Using a service design model to develop the “Passport to Safer Birth” in Nigeria and Uganda

Abstract

Objective: To demonstrate how a human-centered service design approach can generate practical tools for good-quality childbirth care in low-resource settings.Methods: As part of the WHO "Better Outcomes in Labour Difficulty" (BOLD) project, a service design approach was used in eight Ugandan and Nigerian health facilities and communities to develop the "Passport to Safer Birth." There are three phases: Research for Design, Concept Design, and Detail Design. These generated design principles, design archetype personas, and Passport prototypes. Data collection methods included desk research, interviews, group discussions, and journey mapping to identify touchpoints where the woman interacts with the health system. Results:A total of 90 interviews, 12 observation hours, and 15 group discussions were undertaken. The resulting design principles were: a shared and deeper understanding of pregnancy and childbirth among family and community; family readiness for decision-making and action; and the woman's sense of being in control and being cared for. Four archetype personas of women emerged: Vulnerable; Passive; Empowered;Accepter. Subsequent development of the Passport to Safer Birth tools addressed three domains: Care Mediator; Expectation Manager; and Pregnancy Assistant. Conclusion:The service design approach can create innovative, human-centered service solutions to improve maternity care experiences and outcomes in low-resource settings. K E Y W O R D SCo-design; Human-centered design; Maternal health; Nigeria; Passport to safer birth; Service design; Uganda | INTRODUCTIONIn 2014, the WHO initiated the "Better Outcomes in Labour Difficulty" (BOLD) project to address the quality of facility-based childbirth care in low-resource settings. The goal of this project is to accelerate the reduction of childbirth-related maternal, fetal, and newborn mortality and morbidity by addressing critical impediments in the process of labor and childbirth care, taking advantage of the interactions between the health system and the community. 1 The project sought to achieve this goal through a two-pronged approach: the development of a Simplified, Effective, of service prototypes and/or tools that improve or enable new interactions between communities and health facilities. These tools were designed using an approach that applies humancentered design methods to co-design solutions together with end users. This paper reports on the development process. The PSB tools developed as a result are described in Salgado et al. 4 | Service design process as a tool to engage users and stakeholders in service innovationThe approach used to design the PSB service tools and concept is called service design, which is an emerging discipline focused on ideating, defining, and implementing services using a customer centric approach. 5 The service design process aims to innovate and improve new or existing services to make them more useful, desirable, and usable to the customer while ensuring efficiency and effectiveness to the service provi...

Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study

“…The findings suggest that women place high value on positive emotional and interpersonal experiences of care, equally with technical and clinical measures of quality medical interventions, and that optimal use of maternity care could follow from local service design based on these preferences. Results from this study have been integrated into the development of the Passport to Safer Birth . Researchers, policy‐makers, facility administrators, and other stakeholders should integrate women's preferences and values into designing maternity services and should consider the implementation of interventions to promote positive childbirth experiences.…”

“…With growing recognition of the importance of providing woman‐centered and respectful maternity care, WHO initiated the Better Outcomes in Labour Difficulty (BOLD) project in 2014 to address the quality of facility‐based childbirth care in low‐resource settings with a high burden of maternal and neonatal morbidity and mortality (Nigeria and Uganda) . A two‐pronged approach was used: the development of a Simplified, Effective, Labour Monitoring‐to‐Action (SELMA) tool and the Passport to Safer Birth . SELMA is a digital solution developed to enhance the expertise of health professionals assisting women in labor in health facilities.…”

The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study

“…The goal of this project is to accelerate the reduction of childbirth‐related maternal, fetal, and newborn mortality and morbidity by addressing the critical impediments in the process of care of women and fetus during labor, and taking advantage of the interactions between the health system and the community to learn what kind of care women want and value. The project seeks to achieve this goal through a two‐pronged approach: the development of a Simplified, Effective, Labour Monitoring‐to‐Action tool (SELMA) and the Passport to Safer Birth . SELMA is a digital tool developed to enhance the expertise of health professionals assisting labor in health facilities.…”

“…While women themselves are the “gold standard” for information on their own needs and preferences, healthcare providers and administrators can provide interesting input to explore convergent and divergent perspectives on women's needs. This paper is part of a series on the BOLD project formative research; other aspects of the project are described in detail elsewhere in this Supplement …”

Turning local knowledge and experience into innovative tools for quality care during labor and childbirth: The BOLD project experience

“…The final and completely unique step in the process was to integrate the collaboratively developed quality standards into locally relevant tools. Using a service design approach, the team co‐developed a new and visually appealing set of materials that integrate insights from commercial design and from behavioral psychology . This has resulted in an innovative portfolio of tools that are closely linked to the accounts and preferences of local women, communities, and service providers, and that are sustainable, affordable, and articulated with the service provision that is on offer.…”