDPR), aimed at regulating data policies and enabling individuals to trust that their information is being handled responsibly. We help your organisation anticipate needs, and to actively shape the data ecosystems to meet said needs.

For more information, see our complete DPIA Service offering here.

If you would like to collaborate with Outsight International, please use our contact form to get in touch.

The Chatbot Series: Part One: What is a chatbot?

What is a chatbot? Probably not this…

What is a chatbot? Probably not this…

The wide use of chatbots has increased dramatically since the start of the COVID-19 pandemic. Their use as a tool for public information has proven extremely effective over previous dissemination tools such as websites or hotlines, due to their targeted and adapted answers. The use of chatbots has now gained a firm foothold in humanitarian and development organisations (HDOs) — with these organisations looking to provide adapted systems to different communities that they serve.

At Outsight International, we have a number of experiences working with chatbots in the past. In this blog, Devangana Khokhar, Hanna Phelan and Michelle Chakkalakal provide and overview of what chatbots are and how they can be used. Stay tuned for a follow-up blog on key considerations when designing a chatbot.

What’s a chatbot? The Types of chatbots

Chatbots are a relatively recent addition to the world of human computer interaction. While Question-Answering systems have existed for a long time — powered by both rule engines as well as Artificial Intelligence (AI) —, recent advancements in the world of Natural Language Processing (NLP) have made it possible and convenient to build chatbots that are context-aware and optimise the interaction between a human and a machine.

Chatbots come in a number of different forms. At their most basic, they are a tool for automation. Chatbots can vary from very simple ‘rule-engines’ that work like integrated voice recognition (IVR) where users select predefined options to more advanced forms of computer programming that use natural language processing (NLP) and artificial intelligence (AI) to provide genuinely responsive experiences.

Broadly speaking, we can break chatbots down into three main categories:

  1. Rules-/Menu-Based Chatbots: Users can select options using a pre-defined scenario tree, similar to integrated voice recognition menus. You can tell you're using a menu-based chatbot, when the prompt is something like: Hi I'm Pavi, your friendly customer service agent, and I can help you with these issues. Please select your issue from this drop-down menu or press this number/letter etc...

  2. Hybrid Bots: Users can select their issues from a pre-existing menu or they can type their question in. It looks something like this. Hi, I'm John. How can I help you today? Select your issue from this menu OR type in your question below. The more complex the issue, the greater the chance a company is using a combination of pre-defined scenario trees, mechanical turk (a human assisting the language sorting), and training its AI with more queries. This approach works well when a certain set of frequently-asked questions are known along with their answers, thereby solving the cold start problem.

  3. AI Chatbot: Users can interact with the bot by typing their question, and the bot powered by AI and NLP to find the answer. Such chatbots often work with engines that extract and understand the intent as well as the entity/entities tied to that intent from the user’s query. The identified intent as well as the entity/entities are used to query a knowledge base in order to build the context and respond to the user with that context. There have been recent advancements in context and next-step prediction inspired by the use of AI in the gaming world that allows the system to predict the next question that a user is going to ask thereby improving the end user experience.


chatbots in the humanitarian and development sector

As mentioned, chatbots have started to be used by a wide range of actors looking to impart information or provide services to populations quickly and in a more personalised way. For many HDOs, this theoretically fits well with their model of responsive operations that can reach swathes of beneficiary groups in an on-demand manner.

However the success of chatbots is often determined by the consideration that went into their design and implementation. How one looks understands the problem they are trying to solve — taking a system view, involving AI, the user experience, and the feedback loops — determine the longevity of the solution.

To consider the different approaches to chatbots, we have identified two case studies from the sector which we think took differing approaches to chatbot design.

Case study 1: Praekelt.org - Scaling COVID-19 Truths

World Health Organization: HealthAlert from praekelt.org

World Health Organization: HealthAlert from praekelt.org

WhatsApps has received a lot of negative press in the past 12-months over concerns with their role as a channel where COVID-19 misinformation was rife, as well as over updates to their privacy policy.

Despite this, many organisations recognised that WhatsApp — with 1.6 billion users — would have to be addressed if evidence-based public health awareness was to prevail. Enter, Praekelt.org and their chatbot-based solution Turn.io. The South African organisation focused on building technical infrastructure to provide users with information hotlines and chatbots to understand which healthcare services were available and what precautions should be taken to remain safe during the pandemic. The solution soon attracted interest from a number of significant healthcare stakeholders including the World Health Organisation (WHO) and governments of Ethiopia and Mozambique. This was the first time WHO has used the WhatsApp for Business API.

Since its launch, the chatbot has been used by over 12 million users around the world, seeing a particular peak in usage in locations experiencing spikes in infections. The offering has since been made available free of charge by Praekelt.org and Turn.io to any ministry of health worldwide.

Beyond the COVID-19 chatbot use case, Turn.io has been developed to address a variety of other needs. One such partnership is in collaboration with Girl Effect, an international non-profit supporting adolescent girls in low- and middle-income countries (LMIC) to make informed health and wellbeing choices. The initial pilot of this chatbot solution was launched in South Africa for girls between the age of 13-17 to answer questions that may be difficult to raise in another forum, concerning emotional, social, and practical elements of sex and relationships. The Girl Effect chatbot has since been tested in three other countries (Nigeria, Philippines and Tanzania), with over 10,000 users having interacted with ‘Big Sis’ — the chatbot’s ‘persona’.

The scale and speed of rollout for this particular solution is impressive. However WhatsApp data privacy concerns will have to be addressed head-on going forward particularly when considering implementations for vulnerable communities.

Case study 2: Babylon Health GP at Hand Decision Support Chatbot

The Babylon Health chatbot

The Babylon Health chatbot

Babylon Health is in many ways a digital health success story now employing over 1,000 people in the UK, US and Rwanda, however it hasn’t all been smooth sailing. Babylon, since their founding in 2013 have embedded themselves in the UK’s NHS — offering a consumer facing AI-powered decision support tool and other telehealth interactions where users can access video or phone consultations with NHS clinicians and book in-person appointments.

The main concern around Babylon has been centred around the ambition of the AI diagnostic and triage chatbot. While the company claimed that the chatbot element was not intended to act as a validated diagnosis, critics pointed to methodological concerns; especially in their claims that the Babylon chatbot outperformed the average human doctor on a subset of the Royal College of General Practitioners exam. Questions included whether the Babylon chatbot would perform as well in real-world situations with data being entered by people with no clinical experience and additionally if it would be as successful in a more unusual situations. According to a recent paper in the BMJ, it would not. There have been calls for independent review of these types of solutions and increased regulatory measures to validate AI healthcare solutions.

Babylon seemed to recognise the risk associated with the chatbot element of their offering when expanding efforts to Rwanda in 2016 and chose a slightly different operating model in this context focusing primarily on phone and SMS services that connect clinicians and community health workers with users.

Conclusion

Given the range of different chatbot solutions available and their diverse applications. Picking the right tool for the job can be daunting. Considering the factors that lead to the success or failure of new chatbot platform will thus be the topic of our next blog where we’ll provide you with key considerations when deciding if to use a chatbot, and how to implement it successfully.

If you've worked with chatbots yourself or interacted with one that stood out to you, either as a success or a failure, we'd love to know about it! Share with us your tales of chatbots or just leave the link to your favourite chatbots in the comments. If you’re looking for chatbot expertise, get in touch with us through our contact form.

ABOUT THE AUTHORS AND OUTSIGHT INTERNATIONAL

Devangana Khokhar
Devangana Khokhar is an experienced data scientist and strategist with years of experience in building intelligent systems for clients across domains and geographies and has a research background in theoretical computer science, information retrieval, and social network analysis. Her interests include data-driven intelligence, data in the humanitarian sector, and data ethics and responsibilities. In the past, Devangana led the India chapter of DataKind. Devangana frequently consults for nonprofit organisations and social enterprises on the value of data literacy and holds workshops and boot camps on the same. She’s the author of the book titled Gephi Cookbook, a beginner's guide on network sciences. Devangana currently works as Lead Data Scientist with ThoughtWorks.

Hanna Phelan
Hanna is an expert in digital health implementation currently working as a health innovation Case Manager with the MSF Sweden Innovation Unit. In the past, she has advised leadership teams in health systems and pharmaceuticals. She received her MSc in Global Health from Trinity College Dublin, during which she conducted field assessments of rehabilitation approaches by Handicap International for Syrian refugee populations in IDP camps and community settings.

Michelle Chakkalackal
Michelle is an experienced entrepreneur, researcher, and impact strategist, specialising in growing a project or an organisation from start to scale, globally. She has 15+ years of experience working in systems change and facilitation at the crossroads of impact, tech, gender, diversity, equity, and inclusion (DEI).

Outsight International
Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please
get in touch or follow us on LinkedIn for regular updates.

The Complete Picture Project: Uncovering hidden AI bias

Can the diversity of the crowd be properly represented in AI datasets?

Can the diversity of the crowd be properly represented in AI datasets?

How do developers and users ensure that Artificial Intelligence (AI) algorithms serve all the members of a community equitably and fairly? The Outsight team has a solution…

This is not a small question. According to Forbes, the global AI-driven machine learning market will reach $20.83B in 2024. Low- and middle-income countries have already seen a rapid expansion in applications using this technology. Not surprisingly, the humanitarian and development sectors increasingly make use of machine learning models to reach beneficiaries faster, understanding needs better and make key decisions about the form and execution of life-saving programs.

AI-driven applications range from chatbots that connect individuals affected by disaster to their required resources, to applications that help diagnose bacterial diseases. These increasingly powerful new tools have the potential to dramatically improve aid delivery and life in communities affected by crisis. However, this value is tempered by the reality that biases can easily find their way into even the most diligently engineered applications.

AI models and applications are often built far from the communities where they will eventually be used, and are based on datasets that fail to reflect the actual diversity of these communities. This disconnect can lead to the inclusion of unintentional biases within an AI model, ultimately driving unfair system choices and recommendations that are difficult to detect.

For example, a recruiting application using AI may be designed to encourage new economic job opportunities and evaluate all the candidates applying for jobs. This is a laudable goal, but it can be tainted by biases in the algorithm that unfairly treat factors associated with gender, social background, physical ability, or language. The algorithm can systematically exacerbate existing disadvantages faced by certain groups.

Similar challenges can face large-scale aid programs that attempt to leverage AI. A cash distribution program serving an area hit by disaster or a conflict may use AI to guide cash distribution, check for misuse, and measure performance. If these automated insights favour certain communities, they could end up excluding already marginalised groups and individuals.

The Hiding Places of Bias

Whenever AI is employed in a decision-making system, it is in the interests of technical developers, adopting organisations, and communities to ensure that the algorithms are providing value, while not causing harm due to bias.

Determining whether subtle bias exists within an algorithm is a difficult task — even for experienced data scientists and conscientious AI users. A wide range of factors may contribute to bias within an AI algorithm, some of which are the result of the algorithm’s performance. There is a growing set of tools to help search for algorithmic bias within the logic of an AI application.

Evaluating the ‘wiring’ of an AI tool is important, but it is not the only concern. The sources of bias may inadvertently be embedded in the data set itself. Data bias risks can include:

  • Who is included — Bias in choosing who is selected in a data set.

  • How data are connected — Failure to recognise connections amongst different data that are important within a community.

  • Depth of insight — Failure to capture elements that are uniquely important for members of a community group.

As an example, datasets that are used to train and test AI models often only represent the digital footprint of a community and not its real diversity. As a result applications are developed based on the characteristics of well represented community groups.

A typical, unrepresentative dataset, upon which AI models are often based.

A typical, unrepresentative dataset, upon which AI models are often based.

In contrast, a true picture of the community might reveal many more ‘invisible’ members whose needs, resources, and desires are quite different; but that are not represented in the digital footprint.

The invisible real picture.

The invisible real picture.

An algorithm that bases its logic on an incomplete or inaccurate picture of a community will be hard pressed to assure it has not inherited biases from the data it used. Similarly, it will be difficult for a potential user of a new AI algorithm to evaluate whether it exhibits bias, if the data used for the test is itself incomplete and fails to accurately reflect the diversity of a community.

The Complete Picture Project: Building Complete Views of Communities

The Complete Picture Project (CPP) addresses the challenge of hidden bias in incomplete data sets by constructing data resources that offer a complete view of the true diversity within a community. These data sets are assembled from multiple sources and may include a wide range of source content. The goal is to provide those working to evaluate AI bias with a known starting point — where representation within the community has been carefully considered within the data.

These data sets are well positioned to support various actors in the AI ecosystem (AI designers, AI developers, data scientists, policy makers, user researchers as well as users of AI systems) who are seeking to test AI bias. These evaluations are particularly important when engaging with communities most impacted by the SDG’s. These communities may have unique traits that differ from those included in more conventional data sources. They are also more likely to have data gaps and distortions due to access to digital technologies.

These independent, broadly diverse, representative test datasets offer developers and other AI testers a data resource for which the form and content are known. These datasets can then applied to AI models and the results inspected for biases that are hidden in the model itself. This ability to test for bias across the whole community would support efforts to detect gender and other group biases at any stage of the AI development lifecycle, from early design and development to long after pre-trained algorithms are already in use.

Scaling the Impact of CPP Data Sets

CPP data sets can provide a valuable resource in support of responsible AI development and use. Intentionally constructed data sets that broadly reflect the true diversity of communities can help advance gender equality and women’s empowerment (SDG 5).

While these datasets are being initially designed to specifically address data scenarios that are relevant to women, children, and communities who are most impacted by the SDGs, the CPP methodology we establish could be easily be extended and scaled to include other applications where parameters of where algorithmic bias is a risk as well.

The definition of bias is ever-evolving. As AI developers and their sponsors build a better understanding of the real world and the biases in it from various dimensions (such as geography, culture, non-binary gender, language, migratory status, ethnicity and race), it will be important to expand the availability of intentionally representative data sets. Building a collaborator network is key to the strategy for broad development and use of CPP data sets. Collaborators are needed to better understand communities, provide and shape data sets, and to apply data to AI algorithms. There are strong network effects among this ecosystem, where AI sponsors, governments, developers and data owners combine to drive and build off each others contributions.

The intent of the CPP team is to capture and distill practices and methodologies so that they can be broadly shared and adopted by others. The availability of individual data sets will vary according to each specific use case, but open data resources would be created when possible.

Overview of the planned CPP approach.

Overview of the planned CPP approach.

Next steps

The CPP team are keen to connect with organisations who are interested in collaborating on the project. Please feel free to get in touch or contact us on LinkedIn to find out more.

About the Authors and Outsight International

Devangana Khokhar
Devangana Khokhar is an experienced data scientist and strategist with years of experience in building intelligent systems for clients across domains and geographies and has a research background in theoretical computer science, information retrieval, and social network analysis. Her interests include data-driven intelligence, data in the humanitarian sector, and data ethics and responsibilities. In the past, Devangana led the India chapter of DataKind. Devangana frequently consults for nonprofit organisations and social enterprises on the value of data literacy and holds workshops and boot camps on the same. She’s the author of the book titled Gephi Cookbook, a beginner's guide on network sciences. Devangana currently works as Lead Data Scientist with ThoughtWorks.

Dan McClure
Dan McClure specialises in complex systems innovation challenges, and acts as a senior innovation strategist for commercial, non-profit, and governmental organisations. He has authored a number of papers on systems innovation methodologies and is actively engaged with aid sector programs addressing cutting edge issues such as scaling, localisation, and dynamic collaboration building. His work builds on decades of experience as a systems innovation strategist working with global firms in fields spanning technology, finance, retail, media, communications, education, energy, and health.

Lucie Gueuning
Lucie manages the MSF REACH project — researching AI and machine learning in the humanitarian context. More widely, she focuses on digital implementation for the development and humanitarian sector. She believes that digital solutions can be harnessed in order to increase the efficiency of the humanitarian sector and the service provisions for the most vulnerable.

Denise Soesilo
Denise is one of the Co-founders of Outsight and has worked with many humanitarian and UN agencies — advising on the application and implementation of technologies in humanitarian operations.

Outsight International
Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please
get in touch or follow us on LinkedIn for regular updates.

Building an educational sectoral crypto-currency for the development sector

exchange

Recently Outsight was asked to help the Italian NGO, Helpcode, in partnership with the Politecnico Milano, scope how crypto-currency might be used to provide better services to beneficiaries in their projects. After some initial research we focused on sectoral currency as a way to multiply the value of donations in the education sector. Louis and Denise, the two founders of Outsight discuss the work…

The non-profit sector has, in recent years, started to take an interest in emerging blockchain and crypto-currency technologies, as these provide the potential process large amounts of transparent transactions at low transaction costs. These qualities — in theory — should enable the financial inclusion of beneficiaries, as the barriers of entry are low. In addition, specialised crypto-currencies can be utilised to multiply the impact of monetary funds when set up as a sectoral currency.

What is sectoral currency and how does it work?

The late Bernard Lietaer was a strong proponent of the radical possibilities of sectoral currencies and monetary systems to solve many challenges of today’s world. These included looking at the way we value resources in a short-termist fashion, to proposing mechanisms to protect the world economy from inflation. Among his many interesting initiatives, is the ‘Saber’ educational currency idea, designed for implementation in his native Brazil.

The educational currency is designed to set in motion “a substantial “learning multiplier” so that a given amount of money can facilitate substantially more learning for a greater number of students. The currency would fuel this learning multiplier without creating any new financial pressure on the economy. What this means in practice is that a tangible resource (in this case, a university scholarship) is given to younger students, rather than those who will use it. As the resource — turned into tokens — enters the educational system at a younger age, it is then possible to build a transaction chain between students of different ages until the tokens reach the older students who can cash them in with the university. The transactions that take place along the chain can be adapted to the needs of the system. In this case, the aim is for older students to provide mentoring services to younger students.

Students in the system hold an electronic wallet containing tokens. When a mentoring session takes place, the younger student will then ‘pay’ the older student with the tokens, which over time pass up the chain, age-group by age-group, until they reach the university students by the deadline of that year’s currency validity. Importantly, a demurrage fee (it loses its value after a set period) is attached to the currency in order to keep it in circulation. This prevents students from holding onto the tokens for their own profit later on as 100 tokens this year will become 50 tokens next year if not used. We have illustrated this chain below.

An overview of the educational sectoral currency system in the hypothetical DRC context.

An overview of the educational sectoral currency system in the hypothetical DRC context.

In this example, a token could pass through five transaction points before being cashed in. Thus, a single scholarship for one student is having a positive impact on five other students who would otherwise not receive any direct benefit. This multiplying effect is the true genius of the sectoral currency approach and can be adapted to help many sectors, such as environment or care.

About the context

The Helpcode project location of Bukavu, Democratic Republic of Congo was used as a hypothetical location for the use of sectoral cryptocurrencies in support of ongoing programmes with the broader aim to reduce poverty through improved access to education. At the current stage of the research, the location provided the use case for the exploration and prototyping. There are currently no plans for direct implementation.

Bukavu is a city of about 800,000 inhabitants in the east of the DRC on the southernmost shores of Lake Kivu. Bukavu is a commercial and industrial center in the region and is known for the production of coffee, tea, tobacco and strawberries). Bukavu is host to four universities and at least four higher learning institutes including a teacher training college, a scientific research institute and an Institute of medical technology.

Helpcode has a small presence in Bukavu mostly through financially supporting school children. Funds are administered to the Foundation Foyer Ek’Abana, who then disburses the funds to about 1,600 beneficiaries — all of them children — to support the costs of attending schools.

Additional projects are planned to provide a mobile medical unit to serve about 1,500 street children throughout the city with basic medical services, alongside programs to reunite these children with their families and to provide economic support, as well as supporting return to school and connecting to job opportunities. Many children living on the streets are orphaned. Many do not have identities, though some support exists now to issue birth certificates and IDs. Unconditional cash transfers alongside the current support may be an option to older children, but these children do not typically have smartphones.

In this context, sectoral currency could offer the added benefit of increasing value for every dollar invested by providing the system to school age children who could then exchange credits for mentoring or services from older children who will use them for scholarships. The value of the system would be underpinned by Helpcode by making an agreement to exchange the local currency for an agreed cash value at the end of each school year. As the currency moves up the chain towards the final use at university, each owner can receive something in exchange for the currency that is of value to the older students — i.e. mentoring, care services, food. The value of each dollar of the currency effectively increases each time it changes hands moving up the chain.

The prototype

Following the system proposal, Politecnico Milano produced a prototype built using the Ethereum platform. The prototype offers the following features:

  • Registration as a student

  • Peer-to-peer transactions for mentoring sessions using QR codes.

  • Picture proof for mentoring sessions.

  • Demurrage of currency for each school year.

  • Cash-in at university.

At an early prototype stage, this is how the app looks.

The welcome page of the app.

The welcome page of the app.

The wallet page of the app. Here you can select the type of service and whether to send or receive tokens.

The wallet page of the app. Here you can select the type of service and whether to send or receive tokens.

The transaction history page of the app. Where students can view their transactions.

The transaction history page of the app. Where students can view their transactions.

The transactions themselves are made using a QR codes. The mentoree scans a QR code on the mentor’s phone once a session is complete to send credits to them.

The mentor’s receiving page.

The mentor’s receiving page.

The mentoree’s sending credits page. This would turn on the camera to scan the QR code.

The mentoree’s sending credits page. This would turn on the camera to scan the QR code.

Other important considerations

As a novel and relatively complex concept, it is important to consider the potential pros and cons of pursuing this idea in a development context.

Pros:

  • Sectoral currency has been trialed in Japan.

  • Some progress on humanitarian local currencies with ICRC.

  • Increases the value of scholarships beyond just recipients.

  • Existing demurrage crypto-currency example.

Cons:

  • Need to ensure access to suitable end devices for trading with the currency.

  • Risk of unforeseen variables — what if the currency becomes tradable for illicit services?

  • Risk of monetizing transactions that should otherwise be freely shared (casual homework support, advice)

We also listed some remaining questions and concerns that need to be addressed before pursuing implementation further.

  • Does this process require a critical mass of users to be effective?

  • How much adult guidance is required in this process for oversight and guidance?

  • What constitutes a valid mentoring session to initiate a transaction?

  • Do all children need their own smartphone or can a third party on the ground manage the transaction while younger children deal with hard tokens / paper wallets only?

  • What basic conditions need to be met for a sectoral currency to be successful?

Next steps

Together with Helpcode and Politecnico Milano, Outsight is pursuing the further development of the educational sectoral currency platform. We aim to engage with end users from a UX and service design perspective in order to ensure we can address the outstanding questions and make the tool more specific for its context of use. If you’re interested in using sectoral currency or want to discuss the topic with us, please feel free to get in touch.

ABOUT the authors AND OUTSIGHT INTERNATIONAL

Denise Soesilo
Denise is one of the Co-founders of Outsight and has worked with the World Bank and other development, humanitarian and UN agencies — advising on the application and implementation of space-based systems and other technologies in humanitarian operations.

Louis Potter
Louis is one of the Co-founders of Outsight. He has a wide range of experience covering development, health, innovation, technology and research. Having worked in the field, he is well acquainted with the practical realities of delivering impact. In recent years, he has been helping organisations to improve innovation processes and outcomes. He is an experienced facilitator and has been closely involved in efforts to improve collaborations between the nonprofit, academic and commercial sectors. He is based in Lausanne, Switzerland, and received his MSc in Global Health from the Karolinska Institute, Sweden.

Outsight International
Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please
get in touch or follow us on LinkedIn for regular updates.

How can behavioural economics help us understand decision-making during COVID-19?

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Behavioural economics offers an insight into why people make the decisions they do. In a pandemic — when even apparently small decisions may involve high stakes — the discipline can provide an insight into how such choices are made, and critically asses the emotional vs logical. In this blog, we offer an overview of some of the basic concepts of behavioural economics and how these apply to the current COVID-19 outbreak…

Many countries are moving forward and easing lockdown restrictions while there are still many unknowns about the virus and how it spreads. They are proceeding with varying degrees of caution in the face of unknowns related to both where and when the virus will flare-up as well as economic uncertainty. For example, EU countries anticipating the summer tourism season have focused on easing travel restrictions and opening up the leisure sector. But already, reports from several countries highlight the reality of recurring flare-ups of the disease.

There is widespread reluctance to re-impose lockdowns, and to incur further risks to economies as well as general morale. But in economies that are driven by consumer spending, how individuals make decisions in the face of such uncertainty will have profound impacts on both the path of economic recovery as well as the course of the pandemic. Previously mundane decisions such as whether and when to go clothes shopping, visit the mall, or to go out to a restaurant or pub, now have to take into consideration risks associated with COVID-19.

The field of behavioural economics could have much to offer as policy makers face difficult choices and trade-offs in the months ahead as the world adapts to the reality that COVID-19 is not going away soon. In the UK, the government use of behavioural insights has already been widely trailed, though not without some controversy. Behavioural economics studies the influence of psychological factors on how humans make economic decisions. It extends traditional economics to better account for real people’s beliefs and biases. Nobel prize-winner Richard Thaler summarises these extensions in terms of three 'bounds' on the behaviour economists have tended to assume:

Bounded rationality reflects the limited cognitive abilities that constrain human problem solving. Bounded willpower captures the fact that people sometimes make choices that are not in their long-run interest. Bounded self-interest incorporates the comforting fact that humans are often willing to sacrifice their own interests to help others.”

As countries and communities move from an initial phase of tight lockdown and the associated restrictions on activity — which were necessary to “flatten the curve”, slow the spread of the virus, and avoid overloading health facilities — behavioural economics can teach us, first, about how people assess risks and, second, about how they then go on to make decisions based on the risks that they’ve assessed.

Assessing risks

Fundamentally, human beings are not always good at assessing risks. To take just three examples (though there are many more):

  1. Probability weighting is a key element of Daniel Kahneman and Amos Tversky's Prospect Theory, introduced in one of the most cited social science papers of all time. Probability weighting tells us that we systematically overestimate small risks and systematically underestimate large ones. But we generally get certainty and impossibility right, which means there's a discontinuity or certainty effect at the extremes. As long as the risk to individuals of catching COVID-19 remains low, we might expect this effect, on its own, to lead to an abundance of caution.

  2. We make mistakes about the independence of events. One manifestation of this is in the gambler's fallacy, through which people create imaginary dependencies between independent events. For example, the gambler’s fallacy predicts a strong intuition that a black is 'due' on the roulette wheel if we’ve just witnessed a long sequence of reds. Or that, in relation to Covid-19, we’ll feel that an individual risky behaviour becomes that bit riskier with each successive occasion that we get away with it (the total risk does increase, of course, but not the risk per occasion).

  3. We easily confuse the probability of seeing some piece of evidence given that a hypothesis is true (e.g. the chance that I get a positive test result, given that I have COVID-19) and the probability that a hypothesis is true given that I see some piece of evidence (e.g. the chance I have COVID-19, given that I get a positive test result), when in fact these quantities are often very different. For instance, say that there's a 0.1% rate of the disease in a population, and a test for the disease gives the right answer 99% of the time. Most people who get a positive test result during a routine screening will think it is now 99% certain they have the disease. But because the rate of infection in the population is low, the true probability in this case (which statisticians can calculate with Bayes’ Rule) is actually still under 10%.

Making decisions under risk

Behavioural economics tells us a wide range of ways in which our probability judgments tend to go awry. But even given correct probabilities, the way we use those probabilities to arrive at choices often seem to lack any immediate sense.

A key influence here is framing and, in particular, whether changes are presented in terms of gains or losses. As it happens, an illustration given in a paper by Tversky & Kahneman in Science hits rather close to home. The setup is as follows:

Imagine that the U.S. is preparing for the outbreak of an unusual Asian disease, which is expected to kill 600 people. Two alternative programs to combat the disease have been proposed. Assume that the exact scientific estimate of the consequences of the programs are as follows:

- If Program A is adopted, 200 people will be saved.

- If Program B is adopted, there is 1/3 probability that 600 people will be saved, and 2/3 probability that no people will be saved.

Which of the two programs would you favour?

On the average, programs A and B will save the same expected number of people (200), but A is a safe bet on saving exactly that number, while B is a gamble that may or may not save them all.

A big majority of respondents in the study (72%) favoured the safe option, program A. But then the researchers polled a second group, making a simple tweak to the language they used:

- If Program C is adopted 400 people will die.

- If Program D is adopted there is 1/3 probability that nobody will die, and 2/3 probability that 600 people will die.

These new programs do nothing but reframe the first set: C is identical to A, and D is identical to B. But, strikingly, this reframing utterly reversed the majority preference. Now, 78% of respondents preferred the risky program, D.

This is no fluke. One of us (GM) has replicated the result seven years in a row with students on a behavioural economics course. The reasons have to do with our diminishing sensitivity to both gains and losses relative to a reference point, which Prospect Theory captures with something called the Value Function (a replacement for economists’ usual workhorse, the utility function).

The upshot is that we’re generally risk-averse in relation to prospective gains but risk-seeking in attempts to avoid losses. The effect is extremely deep-seated: it has even been demonstrated, through some rather ingenious experiments, in capuchin monkeys by Chen & Santos.

Communicating risk

These sorts of effects are of clear relevance to leaders and governments responsible for formulating guidance and communicating to the wide public during times of uncertainty. The words and behaviour of a leader will strongly influence how a large majority of the population will make individual decisions that will have major economic and human impacts in consumer-driven societies.

With what we know from behavioural economics, how individuals actually decide what is gain and what is loss will influence these decisions.

For example, a political leader that states. “We’re open again for business”, and who accompanies that with a relaxation of social distancing measures may set an expectation that social activities such as congregating in bars, in parks, or beaches is again the norm. Thus, individuals could see not resuming these activities as a loss; and therefore, according to behavioural economics, engage in risk-seeing behaviour, not wearing masks and not respecting social distancing. The spike in cases we’re seeing in some US states, could potentially be due to this phenomenon.

On the other hand, a leader who leans too much towards caution — out of fear of seeing even a handful of new cases — may lead to people hesitant to venture out of their homes even for lower risk situations, such as going out to the park for a walk. There has been a lot of criticism of public health leaders: from their perspective, a high degree of caution will continue to be needed until the threshold of herd immunity is reached; which could be 1-2 years away. However, our economies will struggle to continue in suspended animation until then.

Therefore it is advisable for leaders to use wording and to communicate in ways that are balanced: it’s possible to be “open for business” while also assuring the population that “we’re going to double the number of testing centres” to retain the sense of caution. 

Getting this right is crucial over the months ahead as we all manage health and economic risks.

About the authors and Outsight International

Dr George MacKerron
George is a Senior Lecturer in Economics at the University of Sussex. His research is in subjective wellbeing, behaviour and the environment. He runs Mappiness, the world's largest experience sampling study, and is a co-founder of startup Psychological Technologies. George gained his PhD at the LSE, and prior degrees from Imperial College London and the University of Cambridge.

Dr Evan Lee
Evan is a trained MD and MBA with degrees from Harvard and MIT, he has dedicated his career to improving access to health. Initially practicing medicine in community health centers; for the past 20 years, he has worked across the private sector, NGO sector, and collaborated closely with UN partners to address access issues related to medicines, diagnostics, and other health technologies.

Louis Potter
Louis is one of the Co-founders of Outsight. He has a wide range of experience covering development, health, innovation, technology and research. Having worked in the field, he is well acquainted with the practical realities of delivering impact. In recent years, he has been helping organisations to improve innovation processes and outcomes. He is an experienced facilitator and has been closely involved in efforts to improve collaborations between the nonprofit, academic and commercial sectors. He is based in Lausanne, Switzerland, and received his MSc in Global Health from the Karolinska Institute, Sweden.

We believe that understanding the motivations behind behaviour is an essential part of quality strategy planning. This can apply to governments, industry or the third sector. As Outsight, we are happy to consult Outsight International provides services to its clients in an efficient and agile way using the ‘Hollywood Model’. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

The Hollywood Model: Dynamically built teams for creativity at scale

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Outsight works with its network of Associates using the Hollywood model — a way to build dynamic teams, quickly, that are best-suited to a particular project. This can be particularly useful in the humanitarian and development sectors, where the tendency is to hire based on narrow technical competencies. But how does it work? And why is it called the Hollywood model? Dan McClure, an Outsight Associate explains more…

How many organisations can produce the equivalent of a hit movie? While it’s easy to roll your eyes at some of Hollywood’s efforts, the reality is that this industry is capable of repeatedly undertaking new and original initiatives: leveraging a myriad of different skills in the service of a complex and rapidly shifting market. Their survival and success depends on the ability to repeatedly do creativity at scale.

Until recently, few other industries had to meet similar creative demands. Most organisations — whether they were commercial businesses, government agencies, or non-profits — could focus on mastering the things they already did. A leader’s goal was to make sure things were well run and competent. Any incremental improvements reinforced established capabilities.

Committing to a steady course like this requires a stable world. Unfortunately, disruptive change is sweeping through one industry after another. Even before the advent of the global pandemic, it was clear we had entered into a turbulent era where new ideas, bold action, and systemic change would be necessary to claim a relevant place on the world stage. The winds driving this change are powerful: new technologies of a fourth industrial revolution, trans-border problems like climate change, and massive societal shifts in education, economic capacity, and urbanisation.

This is a world where being good at bold imaginative change has become a necessary core competency. For that reason, it is well worth taking a closer look at what Hollywood did to prepare for a business based on creativity at scale.

The Hollywood Studio System

Organisations are built to address the type of challenge they face. When mid-twentieth century Hollywood had to produce primarily for middle America’s host of movie theaters, the studio system arose. Large integrated movie studio operations bought together, under contract, the many types of talent needed to imagine and create a movie. Actors, directors and a host of other professionals in the employ of the studio execs — establishing a model that could efficiently produce a steady stream of films for a single major distribution channel: local movie houses.

This is not so different from the approach most large commercial and public sector institutions take to professional staffing today. As projects come and go, the organisation’s portfolio of skilled individuals are moved within the organisation, perhaps augmented by consulting resources that expand or fine tune the skill set.

Assuming a stable world, organisations can align the skills they have on staff with their mix of needs.

Skills Matching in a Stable World.png

The studios’ comfortable level of control was challenged in final decades of the century, when the movie industry faced an increasingly challenging creative environment. New competitors threatened their entertainment monopoly and audiences demanded a more sophisticated and varied fare. Movies yielded ground to TV, which gave way to cable, and has now fragmented into a host of streaming services and other specialised media platforms. The quantity and sophistication of content has rushed ahead too, with last decade seeing the number of scripted shows growing by over 150% ushering in an age of peak TV.

The industry had to produce more demanding creative work at an ever accelerating pace. The unique demands of ambitious projects made it increasingly difficult to effectively bring the talent needed for the varied efforts under one roof. While a big budget action film might be best served by one set of skills, these could quite different from those needed to successfully realise an intimate drama or scripted TV series on a streaming service.

As creative projects grew in ambition and became increasingly unique, the studio lost its role as the centralised home of talent. Thus, more projects were assembled from a pool of individuals and organisations that had specific skills and resources.

Dynamic Collaborations: Building the Right Team

This shift from highly centralised team to custom-created networks of collaborators makes sense when program efforts must be both ambitious and original. Big ambitious challenges need a wide range of different skills, so there is creative power in a model where the right talent can be bought together for each unique project.

An organisation with its own ‘studio’-style teams inevitably find it difficult to overlay their fixed set of organisation skills on such shifting needs. Mismatches and gaps quickly emerge. In some cases, additional capacity will be needed, while in others, exceptional skills will go to waste. Gaps emerge in areas of expertise either because existing staff are insufficiently skilled or because the role is entirely new.

Skills Matching in a Changing World.png

In this turbulent creative environment, the value of a stable, highly optimised, organisational skillsets is eroded. The new Hollywood Model recognised this, assembling a tailored team for a specific initiative and then allowing the various professionals to move to another project.

It should be noted that this ability to build dynamic teams is not about fighting for the top 1% of super skilled individuals. That’s a game that large well funded organisations will almost always win. Instead, highly effective teams are created by tailoring the right type of talent to the task. Someone who might be of marginal value on one project, could be a premier contributor on a different type of initiative. Leaders don’t need to fight for the widely recognized superstars, but rather can focus on finding the uniquely right contributor.

The ability to align complex projects with diverse talent also provides creative returns to the project contributors. Practitioners with a unique set of skills can cobble together a series of similar projects where their talents are fully appreciated. It also becomes possible for those with a more vagabondish soul to diversify their work, avoiding pigeonholes by embracing a number of different efforts.

Fostering Dynamic Creative Ecosystems

As the demands for creativity at scale grow in the world, other sectors can and should look for opportunities to adopt a Hollywood Model of dynamic collaboration building. Of course, this shift comes with new demands. One of the crucial advantages of traditional self-contained organisations is that the infrastructure for managing and integrating teams is clearly defined. When Hollywood abandoned the studio system, a number of new supporting services needed to emerge to fill these ecosystem building needs.

This is not trivial work. Dynamically constructing a collaboration requires the ability to identify and validate talent, negotiate acceptable terms of engagement, and integrate day-to-day activities. Simply trawling the world talent pool for potential matches between a project and a professional creates excessive overheads for all involved.

An ecosystem of both formal and informal support for collaboration building is needed to make the model viable. Across different sectors, nimble supporting services are rising to the challenge. A wide range of approaches are emerging, ranging from bare-bones freelance marketplaces to far more sophisticated program facilitators that take an active role in execution of collaborative work.

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Other aspects of the collaborative ecosystem evolve more organically. For example, a study of video game development, where the product is created by many different collaborators, found that within the shifting networks of contributors were informal clusters of professionals and teams that regularly worked together.

Time to Embrace of the Hollywood Model

As organisations find that their challenges are increasingly defined by disruptive change, rather than stable performance, the need to create at scale becomes more urgent. Leaders may be tempted to see this as an issue of imagination, driving them to promote ideas and innovations from within an organisation’s walls. Encouraging creative thinking certainly isn’t a bad course of action, but it fails to recognise the systemic barriers a self-contained organisation faces when it seeks to actually realise an ambitious new vision.

Reaching outward, creating a more flexible organisational structure by dynamically building the teams that tackle initiatives, opens the door to effective action on big ideas. Ideas can be more original (tapping the right unique skills) and bigger (assembling larger creative teams). This is done while still making it possible for each new initiative to pursue possibilities that are different from the program before.

This is the kind of creative capacity our era of disruptive change demands. Whether an organisation is working in business, government, or non-profit action, it’s time to take inspiration from the Hollywood Model, and break down walls in the name of creative prowess.

ABOUT DAN AND OUTSIGHT INTERNATIONAL

Dan McClure has spent over three decades working on the challenge of disruptive systems innovation. He has advised global commercial firms, public sector agencies, and international non-profits in support of their ambitious efforts to imagine and execute agile systems level innovation.

Outsight International is an organisation specialised in providing services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Dan and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Decrypting human-centred design: Why it is important for the third sector

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What role can human-centred design practically play in development and humanitarian work? As a researcher and designer, Gunes Kocabag — an Outsight Associate — is often asked this question. Sometimes with scepticism — but more often with genuine interest.

Human-centred design has become a respected practice in certain parts of the humanitarian and development sectors (aka the third sector). However, while many people may have seen references to its techniques, it may not be obvious how it is applied in practice. In this article, she outlines: what is human-centred design; why it is necessary; and how to apply it in humanitarian and development contexts.

FROM DESIGN AS A CRAFT TO DESIGN AS A MINDSET, and FROM USER-CENTERED TO HUMAN-CENTERED

Design has historically been categorised as an art, a craft, or as a way to improve the look and functionality of products. However, from the 80s onwards a new perspective on design has progressively taken hold – an approach that defines design as a process and a mindset that can be applied to solve diverse problems. The term ‘Design Thinking’ was popularised by the design firm IDEO in the early 90s and today has gained increasing popularity in the business world as a methodology to approach complex problems.

A key principle of the design mindset is its emphasis on placing user needs and expectations at the centre of the process. As users (aka customers) in the commercial context are more and more empowered with their decision making, companies are racing to understand their users and identify their innermost unmet needs to create the next winning product in the market. That is why user-centred design is increasingly popular in corporate innovation circles.

Global development work often happens within complex systems made up of multiple partners, people on the ground, multiple end beneficiaries and various contextual factors. So it is not only about creating solutions that work for the end-user but also for all key stakeholders within the system. It requires an approach that is not only user-centred, but human-centred, which takes into account the complexity of all stakeholders. Thus, in humanitarian and development innovation, the term that is predominantly adopted is human-centred design (HCD).

WHY HUMAN-CENTRED DESIGN?

Although human centred-design is becoming increasingly recognised and embraced by leading third sector actors such as the Bill & Melinda Gates Foundation, UNICEF and WHO working regularly with innovation, there remains lack of clarity on how human-centred design can be properly harnessed to ensure better interventions for a greater range of projects.

Here are three key reasons why human-centred design can greatly improve the success of humanitarian and development projects.

Reason 1: HCD complements system thinking to reveal differences between how the system works in theory and how people actually engage with it

Systems thinking is often referred to as a go-to approach to solve complex problems — and rightfully so — as it provides a great way to break down and make sense of the parts of a system and the relationships between them.

The systems thinking pioneer Donella Meadows defines social systems as “the external manifestations of cultural thinking patterns and of profound human needs, emotions, strengths and weaknesses.” Human-centred design can help dig deeper into those external manifestations to get to the core of human behaviours, needs and expectations behind them.

By placing the focus on the human actors within the system, HCD helps bring abstract concepts such as beneficiaries, government officials or private sector initiatives to life.

By placing the focus on the human actors within the system, HCD helps bring abstract concepts such as beneficiaries, government officials or private sector initiatives to life.

By placing the focus on the human actors within the system, HCD helps bring abstract concepts such as ‘beneficiaries’, ‘government officials’ or ‘private sector initiatives’ to life: identifying the human stories behind each, with their unique needs, motivations and goals. HCD’s emphasis on qualitative data helps us move beyond an understanding of what people do to an understanding of the social, cultural, and psychological patterns that reveal why people behave the way they do.

Understanding not only how the system theoretically works, but also how people live and breathe within the system, we can create effective solutions that meet needs and expectations at both functional and emotional levels.

Case study: Improving the adoption of home-based immunisation records (HBRs) in Africa

Home-based records are medical documents issued by a health authority, and provide a record of an individual’s history of primary healthcare services (e.g. vaccinations) received. They are maintained in the household by an individual or their caregiver. Since the beginning of the Expanded Programme on Immunization (EPI) in 1974, home-based records have served an important role in increasing the effectiveness and efficiency of immunisation programs around the world. However, retention rates in many countries remain significantly low, which is particularly worrying in countries with a high birth cohort.

To tackle this problem, we first need to understand the system and the actors within the system. A systems-thinking approach focuses on understanding the key parts of the system and how they interact with each other. Adding human-centred design to that, we glean a better understanding of the human actors behind the institutions and the human actors that affect and get affected by the system.

When I worked on this challenge in collaboration with WHO and multiple other development partners, focusing on six African countries, our first task was to understand the system map and identify the key stakeholders. Then we applied HCD to dig deeper. Through ethnographic, immersive research on the ground with health workers and caregivers as well as officials in the Ministries of Health, we were able to challenge the big picture.

During pilot research, we brought together Ministry of Health officials, caregivers and health workers to compare their knowledge of how the system should be working, with an understanding of how it is actually working. Being able to observe what was actually happening, the physical and emotional burdens on the ground, what unofficial, makeshift solutions were put in place by those who had to solve problems on the ground helped us all view the system under a different light and helped shift priorities at the institutional level. Through this nuanced understanding, we were able to align key stakeholders on prioritising the needs of the end beneficiaries and health workers on the ground, as well as creating a roadmap for successful implementation that balanced the different priorities of the stakeholders involved.

Reason 2: HCD goes beyond creating solutions to creating end-to-end experiences that drive adoption

For successful adoption of a developed solution, a functional framework focusing on efficient delivery is not enough. To deliver a solution that is efficient and effective, we need to ensure it fits into the lives of those who will be using it. The main premise of HCD is to frame the whole challenge from the perspectives of the human actors, be this the end beneficiary, a specific actor in the value chain, or a key decision maker. We then design interactions and experiences tailored for the specific context and expectations of those who will be interacting with the particular product or service.

When designing services, HCD addresses these interactions not only at one point in time but through the whole journey of service delivery: before, during and after. This helps us understand the functional and emotional highs and lows of the experience, developing fixes to mitigate the lows and catalysers to enhance the highs. Through this methodological approach we can identify potential pitfalls early on and design solutions that work end-to-end.

A service journey maps out the user’s experience step by step, as well as the people, processes, policies, and systems behind the service delivery.

A service journey maps out the user’s experience step by step, as well as the people, processes, policies, and systems behind the service delivery.

Case study: Improving the quality of data in humanitarian emergencies

Access to high quality and timely data can be a life and death-defining factor when monitoring humanitarian emergencies. The MSF REACH project, coordinated by my colleague, Lucie Gueuning, is an initiative addressing exactly this problem through creating a web-based platform to support MSF staff on the ground. The platform combines institutional data with crowd-sourced information from various sources.

While all are working towards a common goal, the platform needs to be used by different types of users with different levels of familiarity with the technology, different environments of use, culture and legal context, different skill sets and mental models. The quality of the data, which is key to the platform’s success, depends on providing an inclusive experience to all its different users.

A human-centred approach to solution development in such a context, can ensure that the user experience of the platform is designed to maximise its effective use by different users, taking into account all steps of the experience from accessing the service to data entry to making sense of the data. To give one specific example, the design of the user interface can have a significant impact on the quality of the data as well as how users perceive and prioritise data.

By putting users at the centre, human-centred design ensures that the interactions fit the users’ different mental models and drives the adoption and successful use of the platform. For MSF REACH this means high quality data, which is critical for saving lives.

Reason 3: Through divergent thinking, HCD catalyses new perspectives and out-of-the-box solutions

HCD is a process that can be applied to different problem spaces. It is made up of iterative cycles of divergent and convergent thinking, following a pattern of exploring possibilities before narrowing down on one solution. This emphasis on divergent thinking allows its practitioners to ask ‘what if…’, think out of the box and imagine possibilities beyond established patterns of thinking. Divergence is then followed by a structured and criteria based process of convergence that defines what is possible.

HCD follows an iterative process where divergent thinking is followed by structural convergence, both for problem definition and for solution development.

HCD follows an iterative process where divergent thinking is followed by structural convergence, both for problem definition and for solution development.

Bringing together different mindsets and skills sets is essential for divergent thinking. This helps explore the problem space from different perspectives and create richer solutions. Thus, HCD projects rely on a combination of different topic expertise combined with the perspectives of stakeholders on the ground. Participatory design, co-creation with communities, design sprints are common methodologies that are used to catalyse divergent thinking in a structured way.

Case study: Developing a strategy for 10 years from now

Developing strategies and roadmaps in the humanitarian and development context is a complex task. It involves multitudes of stakeholder (often with very specific areas of expertise) who need to understand one another, if not reach a common understanding. Building empathy between stakeholders is key to having a meaningful conversation around priorities. HCD, with its emphasis on divergent thinking, can create a space for building empathy among stakeholders, a safe space to step into someone else’s shoes and think creatively. It is here that HCD practitioners can thrive in a facilitating role, helping structure discussions, outcomes and strategic roadmaps.

When I worked with a global foundation as a consultant on HCD, our challenge was to bring together employees to co-create a future strategy while introducing the HCD methodology. Using a HCD approach, we were able to get participants from different groups within the foundation to work together and collectively discuss how the foundation should evolve to support its global network of partners. In a workshop setting, participants stepped into the shoes of policy makers, advocates, scientists, end beneficiaries and other actors they interact with day to day. With this new perspective, they articulated how the future could impact those actors and what this could mean for the foundation’s strategy. This approach enabled participants to leave behind their roles and titles and explore the problem space from a new angle, providing a strong foundation for the definition of a new strategy.

To sum up, human-centred design can greatly improve the success of humanitarian or development projects by:

  • Revealing the nuances between how the system works in theory and how people actually engage with it.

  • Creating end-to-end experiences that drive adoption.

  • Catalysing new perspectives and out of the box solutions.

HOW CAN WE APPLY HUMAN-CENTRED DESIGN IN THE THIRD SECTOR?

Going back to my initial question, ‘What role can human-centred design practically play in development and humanitarian work?’, I would like to finish this post by providing some concrete pointers on when and how you can incorporate HCD into your work:

  • During scoping and need identification - to ensure we’re accounting for the experiences, needs, mindsets and context of the all human actors involved and not just making assumptions about what is needed.

  • During solution development - to develop solutions that fit into the lives of the target group and provide an end-to-end experience that drives adoption.

  • During implementation - to prototype and test solutions with users and stakeholders, to learn and iterate to improve the solutions.

  • During monitoring and evaluation - to complement quantitative data on what is happening with qualitative exploration of why it is happening.

  • Throughout our work - to catalyse collaboration, out of the box thinking, iterative solution development and experimentation through design sprints, co-creation workshops or methodological training.

Human-centred design is not just a high-level theory, but a practical tool that can add value over different project phases. For those who use it, it quickly becomes indispensable for achieving efficient and effective implementation. It is exciting to see its increased adoption in the global development field, yet there are still many more situations in which humanitarian or development practitioners are not taking in the whole picture, and thus missing opportunities to implement much more efficient projects and systems.

ABOUT Gunes AND OUTSIGHT INTERNATIONAL

Gunes is a researcher and service designer specialising in the development of human-centred solutions in complex stakeholder environments. She has worked as a consultant for public and private sector entities as well as global development organisations in areas including global health and financial inclusion.

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Gunes and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.

Making development self-sustaining: Seven essential principles

The Kit Yamoyo diarrhoea treatment kit under local production in Zambia for the local Zambian market. The kit was designed, and the local market developed, using one-off donor funding.

The Kit Yamoyo diarrhoea treatment kit under local production in Zambia for the local Zambian market. The kit was designed, and the local market developed, using one-off donor funding.

What is self-sustaining development and why is it important? Simon Berry — Outsight Associate — explains…

The term ‘sustainable development’ appears often in international development discussions. But what does it mean? The phrase can be used interchangeably to mean one of two things which are, in fact, very different. In the environmental sense it means ‘living within our environmental limits’ — development that ‘meets the needs of the present, without compromising the ability of future generations to meet their own needs. The term, however, also describes development that carries on once the resources used to create it are removed. Here, I refer to the latter form of sustainable development as ‘self-sustaining development’, to distinguish it from what one might call ‘environmentally sustainable development’.

In 2010, my partner and I started discussions with stakeholders in Zambia around transforming access to oral rehydration salts (ORS), the globally recommended treatment for childhood diarrhoea. Having established that there was local interest, we set-up a UK-based charity, ColaLife, to take the idea further. We started with a trial of the idea and went on to a national scale-up. By 2016 a locally designed and tested diarrhoea treatment kit was available nationwide in supermarkets and in hundreds of small shops. Additionally, the government were showing interest in a government-branded version for distribution through its clinics.

Donor funding finished two years ago (March 2018) and ColaLife formally completed its role in September 2018. It is early days, but all indications are that the transformation we achieved while we were involved and donor funds were flowing will continue to be self-sustaining. In fact, things have developed further with the government adopting the diarrhoea treatment kit as the standard in the public sector. The change that was created with the help of donor funding and external support from ColaLife has survived following the withdrawal of both. It has proved to be self-sustaining.

How does one achieve development that is self-sustaining?

Here are some key principles I have developed over the years while working with others on development projects that I think are crucial if you are to achieve self-sustaining development.

  1. Plan for self-sustainability from the outset - You don’t achieve self-sustaining development while being forced to come up with ‘an exit strategy’ two years before donor funding comes to an end.

  2. Don’t do anything that makes you or your organisation a permanent part of the solution - This is crucial and is the foundation for the other principles. If you allow yourself to become a part of the solution, then, by definition, when you leave, part of the solution will leave too! It is alarming how many ‘development’ initiatives fall into this trap, always with at least two negative consequences: firstly, the change they created while operational is not sustained; secondly, while operational they are likely to have undermined and weakened the capacity of local organisations who have the long-term responsibility for creating and sustaining the desired change.

  3. Do everything through local systems and structures - If you are not to become a permanent part of the solution, then you will have to work through local systems and structures. Where these lack capacity or direction, help build the capacity, help refine or improve the direction. Above all, avoid setting-up parallel systems or structures.

  4. Build a ‘smart partnership’ to guide planning, testing and scale-up - It follows that you will need to work in partnership with local stakeholders. However, it is important how these partnerships are formed and operate. It is important that partnerships are formed around a shared vision not around an organisation or an individual. When this is done successfully, it promotes engagement, ensures shared ownership of the vision and helps ensure that the partnership will survive the departure of any single member. We call partnerships formed around a vision ‘smart partnerships’. From the outset, be open and inclusive: invite everyone in, as part of a process where a broad membership can self-select their level of engagement. Some may go on to become implementation partners, while others may continue as a broader consultative group.

  5. Self-sustaining development should fit with government policy - If it doesn’t, seek to better align plans or work with government to influence or advocate for policy change. It is unlikely that any initiative that doesn’t fit with local policy will be self-sustaining.

  6. Engage your intended beneficiaries from the very outset - This sounds obvious but it often overlooked. It is essential to operate on the basis of what you know people want, rather than on what you think they need.

  7. Be invisible - The urge, on the part of donors and development agencies, to brand everything they fund or support is overwhelming. However, this must resisted as it completely changes how the intervention is perceived. For example:

This was the original artwork for the billboard for the promotion of the diarrhoea treatment kit - Kit Yamoyo – at the start of the scale-up in Zambia.

This was the original artwork for the billboard for the promotion of the diarrhoea treatment kit - Kit Yamoyo – at the start of the scale-up in Zambia.

In a second phase of marketing a USAID project, run by JSI, agreed to fund additional billboards but insisted on having their logos on the billboards and these ended up looking like this.

In a second phase of marketing a USAID project, run by JSI, agreed to fund additional billboards but insisted on having their logos on the billboards and these ended up looking like this.

This was a mistake. Inherent in ColaLife’s self-sustainability approach is that any donor assistance should not be permanent. This approach is not compatible with donor branding being on any customer-facing aspect of the intervention.

Integrating these principles into your project

Undoubtedly, many of these principles may require a more extensive level of planning and analysis than was originally thought necessary, yet there is no such thing as too much preparation. As explained by Dan McClure (another Outsight Associate) in his blog post on ‘Mastering the art of hard problems (and avoiding the rush to easy solutions)’ — mapping the complex systems and stakeholders involved with a problem or possible solution is essential in order to ensure that these principles can be integrated efficiently into development initiatives. Do not be scared to think big and think ahead early on in order to ensure you’re not putting out fires or having to re-orientate the project at significant extra cost further down the line.

Investing in the right things at an early stage — system design thinking, researching the existing structures, analysing the problem, and stakeholder engagement — will ensure a project stands a much better chance at becoming self-sustaining and, thus, create a greater positive impact for beneficiaries.

ABOUT Simon AND OUTSIGHT INTERNATIONAL

Over a 40-year career Simon has been a leader in the voluntary, private and public sectors. He has lived and worked in South America, the Caribbean, North Africa, sub-Saharan Africa and the UK. He is an expert on self-sustaining development – development that out-lives the resources that were used to achieve it.

Outsight International provides services to the humanitarian and development sector in an efficient and agile way. Outsight International builds on the range of expertise offered by a network of Associates in order to deliver quality results adapted to the specific tasks at hand. If you’d like to discuss working with Simon and the Outsight team, please get in touch or follow us on LinkedIn for regular updates.