Innovating to solve urgent challenges in quality of care delivery and public health security, two key areas in the fight against the Covid-19 pandemic

The Covid-19 pandemic highlighted structural challenges in the healthcare system of Ekiti State, Nigeria, leading MIT GOV/LAB’s Innovation unit to partner with local teams aiming to co-design solutions that address these challenges.

In mid-January, two teams within the State’s Ministry of Health started user research activities as part of the discovery phase of MIT GOV/LAB’s Governance Innovation Lifecycle Challenge and Accelerator. The initiative uses human-centered design and social science to devise solutions to statewide health challenges in quality of care delivery and public health security. The user research training follows a one-week intensive Governance Innovation Bootcamp that took place in December. The January training phase reinforces the skills that the teams learned in the bootcamp and allows the teams to practice human-centered design research in an applied setting. “The two-day training strengthened our commitment to our problem statement, gave us more understanding of the literature review, and served as a foundation for the Discovery stage,” said members of the Epidemiology Surveillance team.

The Ministry of Health teams were able to test the research tools they developed with the support of human-centered design experts. The Epidemiology Surveillance team selected the Igede – Irepodun/Ifelodun Local Government Area while the Quality of Care team selected Oba Adejuyigbe General Hospital in Ado Ekiti as the location for their pilot field research. 

“The field activity further helped us appreciate the centrality of the human in the governance innovation process. We were able to broaden out our sampling frame, organize our proposed instrument and also note possible sources of bias to be eliminated in the final activity,” reflected the members of the Quality of Care team.

Team Episurv (Epidemiology surveillance) visits Igede-Irepodun/Ifelodun Local Government Area to test out research tools [left] and Team Qualicare (Quality of Care) visits Oba Adejuyigbe General Hospital in Ado Ekiti [right]. Jan 2022 [CcHUB]

A Framework for Innovation in Governance

The initiative is co-led by MIT GOV/LAB, the Nigerian public policy and strategy firm Gatefield, and the pan-African innovation centre Co-Creation Hub. The program is grounded in MIT GOV/LAB’s Governance Innovation Framework, a tool developed with design engineers at MIT GOV/LAB and piloted in Sierra Leone in 2021. This framework combines elements of human-centered design, behavioral and social science, and systems thinking to give government bureaucrats and civil society actors the tools to develop innovative solutions to governance challenges. 

Through the Framework’s iterative process, public sector organizations and civil society actors work to create alignment in the presence of conflicting interests, discover a variety of resolutions to service delivery problems, understand the needs, capabilities, and capacities of end-users and stakeholders, co-create appropriate solutions, and pilot designs that encourage measurement, evaluation and learning. This process allows for greater intentionality and understanding of the up and downstream effects of design decisions on end-users and the network of stakeholders in the policy ecosystem. 

The Framework is being deployed in phases and will continue to support the teams over the eight-month period with the technical expertise necessary to undertake research, co-create solution scenarios and develop a solution prototype. 

Ministry of Health team members brainstorm during December’s Governance Innovation Bootcamp. Dec 2021 [Gatefield]

The research work that commenced on the ground last week builds on last month’s program launch and Governance Innovation Bootcamp, which took place in person in Ado Ekiti during the first week of December 2021. The four-day governance innovation training bootcamp focused on delivering the Ministry of Health teams the knowledge, understanding and skills necessary to co-design governance solutions.

MIT GOV/LAB, Co-Creation Hub, and Gatefield teams meet with Dr. Kayode Fayemi, Governor of Ekiti State, and Dr. Oyebanji Filani, State Commissioner of Health, leading up to the program launch. Nov 2021 [Gatefield]

A primary healthcare worker describes her clinic’s system for keeping medical records. Ado Ekiti, Nov 2021 [Carlos Centeno/MIT GOV/LAB]

The three-organization team selected Ekiti as the initial partnership state based on the state’s high-level commitment to innovation. 

Dr. Oyebanji Filani, Ekiti State Commissioner of Health, described the Ministry’s interest and commitment to the program: “We have carefully assessed our health system and recognised gaps in service delivery that need to be addressed. In view of this, we decided to put innovation at the core of driving solutions in the health sector.”

What would happen if innovators within the government had the resources, space and support to think differently? 

In addition to developing innovative solutions, MIT GOV/LAB is hoping to understand what sparks and sustains governance innovation inside Ekiti State’s Ministry of Health. The environment for innovation in the public sector is complex: unlike iterating and prototyping in the private sector, where failing is part of developing solutions for paying customers, innovating in or around the public sector is a high-risk activity constrained by limited resources and time, pushing civil servants keen on innovating toward less complicated problems. What would happen if innovators within the government had the resources, space and support to think differently? 

A woman posting on a flip chart

Bosede Alowooye, Acting State Epidemiologist, participates in a collaborative activity as part of the December Bootcamp. Dec 2021 [Gatefield]

Whereas many public sector innovation interventions focus on early-stage support, MIT GOV/LAB has learned that successful projects depend on rendering support not just at a hackathon or design session, but throughout the lifecycle of the project or idea. During the next few weeks, MIT GOV/LAB will work with the partners and teams as they deploy to conduct field research that will inform the design of the solutions. Thereafter, the teams will build on the findings, ideating and co-creating solutions leading up to a pitch event where one team’s solution will be selected and supported through product development.

Both teams will continue to work with all three Governance Innovation implementing partners to develop continuity and resilience plans rolling into solution implementation.

Hero Image: Team Episurv (Epidemiology surveillance) visits Igede-Irepodun/Ifelodun Local Government Area to test out research tools Jan 2022 [left, CcHub]; Primary care delivery workers share their experiences with researchers during the Governance Innovation Lifecycle Challenge and Accelerator launch in Ado Ekiti. Dec 2021 [Carlos Centeno/MIT GOV/LAB]