Co-Creation Hub (or CcHUB) is a regionally-based African innovation center that provides tech design support to start-ups and governments that are addressing economic prosperity. Kome Sideso is a User Experience Designer at CcHUB. He worked closely with Nigeria’s Ekiti State Health Commissioner, the Ministry of Health, and MIT GOV/LAB to co-design a tech solution that improves health facilities’ quality of care. As the local consulting lab for the Ministry, CcHUB provided both technical support and knowledge sharing on the best ways to implement technology and engage users. Kome led the design of the research methodology, user experience, and final prototype. 

This project was launched following the December 2021 Governance Innovation Lifecycle Challenge and Accelerator, which was organized by MIT GOV/LAB and concluded a year later. The Accelerator introduced MIT GOV/LAB’s Governance Innovation framework, which would later become the Lean Governance Innovation Design model for addressing governance challenges. A high fidelity prototype was designed and tested with the winning team, but not implemented. 

Seongkyul Park, Governance Innovation Project Manager at MIT GOV/LAB, spoke with Kome about the dynamics that local designers navigate when supporting governments to innovate — in this case, to digitize patient interaction to improve the quality of care.

Seong: You led the development and testing of the health facility app and dashboard. Can you tell us about these wireframes and how they intended to improve the relationship between citizens and the government? 

Kome: The mobile app allows citizens to share feedback about their health facility visits, while the dashboard allows the government to respond and help health facilities improve patient experiences over the service lifecycle. This solution can also make health workers’ jobs more efficient and transparent. It helps the state connect the dots between feedback from communities and healthcare workers, to inform the right policy development – a need the government voiced at the start of the accelerator.

Seong: How did CcHUB and the Ministry collaborate to co-design the prototype? What were the benefits of having an academic team like the MIT GOV/LAB provide design reviews and project management support along the way? 

Kome: We first worked alongside MIT GOV/LAB to co-create the Lean Governance Innovation Design model. Then we worked with the Ministry of Health to both implement and expand upon the model. For example, initially we had included an alignment phase at the start of the model, but when we presented this to the Ministry, they blew it up by letting us know that we needed a much longer consultation phase with many more sessions and a longer list of stakeholders – the healthcare workers, the permanent secretary, the heads of various different departments, the nurses, and such. 

The hands-on engagement with both the Ministry and citizens as part of the co-design sessions really helped to humanize the health system and to deeply understand both the people and the command chain line involved, as opposed to applying something we simply cooked up in a lab. MIT was a helpful accountability partner along the way, helping us to focus on the outcomes we wanted and supporting the monitoring and managing of the progress.

Seong: What were some of the challenges or key lessons learned from working with the government, or the Ministry of Health, to improve the design of public health services? 

Kome: One of the key challenges was having a continuity plan, as there were elections and changes within the government during the project. We had to keep pivoting and asking ourselves, “what will happen if the administration and/or the data changes at this point or that point.” We needed to be very aware of the governance system and look for ways to get buy-in from the current government that was serving the ministry. We made sure to not come in to destroy the status quo, but tried to adapt to how the government’s compounded systems work together. 

We also had challenges in engaging end users during the testing phase. For example, we had asked the healthcare workers to use their own devices to test the mobile prototype. This resulted in a lot of failed results because their devices weren’t good or the connectivity and the bandwidth were bad. We hadn’t considered this issue and didn’t include ways to troubleshoot such challenges during the pre-training. It was a struggle to balance CcHUB’s role in supporting the Ministry team to become independent champions and users of the solution within a few months versus maintaining the quality of the research through a hands-off approach. 

The final challenge was that the government believed that those responsible for responding to citizen feedback would be able to effectively manage and personalize the suggestion box or prototype. It was only after testing that we learned that even if the mailbox was full, metaphorically speaking, that nobody was checking them – either because the government staff who should be responsible was either in the dark or wasn’t consistently being fed the right information.

Seong: Do you have recommendations for how governments can best improve public services – whether by partnering with design agencies like CcHUB or by building the right in-house expertise?

Kome: Consistent engagement. There’s this idea that you can do things once and that’s it. But collaboration isn’t a painkiller, it should be more like a vitamin. We need to address the core problem and build a system where you keep treating the core issues. This is why we also kept coming back to discussions about having the right policies, and exploring potential public-private partnerships that would be ongoing as opposed to one-off consultancies. 

I don’t think we should leave the government to solve public challenges on their own. Governments can be more proactive about inviting people from other sectors to roundtable sessions, and not the other around. They should regularly host discussions about how to improve services, and say “we’re going to do this, we need you to keep us accountable, and recommend us on ways we can improve public services based on your experiences in the private and non-government sectors.” Public services are designed to be launched, but there isn’t often a sustainability plan. So having sessions where non-government teams support the maintenance culture would be helpful.

Seong: Are there any next steps for the prototype or the partnerships between CcHub and the Ministry? 

Kome: We’re still open to working together on this solution. We’ve shared a four-part implementation plan with the ministry. The plan makes suggestions for how the ministry can further develop the app, organize a tech admin team, measure metrics that can lead to policy change, and sustain the services through the right funding. The overall sentiment I get from this experience is “we had an itch, we scratched it, and we had a good scratch.” On our end, we saw a problem, we took a swing, and we don’t mind keep swinging if the ball keeps coming back.

Photo: Kome, on the far left, brainstorms with the EPISURV team as part of the bootcamp. Credit: Co-Creation Hub.