How can we improve life for more than 3,000 HIV patients in Yangon, Myanmar?

 

This is the pressing question that Pepal, a UK based non-profit organization, asked Board of Innovation, an innovation consultancy, when they contacted the Antwerp based organization asking them to join a collaboration to find innovative solution for one of the country’s most pressing problems.

 

Local NGOs were looking for a solution to give better care to HIV positive people who were struggling to keep up with a treatment plan which involved multiple visits to offices, pharmacies and doctor every three months. This schedule required them to take a lot of time off regular work, travel often across a jam packed city incurring expenses in both time and money.

Adding to the patients difficulties was Alliance Myanmar’s growing economic restrains. As an NGO its financing strongly relied on donors, something that was about to come to an end given that in 2015 the World Bank changed Myanmar’s status from that of a “low-income country” to a “lower-middle income” making it harder for local non-profits to access large institutional donors.

 

International institutional investors have strict rules; only countries classified as “lower-income” can access funding.

 

As an innovation consultancy BOI worked in a collaborative partnership with Pepal, Janssen (Pharmaceutical Companies of Johnson&Johnson) and the NGOs themselves to find solutions for both challenges.

 

This  is how they helped Yangon’s HIV positive patients receive better and more affordable care, and Alliance Myanmar to become more economically sustainable:

 

Step 1: Get the stakeholders onboard

 

Who was involved?

 

• Board of Innovation (BOI): innovation consultancy
• Pepal: UK based NGO which brings together NGOs, global corporations and local governments to develop leaders and find practical solutions to challenging social issues
• Janssen (Pharmaceutical Companies of Johnson&Johnson): large pharmaceutical company that brought staff onto the leadership and innovation programs in country and largely funded the project

 

Step 2: Discovery phase – understand who you are helping and what they really need

 

Any search for new ideas on how to improve a product or service through design thinking starts from deeply understanding the end user: their needs, hidden desires, fears, hopes and daily struggles.
Simple as this may sound it is impressive how many projects – both for and non profit – forget to give enough time and attention to this first important step and end up creating solutions nobody really wants to use.

 

Even the big guys make such mistake. Remember Google glasses? Despite all the fanfare and media attention the product never attracted the attention of the consumer and is now no longer being rolled out.

 

To avoid this,  teams of pharmaceutical and NGO staff worked together in Yangon, Myanmar to undertake this critical first step: understanding what patients living with HIV in Yangon were dealing with.

 

Guided by BOI’s experience, teams went to patients houses to meet them, and ask questions about their healthcare routines. They listened to those affected by HIV to begin to get an understanding of the day-to-day problems they faced in receiving treatment and care.

 

(photo courtesy of Pepal)

 

The interviews with patients revealed that:

 

• HIV is hugely stigmatized in Myanmar making it difficult for people to openly seek help and talk about their problem. For example: an interviewee said that a dentist charges 3 times more than they normally do if they know you are HIV positive.
• HIV treatment is very time consuming: every 3 months patients have to go for a check-up and give a blood sample, travel back to get the lab to pick up results, bring the results to a doctor across town, then get a prescription and go to the pharmacy
• The above described a routine which forces a lot of HIV patients in Yangon into poverty. The various touch points of the treatment are dispersed around Myanmar’s capital, and there is approximately a one hour drive between different points of care. Such a time consuming structure makes it hard for many patients to keep a full time job and secure steady income.

 

Step 3: Ideation phase – brainstorm possible solutions

 

 

During the discovery phase, a lot of inputs are gathered and this information is then used in the brainstorming session to answer all the questions that came up when meeting the HIV patients in Yangon. Some of the questions which came up were:

 

• How can we make the process less time consuming?
• How can we create a safe space for those affected by HIV to feel free to talk about it?
• How can we avoid HIV+ people having to take multiple rides across town?
• How can we help HIV+ people keep their regular jobs?

 

The brainstorming was moderate by BOI using a set of tools created to help people turn insights and empathy with users (patients in this case) into actionable improvements which have a positive impact on people’s lives.

 

One of these tools is the “mash-up method”, a fast and fun ideation technique created by design and innovation consultancy IDEO and adapted by BOI that brings odd or unexpected things together to spark fresh ideas.

 

Here is the tool’s framework:

 

How does it works?

 

1.  Frame:  Articulate the challenge as a How Might We statement. How Might We statements allow the brainstorming sessions to stay focused and for those involved in it to not go beyond the scope of the project (remember the opening question of the article? “How can we improve life for more than 3,000 HIV patients in Yangon, Myanmar?”)
2. Narrow: Pick two broad, unrelated categories, like hospitals and hotels or waiting rooms and schools. Think outside your sector.
3. Generate: Starting with one category at a time, list as many elements of these two experiences you can in two minutes.
4. Mash-up: Combine items from the two lists to ideate as many new products, services or experiences as you can.

 

The first objective of the mash-up is quantity. The more ideas you come up with, the better chance you have to reach a truly brilliant solution. It also applies constraints. Perhaps most importantly, it helps people using it follow the path from the ridiculous to the radical solution.

 

At the end of the ideation exercise, the stakeholders involved were invited to present the solutions to the NGOs’ executive committee with the aim of getting funding and approval for execution.

 

Step 4: Picking a solution, implementing it and making it sustainable

 

As the team brainstormed a great number of ideas came up. Some were technology driven, some futuristic, some highly creative but much too expensive to implement.

 

One of the most popular ideas of the session was to create digital medical transcript to help doctors and pharmacies communicate directly so patients didn’t have to travel all the way from one to the other.

 

The idea seemed liked a winning one at first, but after a deeper analysis the technical constraints the idea faced in the creation of such a platform meant that it was abandoned by the team.

 

The winning idea ended up being  a one-stop-shop in Yangon, a space able to offer all the services needed by HIV+ patients, under one roof.

 

The vision was one space where HIV patients would be able to do all their checks, exams, and doctor visits without having to deal with multiple different offices or travel across different parts of town. One place, one trip, one solution space. The opposite of the decentralized and disorganized structure that patients had to face in Yangon.

 

The solution was also an improvement on the business side, for the NGO as well as for the patient. Many HIV positive patients were unable to keep regular jobs given the time they constantly had to ask off work to travel across town. Not having a regular job made it difficult to pay for treatment.

On the patient side the one-stop-shop allowed the HIV patients to save time and money,. On the NGO side the system gave Alliance Myanmar the possibility to charge a fee for delivering an improved service making the non-profit more sustainable and less reliable on international funding. A win-win situation.

 

In July 2018 the idea came to life.  Today the HIV clinic helps at least 100 patients per day, an average of four minutes per patient, many of whom who otherwise would not have been able to afford their treatment and care.

All with a small effort: taking time, really listening to those you want to help without imposing your solution and building from the user’s need up. A lesson that can be learned and applied to all projects looking to have a social impact.