Creative Solutions for Social Impact - 2018-2019 Review - Scope Impact
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Creative Solutions
for Social Impact.
2018-2019 Review
1
Preface
As we share this review, the COVID-19 pandemic continues to
impact communities and place unprecedented demands on
health systems everywhere.
The crisis is disproportionately affecting the communities we
serve -women and children, persons living with disabilities, elderly,
refugees, marginalised groups and communities struggling to
survive or make ends meet. COVID-19 is exacerbating structural
inequalities and laying bare our flawed systems, inadequate
healthcare, and the lack of social protection for those most in
need.
In this new world, the work of the global health community as well
as social impact partners is more important than ever.
We are dedicated to advancing health, equality, and gender and
to supporting our partners and communities through this crisis.
Together we are co-designing new interventions and delivery
models as well as ways to enhance civic participation and
social mobilisation. We are supporting national health systems
in maintaining essential services and facilitating communities
in actively participating in the design and provision of care for
them. By bringing together people’s lived experiences, technical
expertise, and data, as well as government actors through new
inclusive collaboration and learning models, we are helping
country partners in adapting and evolving through the different
phases of the pandemic.
We are deeply grateful to our global, regional, and national
partners for the continued collaboration and mutual support
during this challenging time.
We also take this opportunity to share our deep gratitude to
healthcare workers and social sector actors at the frontline of the
global response to the COVID-19 crisis.
2 3
TABLE OF
CONTENTS.
Measuring
A Bit Impact. A Closer
About Us. Page 10 Look.
Page 06 Page 14
Project Work
& Results.
Page 15
Social Innovation #formnigani
Design & Pathways Lab.our Ward
to Impact.
Group ANC
Page 08
The Next T
Adolescent Health
Project
Core
Images as Data
Our Funders, Next Gen MamaWavu #ResistGag Scope’s Social
Fem Mission Fund
Partners &
Projects.
Collaborators. Page 74
Page 84
4 5
A Bit About Us.
Creative Solutions An Approach
for Social Impact. Aligned for
Impact.
• Interdisciplinary
We strive for a world where everyone, everywhere can experience a healthy,
collaboration ensures
dignified, and fulfilling life. This commitment to impact guides our strategy, serves
inclusivity and rigour
as the fire for our daily motivation, and is the guiding principle that informs all of
across the innovation
our work. Our focus areas include health, gender, and equality where we seek
process.
to improve people’s lives by creating innovative, impactful pathways to social
• Creativity is leveraged
change.
to unlock innovation and
novel solutions.
Scope launched in 2008 as a mission-led, independent, and sustainable social
• The combination of
impact company. While headquartered in Helsinki, Finland our work and teams
scientific evidence
are global, spanning Asia, Europe, Africa, and the Americas. In addition to our
and lived experience
client-funded work, Scope also funds and delivers our own social innovation
guides the design of
projects in order to experiment and test novel solutions such as creative
contextually appropriate
campaigns, new technological solutions, or new services.
interventions.
• Co-creation generates
national leadership
in developing and
Interdisciplinary Collaboration + Human- •
implementing solutions.
Building capacity
Centred Design for Sustainable Innovation. supports communities
and systems to
Innovation flourishes where disciplines intersect. Each area of expertise provides accelerate change at
a unique lens and perspective. Scope’s way of working operates just like a scale.
kaleidoscope by creatively combining multidisciplinary expertise across design,
creativity, research, innovation, international development, and global health.
Sustainable change is most viable when it is uniquely informed by the myriad
of people, communities, and systems surrounding an issue. Our way of
collaborating establishes an inclusive model for decision makers, systems actors,
and communities to come together and chart new ways forward for challenges
ranging from improving the quality of maternal and newborn care, to increasing
HIV testing among youth, to catalysing social mobilisation movements around
rights to family planning, and more. Along this journey we also collaborate with
numerous inspiring local partners and experts who, like us, are deeply motivated
to drive positive change.
6 7
Social Innovation Design
The first lever of change happens when key stakeholders begin to
implement newly co-designed solutions or supporting policies.
& Pathways to Impact.
This uptake enables the second lever of change to occur when the target
audience benefits from new solutions or policies. This in turn creates impact,
which is the point in which people experience tangible positive changes to
their health and well-being.
The challenges Scope focuses on are multicausal, requiring a system-centric approach, the
involvement of multiple stakeholders and partners, and input across a range of disciplines.
Typically, we co-design a suite of interventions to be implemented at multiple levels of the
system and with a diverse set of partners to achieve the desired long-term impact.
Pathways to Impact.
Over the past 12 years, we have honed a social impact design methodology which is a
hybrid approach that draws from our different disciplines to arrive at solutions that are user-
Impact at scale Improved development, health, gender, and equality outcomes as per
friendly and practical to implement. Scope works closely throughout each phase with key national and global goals
stakeholders who have the ability to bring solutions to scale. The phases include:
Second lever of People benefit from new solutions or
change changed policy
Defining the problem, mapping
and analysing the landscape, and
building partnerships. First lever of
People utilise new solutions or changed policy
change
Assess &
Ignite Collaborative discovery,
participatory research, and Preparation for
data analysis. change: Proof of
Collaboration
Scale Discover concept, mindset
and support for
change
geographical and
adaptation-based
scaling.
Identifying opportunity The Process Wheel
areas and determining the 7 fluid stages of
innovation strategy. intervention design
Advocate Define
National and global
advocacy for adaptation-
based scaling. Partners for Service Social Impact Private
Communities Government Academia
Implement Create & Pathways to Impact Providers Partnerts Sector
Co-designing, prototyping,
Test
and micro-piloting potential
solutions.
Measurable pilots
The Pillars Inclusiviness Responsiveness Courage Creativity Efficiency
and projects.
(values & principles) Equality Respect Integrity Optimism Pragmatism
8 9
Impact Framework.
Measuring Impact. IMPACT OUTCOMES
Our clients and partners increase their
EXAMPLE
By participating in the creative innovation
1 knowledge and skills in creative innovative process, a major foundation in Nebraska,
Creativity and innovation have the potential to bring novel processes. USA learned the value of this new
approaches to solve complex problems in global health and approach and will support innovation in
development. These methodologies can have a transformative future programming.
impact, not only on health, gender, and equality outcomes, but also
on the way that projects are thought about, designed, and delivered. Our clients and partners gain new insights In Kenya, our participatory design research
There are also a plethora of intangible benefits from creative
problem-solving processes, including improved collaboration
2 and perspectives about issues affecting
people’s wellbeing and others’ perceptions,
helped partners better understand the
complex social and interpersonal factors
between diverse partners, stakeholders gaining new insights on old motivations, incentives, and behaviours. that shape family planning behaviours.
challenges, and increased local ownership of solutions.
However, there is currently no consistent methodology that captures Together, Scope and the people we In Tanzania, we consulted with youth, health
both the tangible and intangible benefits of creative methods and work with find compelling, creative, and providers, and other stakeholders to co-
solutions. In order to better measure and understand the change 3 innovative solutions and campaigns to
prototype, test, and implement.
create and test innovations to address
critical gaps in HIV testing and treatment.
we seek to achieve in our work, we have developed an impact
framework as a way to capture the value of our creative processes
and solutions. Through a collaborative and inclusive self-assessment
of past work, we have identified key desired impacts that our future
The people we work with and those that When redesigning labour wards in India,
projects will work to achieve. To aid in assessing progress toward
these outcomes, we have defined a feasible and meaningful range 4 the solution is for find the solutions and
campaigns acceptable, appropriate, and
we consulted with health centre staff to
ensure new solutions could be effectively
of quantitative and qualitative metrics. The common metrics will feasible. integrated into their workflows.
allow us to aggregate results across projects to demonstrate the
range and magnitude of impact resulting from our innovation
and creative processes. The results will also help to drive internal Organisations invest their time and Our family planning campaign in Kenya
learnings, so that as an organisation we continue to develop and 5 resources to take solutions and policies
through to implementation and scale.
generated 645 million impressions on social
media and led to an increase in budgeting
build our capacity to create positive social change.
for family planning services in at least one
county.
In the coming years, we look forward to committing further resources
towards the development of new creative and innovative methods
to gather more quantitative and qualitative data to substantiate Targeted people use and benefit from the In Kenya, 76.3% of women who participated
our impact. These will range from adopting digitally enabled, rapid 6 solution and policies. in pregnancy clubs completed four or more
ANC visits compared to the baseline value
ethnographic methods for data capture, to exploring ways to of Western Kenya at 51.3%.
leverage artificial intelligence and data science in our analysis.
10 11
As a company dedicated to improving the lives of others, it
is incumbent upon us to not only work toward developing
innovative solutions, but to continually assess and learn from
the outcomes. Our first-ever compiled review of our creative
solutions serves as an important step on an ongoing journey
to continuously examine our work so that we can develop
and strive for even greater impact.
We developed our Impact Framework to serve as a
foundation to enable us to capture the value that we bring
to how programmes are designed and the outcomes they
produce. As an organisational standard, the framework
will be iterated and operationalised across all of our future
projects. The accumulation of this year-over-year data will
provide us with a rich tapestry of insights and nuanced
understandings to inform decision making around how we
work, design solutions, and implement programmes.
By contributing to the evidence around the impact that
creative solutions can bring to solving global challenges,
we can further establish the value of these approaches
and increase their effectiveness. This commitment to
reporting will also provide ongoing documentation of our
participatory research and design methods to share with
practitioners and communities around the world.
Ultimately, this review, and those to come, will continue
to ensure that we remain driven by rigor, connected to
communities we serve, and accountable to our partners.
Looking
forward.
12 13
A Closer Look: Project Work &
Some of Our Creative Results.
Solutions and Their 1. #formnigani
Social Impact. 2. Lab.our Ward
3. Group ANC
The following project stories touch on a wide range of 4. The Next T
challenges. While they take place across diverse communities
and locations, they all reflect Scope’s commitment to 5. Adolescent Health Project
partnering with communities and innovating across systems
to develop new solutions that ultimately improve lives and 6. Core
create impact.
7. Images as Data
14 15
#formnigani focuses on youth
social mobilisation, co-creating
with the arts community, and
collaborating with advocacy
partners.
RESULTS:
A national-level
brand shifting
the narrative of
contraception.
#formnigani
#formnigani advocacy
partners:
• Recognised as a leading social
mobilisation movement in Eastern
Africa with brand awareness of 40%
A youth-led, creative movement
in Nairobi, a reach of 350 million, and
and nearly 650 million impressions.
• Deutsche Stiftung
to mobilise and support family Weltbevölkerung (DSW),
Kenya
• Led to highest attended county
budget public participation events
planning advocacy in Kenya. •
•
E4A Mama Ye!
Jhpiego-AFP, Kenya
in Bungoma county and contributed
to an increase in family planning
• Stage Media Arts, budgets at county level.
LOCATION: Nairobi and Bungoma, Kenya Bungoma • A unique, youth-centric national
• UNFPA Kenya
CLIENT: Bill & Melinda Gates Foundation conversation that touches topics
such as demographic dividends,
youth bulge, and the future of Kenya
Family planning & contraception Advocacy Creativity
with a total broadcast, print, and
CREATES DESIRED IMPACT OUTCOME:
online media reach of 110 million and
coverage with the biggest and most
1 People use and benefit from the solution and policies
influential Kenyan media.
16 17
#formnigani
Collaborative
What’s the Plan? Change Model.
#formnigani (‘What’s the plan’ in Sheng) is an inclusive platform for Kenyans led by
Kenyan youth, creatives, and opinion shapers. The purpose is to help young Kenyans Leveraging popular
creatively frame, discuss, and showcase positivity for family planning in order to achieve culture and
their constitutional right to quality family planning. creativity across four
interconnected phases to
Since the kick-off in 2018, the movement has leveraged creativity to mobilise youth support young Kenyans,
to advocate and shift the conversation to place contraception as a key element for creatives, and advocacy
Kenya’s future. aiming for youth-centred
contraception policies,
budget allocation, and
access as promised to
#formnigani Creative Activation. them by the Kenyan
Constitution.
Social Mobilisation Supporting Create the space by
breaking the taboo
Advocacy tools and training Advocacy to talk about sex and
Future Kenya Think Tanks showcase the positivity
Pregnant men flash mob and future for contraception.
Youth Ideathon
University programme Kenyans arriving in present stunt
Frame the future of
Media programme Strategy, planning, and messaging
Kenya and importance
Photo exhibitions workshops of contraception by
Football tournaments Media panels on TV and radio using future scenarios to
Boda boda races Creative Development of future scenarios start a national debate.
Concerts content for advocacy
Dance and spoken Change Making: Toolbox for grassroots advocacy
word challenges Youth-led Creative support and training on
Street drama how to use future scenarios for
contraception grassroots youth advocates
Street interviews & activation
Dissemination of newspaper from prioritisation
the future
Creative Strategy
& Content
Creative strategy and influence model
Link contraception
Future scenarios, roadmap and Kenya in with personal futures
2030 report by positioning
Futures 2.0 COVID-19 update, roadmap, and contraception as vital to
sexual & reproductive health framework achieve personal future
Creative influencer content including events, plans.
comedy videos, poetry, photography, graffiti,
drama, dance videos, and graphic animation Mobilise young
advocates with content,
Campaign theme song
creative support and
training.
18 192018: The inclusive starting shot of #formnigani featured 100 pregnant men storming the 2019: The Future Kenya theme was kicked off by the female pregnant president of Kenya in 2063
streets of Nairobi. They distributed flyers and performed a dance in front of the Parliament entering the present accompanied by 100 female time warriors. The future Kenyans distributed
to the rhythm of drums. The message was “If men got pregnant, family planning would be a newspaper developed with Kenyan university students featuring the news from a future utopic
accessible to all” which was accompanied by a comprehensive engagement by influencers Kenya. This began a year of activations and engagement designed to get young Kenyans thinking
and public relations activities. and talking about what they want from the future—and the implications for contraception.
20 21The #formnigani Future Think Tanks explored alternative future scenarios of
Kenya in 2030 using data and imagination. The outputs included the ‘Kenya
in 2030: Young Voices on Future Scenarios and Contraception’ report, key
considerations for contraception policy, and a roadmap to the preferred
scenario along with a comprehensive media push, influencer engagement, and
training young social mobilisers how to leverage the content for advocacy.
92%
of young Kenyans think
that family planning
is important or very
important to the future
of the country and
national development.
“Scope is redefining how we do social
justice work which is naturally seen as
belonging to a centre group of people. “Discussions on contraception have long been only by
Scope is redefining what innovation established groups such as civil society and government.
looks like in this sector. The presentation #formnigani’s greatest gain is that it extended the
and representation of young people discussion to the younger demographic in a way that can
as a collective is what is needed to influence stakeholders and policy makers.”
- Dr. Katindi Sivi Njonjo, futurist, Longview Consult
influence policy. Scope centres young
people’s experience in its advocacy and
campaigning.” “#formnigani has a creative approach that acts as a catalyst
- Scheaffer Okore, Afro Political Feminist, for other partners. The impact so far clearly shows that the
#formnigani opinion shaper continuation of #formnigani is essential to our sector.”
- George Ogolla, Options UK/Evidence for Action
22 23Total Results in Numbers.
7,000
13.6
Bungoma event
Attendance
349 MILLION
Print media
MILLION
Social Media
645+ 119.6
MILLION
MILLION Eyeballs Broadcast
9.8 153.6
MILLION MILLION
Online news Radio songs #formnigani COVID-19 Response.
media
110,000 plays
#formnigani pivoted quickly after Kenya reported its first case of COVID-19 on 13 March
Nairobi event 2020. In May 2020, we challenged creatives, poets, and musicians to start a debate
attendance on contraception in the time of COVID-19 by adding to a collective work of art. In just
three weeks, we received 60 creative submissions by young Kenyans, and reached over
3,9 million people on social media.
We also established #formnigani Futures 2.0, building on the Kenya in 2030 report
by adding COVID-19-related stressors to the healthcare system and sexual and
reproductive health (SRH). The outcomes include scenarios around the state of SRH
among marginalised communities, and a roadmap for rebuilding SRH in post-pandemic
Kenya.
24 25An interdisciplinary approach to
redesign the products, services,
and spaces of maternity wards by
placing mothers and newborns at
the centre of care.
As the number of births taking place in health facilities
Lab.our Ward around the world continues to rise, maternity wards must be
adequately prepared to deliver high-quality care to women
Rethinking the
and newborns. Focusing on a woman’s holistic experience
of childbirth, across health facilities’ infrastructure, products,
and services, has the potential to improve quality of care and
birth experience.
impact the health of mothers and newborns.
In 2016, Scope launched a pilot project with the state of
Odisha, India to rethink the design of maternity wards.
LOCATION: Basta, Odisha, India The team focused on understanding the quality of care
in maternity wards from the perspectives of services,
FUNDER: Bill & Melinda Gates Foundation products, and space and the woman’s journey through the
RESULTS: facility (arrival, admission, labour, delivery, and postnatal
CLIENT: Government of Odisha, India
care). Lab.our Ward’s solutions were also designed to align
Maternal & child health Quality of care • Improved quality of with evidence-based practices and the World Health
care in pilot facility Organisation’s Quality of Care Framework.
CREATES DESIRED IMPACT OUTCOME:
reflected in increased
patient satisfaction
1 People use and benefit from the solution and policies
with infrastructure Arrival
Organisations invest their time and resources to take solutions and policies through 2 Admission
2 to implementation and scale.
and the birth-giving
4 The people we work with and those that the solution is for find the solutions and experience.
campaigns acceptable, appropriate, and feasible. • As a result, there was
a 35% increase in the
number of patients who
stayed at the facility
for at least 24 hours
after birth.
Postnatal
3 Labour
4 Delivery
26 27Remaking the Care Journey
Around Mothers’ Needs. MATERNITY WARD
CHALLENGES
During the assessment phase, the team
identified gaps and opportunities in technical • Lack of information for
and service aspects of maternity care. The patients on what to expect
during labour and delivery
design team then worked together with women, • Patients and family members
their families, healthcare providers, community easily disoriented in facility
health workers, facility management, and • Poor waiting environment
and experience
ancillary staff to co-design solutions that • Poor hygienic and sanitation
support key moments in the woman’s journey conditions
through childbirth. The proposed innovations • Overcrowding in the waiting
areas, labour rooms, and
varied from rapidly deployable, such as service postnatal wards
design tools, to long-term changes in systems
and infrastructure. During this pilot, Lab.our
focused on testing and implementing selected
rapidly deployable innovations.
28 29Integrated Innovations
Enhance Quality of Care.
PRODUCT
BABY BED FAMILY PASS
Stage: Post-natal Stage: Arrival
A small newborn bed attached to the postnatal bed enables the Expecting mothers and their companions each receive a wearable
mother and her newborn to be in continuous contact and facilitates pass designed to communicate care preferences and key information,
breastfeeding. Having their babies close by also puts some new providing staff with a quick overview of patients and enabling them to
mothers more at ease and supports bonding routines critical during respond to unique needs or cultural preferences.
recovery.
SPACE
DELIVERY BED
Stage: Delivery
COLOUR CODING & WAYFINDING
A redesigned bed enables women to adjust to different positions to Stage: Arrival/Admission
reduce stress and pain during delivery and to rest in a comfortable
position while starting skin-to-skin bonding with their newborn. The To help women and families better navigate the facility, colour
delivery bed was co-designed with product designers, women, and coding was used to designate areas for each of the five steps of the
medical staff. labour journey. Unique colours were applied to floors, doorways,
signage, and furniture, creating easy-to-follow guides for patients
and families that reduced the need to ask for assistance.
SERVICE
COLOUR-CODED ARMBANDS ACTIVE LABOUR
Stage: Admission Stage: Labour
Staff assign colour-coded armbands to women during triage based Our observational research showed that during the early hours of labour,
on the urgency of their symptoms or risk of complications. This allowed women often lay on the delivery tables or sit passively. Evidence has
nurses to easily identify priority patients in crowded waiting rooms, shown that walking or standing upright can help ease pain during early
reducing inefficiencies and ensuring that at-risk women received labour. A courtyard was renovated to give mother’s space to walk and
appropriate and timely care. handrails were attached in corridors near the labour ward to facilitate
activity.
30 31Lower number
of patients
reporting Improvement in
challenges patient perception
with quality of health facility
of care after infrastructure
implementation
47%
of Lab.our Ward
interventions.
40% before
Lab.our Ward
Interventions
Increase in number of
patients staying at the
18% after facility for at least 24
Lab.our Ward
Interventions hours after birth
35%
Patient perception
of the birth-giving
“We have observed that there are experience improved by
railings now installed in the facility
along with steps in the bathrooms,
which increases our safety.”
- Patient, Basta Health Clinic
25%
32 33A three-country, co-designed
Group ANC group antenatal care model to
improve maternal health.
Peer support Research has shown that quality antenatal care (ANC)
improves maternal is a key factor in improving the health and wellbeing of
pregnant women and newborns. Women who have a
& newborn health.
positive experience during ANC visits from a technical and
interpersonal standpoint are also more likely to utilise health
UGANDA services for delivery and postnatal care. However, ANC
Feasibility Study
services are often not designed to meet women’s needs and
Mbale & Bududa Districts
negative experiences with communication and counselling
LOCATION: Uganda, Kenya & Guatemala (2016)
Concept design & can discourage women from continuing to attend ANC.
feasibility study
CLIENT: Management Sciences for Health The group ANC model is an alternative, innovative woman-
centred model that has shown promise in providing a better
Maternal & child health Quality of care ANC experience of ANC for expecting mothers and improving
their knowledge and utilisation of services. The group model
involves pregnant women attending sessions together and
CREATES DESIRED IMPACT OUTCOME:
actively engaging in their own care.
1 People use and benefit from the solution and policies
In 2016, Management Sciences for Health (MSH) and Scope
2 People we work with and those that the solution is for find the solutions and
campaigns acceptable, appropriate, and feasible
began a collaboration with local partners to test and adapt
a group ANC model in Uganda, Kenya, and Guatemala. In
KENYA each context, Scope used human-centred approaches to
Pilot Study develop a unique ANC service design that meets the needs of
Kakamega County both expecting mothers and healthcare providers.
(2017)
Implementation &
evaluation
RESULTS:
• Pregnancy clubs provided women
with greater social support and
improved their access to more
and improved counselling and
information.
GUATEMALA • In Kenya, the intervention improved
Pilot & Scale
Quetzaltenango (2019) retention in ANC and satisfaction
Adaptation & pilot with ANC services almost doubled
followed by scale-up among respondents.
34 35Uganda: Uncovering New
Perspectives on Women’s and
Health Workers’ Needs.
In Uganda, Scope conducted participatory design research
to gather insights from expecting mothers and healthcare
workers on the challenges they face with current ANC
provision. These resulted in key design drivers that helped
shape a new, more responsive group model as well as meet
health workers’ needs for portable, structured teaching
materials. District and health centre staff implemented the
group ANC model in six facilities with women, providers, and
health system managers all reporting positive experiences. A
qualitative evaluation found that pregnancy clubs provided
women with greater social support through bonding among
women and midwives, opportunities to discuss challenges
and solutions, and increased information sharing from health
providers.
UGANDA
RESULTS:
16 groups of 10+
women
“It is interesting to open the mat,
because we pull it one by one in a
circle. Even if when one comes they are
12
gloomy, by the time you finish opening
midwives the mat that person will be smiling.”
trained - Pregnant woman, Uganda
Mbale and
Bududa
36 37Women
attending four or
Kenya: Collaborating and Co-creating to more ANC visits.
Expand on Lessons Learned.
MSH and Scope engaged with the Kenya Progressive Nurses 76.3%
Association, government officials, and health providers and women
in Western Kenya to co-create the Lea Mimba pregnancy club model
(Lea Mimba is Swahili for “take care of your pregnancy”). Participants
51.3%*
co-designed new rituals, including a Lea Mimba song to open and
close sessions. Scope also designed new job aids to help providers
communicate key ANC messages and created materials for mothers to
track their pregnancy progress and group session attendance.
Over a 10-month pilot, pregnant women shared that Lea Mimba clubs
improved their ability to cope with pregnancy and strengthened their Prior to Women
group in group
relationships with other women and healthcare providers. Providers model model
reported gaining a deeper understanding of expectant mothers’ (Western (Kakamega
behaviours, beliefs, and traditions, enabling them to more effectively Kenya) County)
share key health messages.
* Kenya Demographic Health
Survey 2014.
KENYA
RESULTS:
Kakamega
County
1,600
women enrolled “In the normal ANC clinics, you would find
in 177 Lea Mimba some nurses are tired and they would not
clubs. attend to you well. But in Lea Mimba club
we were well attended to, the nurses did
not discriminate against anyone. Like you
times more
would go to other clinics and be told you
2x
likely that Women’s rating of
are dirty, but here you attended to the way
pregnant women the quality of ANC
you are.”
make birth services almost
- Pregnant woman, Kenya
preparations. doubled.
38 39Guatemala: Adapting
Innovations in a New Context.
MSH and Scope next looked to adapt the model for health
facilities serving Mayan communities in the Guatemalan Highlands,
which has one of the highest maternal mortality rates in the
Western Hemisphere. Historically, healthcare providers have had
strained relations with Mayan communities and the model sought
to build a trusting relationship by incorporating familiar storytelling
formats and local fabrics to increase relatability. The resultant
contextualised group ANC model is currently being piloted in 10
facilities and will be scaled up to 30 health facilities over the next
two years.
GUATEMALA
RESULTS:
ANC groups will be scaled
up to 30 health facilities in
the next 2 years. Quetzaltenango
Model currently being
evaluated through
randomised control trial.
40 41“Part of what we did through the HCD [human-centred
design process] was to understand the provider’s
perspective… so that they are not overburdened, or
distanced or alienated which makes the intervention
successful in terms of how it is embraced.”
- Shafia Rashid, Senior Technical Advisor, MSH
42 43Helping organisations optimise
their HIV services to better meet
adolescents’ needs.
70
Tanzania’s HIV epidemic disproportionately impacts young
people, especially adolescent girls and young women. In
2018, new HIV infections among women 15–24 years old were
more than double those among young men. Yet, testing rates
Interviews & among adolescents remain low, as less than a third of this
16
population know their HIV status.
The Next T
To help reverse these trends, Scope partnered with Tanzania’s
National Institute for Medical Research (NIMR), and Jhpiego
Workshops with to better understand the needs of at-risk young women
Mobilising the youth in Kyela
(Mbeya) & Temeke
and design solutions around their values, motivations, and
lifestyles. The team began with immersive participatory
research with adolescent girls and women, boys, health
Next Generation to
(Dar es Salaam).
providers, male partners, and influential members of their
ecosystems to gain a holistic understanding of the lives of at-
Change the Course 8
risk young women.
of HIV in Tanzania. Interviews with
health providers.
LOCATION: Tanzania RESULTS:
CLIENT:
PARTNERS:
Bill & Melinda Gates Foundation
Jhpiego, Tanzanian National
16
Interviews
• Strong acceptance among partners
and advisors that the Mindshape
Model represents the behaviour
Institute of Medical Research with
change journey for at-risk
influencers.
adolescents.
Sexual & reproductive health
Adolescent health HIV
• Targeting tool based on the
Mindshape Model validated with a
CREATES DESIRED IMPACT OUTCOME:
sample of 2000 adolescent girls in
1
Together, Scope and the people we work with find compelling, creative, and
innovative solutions and campaigns to prototype, test, and implement. Kyela and Shinyanga.
• Counselling training package based
2 The people we work with and those that the solution is for find the solutions and
campaigns acceptable, appropriate, and feasible.
on Mindshape Model received
positive feedback from trainers and
counsellors from Tanzania’s National
Aids Control Programme.
44 45Understanding Complex Systems to
Catalyse Lasting Change.
We found that HIV care-seeking among adolescents is influenced by a host of
factors, across health, social, and economic dimensions of their lives. Research
insights showed that key factors driving adolescent behaviours include an individual’s
knowledge, attitudes, emotions, and risk perception, as well as power dynamics
between partners, accessibility of services, economic inequalities, and social stigma.
In order to take a holistic approach to influencing HIV-related behaviours, Scope
built on the design research to develop an HIV-specific behaviour change Mindshape
Model that takes these multi-level factors into account. The model is built around
different adolescent mindstates about HIV, which determines an indiviadual’s
likelihood of seeking testing or remaining in the continuum of care if HIV positive.
The team used the Mindshape Model to collaborate with a range of stakeholders
including implementing partners, counsellors, and young people to identify, design,
iterate, and test three solution concepts that address gaps along the continuum of
HIV testing, linkage, and care.
“Adolescents are embarrassed to be seen
and viewed as infected. They claim that
their time is wasted there because of the
queue. There are some who agree to go,
but don’t want to stay for such a long time.
There are also some who are shy and don’t
want to be seen there at all.”
- Healthcare Provider, Kyela
46 47The Mindshape Model.
Improved Targeting.
The Mindshape Model targeting tool allows
Our partners at Jhpiego identified the potential of using the Mindshape Model as
programmes to more effectively allocate a screening tool to target population segments based on their attitude toward
valuable resources for HIV testing, linkage, and knowledge about HIV testing and care. To validate the tool, the team
conducted a quantitative study with 2000 adolescent girls in two districts. With
and pre-exposure prophylactic (PREP). this validation, the tool allows programmes to move beyond a one size-fits-all
approach and instead to tailor interventions to where an individual fits within the
behaviour change journey. This allows programmes to more effectively allocate
valuable resources for pre-exposure prophylactic (PREP), HIV testing, linkage, and
adherence to treatment.
AGENCY &
SELF EFFICACY
AGENCY &
SELF EFFICACY
UNDERSTANDING ENGAGED
ACTIVATED
Regular with their
Has overcome medication and
most barriers motivated to keep
to test. May themselves and
UNDERSTANDING feel very alone, others healthy. If
AWARENESS AFRAID overwhelmed and they are open and
Understands the stressed. If barriers enabled about
benefits of testing of agency and their status, they
in clinical as well stigma persist, can advise and
AWARE interpersonal they may not link mobilise others to
to care or drop off
CONFUSED lives. Still limited test.
by agency and treatment.
Realises societal stigma.
importance of
testing in clinical
sense, but
UNAWARE
FATALIST
confused what
testing positive
Helping Counsellors Empathise.
Belief that may do to their
contracting HIV interpersonal and In order to help counsellors better understand their clients’ needs and tailor their
is inevitable and social lives. approach, Scope developed an HIV-specific patient-oriented training module.
knowing your The participatory and contextualised methodology uses facilitated discussions,
status will cause
you to die faster. profile-building exercises, and case study methods to help counsellors better relate
to their clients’ unique challenges. We piloted the training with 10 experienced HIV
testing counsellors and trainers from the National Aids Control Programme in the
Ministry of Health. Participants provided positive feedback on the training and
recommended that it be integrated into the formal HIV counselling curriculum as
the first module.
48 49Combating Stigma with
Creative Campaigns.
“I enjoyed (the counselling solution) Social stigma around HIV continues to deter young Tanzanians from getting tested
for HIV, as a positive test would significantly disrupt their relationships, social
because it was constructed in a way that standing, and economic prospects. For this reason, many people choose the relative
was simple to understand but also it was comfort of uncertainty about their HIV status rather than finding out for sure if they
have the disease.
specifically and focused in a way that
you can personally realise challenges To help address this formidable social barrier to testing, Scope collaborated with
Tanzanian creatives and influencers to develop the KAMA KAWA campaign (meaning
available especially for youth.” “brotherhood” in Swahili). The movement seeks to reframe stimatising persons with
- Nursing Officer, HIV as un-Tanzanian act of discrimination and to promote an alternative path of
offering emotional support and solidarity to those with the disease.
Manyara Regional Hospital
“Almost everything we were discussing,
we usually face them in our work
environment... We face these barriers
and then try to do counselling... So most
of all barriers we discussed there are
real and present.”
- Nurse,
Dodoma Regional Hospital
50 51Led multi-partner team in the
Adolescent Health Project U.S. through the innovation
New Insights and process, developing solutions
to help young people access
Creative Approaches sexual and reproductive health
to Drive Youth- services.
Centred Innovation.
For years, rates of sexually transmitted infections (STI)
among young people in Omaha, Nebraska and the
surrounding counties have been significantly higher
than state and national averages, while teen pregnancy
LOCATION: Omaha, Nebraska, USA Adolescent rates have been particularly high among marginalised
FUNDER: Sherwood Foundation Health Project populations. To help reverse these trends, the Women’s
Fund of Omaha (WFO) launched the Adolescent
CLIENT: Women’s Fund of Omaha HealthCare Programme in 2015. WFO asked Scope to
• Focuses on youth ages help leverage human-centered design (HCD) to better
15-24
PARTNERS: Triggerise (Tech), Smith & Lehmann • Sexuality education
understand barriers that were keeping young people
from utilising these services and work across their partner
(Evaluation) • Free contraception community to innovate new solutions to tackle the issue.
• STD testing & treatment
Adolescent health Sexual & reproductive health Digital health
CREATES DESIRED IMPACT OUTCOME:
Our clients and partners increase their knowledge and skills in creative innovative
WFO grantees
1 processes
providing
3
Together, Scope and the people we work with find compelling, creative, and
RESULTS:
innovative solutions and campaigns to prototype, test, and implement
services
4 Outcome: The people we work with and those that the solution is for find the solutions
and campaigns acceptable, appropriate, and feasible
• Health Clinics • The WFO plans to scale up the
• Community Organisations integrated set of solutions that
• Public Libraries address barriers to sexual and
reproductive health access for
adolescents and young adults across
all of their clinics in Nebraska during
2020-2021.
52 53Immersive Research Leads
to Nuanced Insights.
Scope led WFO and its partners through a mixed-methods research and HCD
process to help them better understand and respond to young people’s needs.
Our multi-disiplinary team of designers, creatives, and public health experts
conducted discovery activities and formative research with 236 young people
across four cities and 10 organisations, including those from marginalised
groups, such as undocumented and LGBTQ youth.
This was complemented by a comprehensive mapping of the political and
policy environment around sexual and reproductive health in Nebraska. The
team synthesised the meticulous quantitative and qualitative market research
into insights, personas, and user journeys that provided a more nuanced
understanding of the complex challenges youth faced in accessing WFO-
funded services.
Scope used these insights to facilitate workshops with diverse participants,
including youth, parents, technical experts, and grantee partners. The team led
them in co-creating more than 20 innovative solutions to address the identified
barriers. We then worked with the WFO to rate and select the most feasible
proposals and created prototypes for testing.
Findings: Why Youth Don’t
Utilise Services.
• Current sex education is not relevant to youths’
lives.
+20
• Sex, STIs, and contraception are taboo subjects at
home or with peers.
• Distrust of healthcare services, especially among
vulnerable youth.
• Messaging about free and low-cost services does
not reach youth. innovative
ideas
54 55Creative Solutions to Enhance
Youth-Friendly Services.
The result was an integrated set of co-designed solutions that
addressed challenges along the entire patient journey.
CHATBOT
To help youth locate and contact service centres, Scope worked with
the WFO to build out a proposed chatbot concept that could be
used over SMS, Facebook, or WFO’s website.
PRE-APPOINTMENT FORM
As many youth expressed privacy concerns about visiting clinics,
the team also created an online pre-appointment form for
youth to note special requests or topics of concern before their
appointment. By allowing providers to better understand patient
needs ahead of time, the pre-appointment form will save staff
time and improve patient-provider interactions.
VIRTUAL CLINIC TOUR
Helps relieve anxiety about visits by providing youth with an
overview of what their visit will look like.
YOUTH APPROVED SERVICES
YOUTH-CENTRIC COMMUNICATIONS
Since youth expressed a preference for peer-approved services,
co-creation participants proposed to build a feedback function into To respond to research insights that youth wanted communications to better reflect
the chatbot. Enough positive reviews will earn grantee organisations their perspectives and voices, WFO worked with Scope to develop a new youth-centric
a “Youth-Approved” emblem to share on their websites, Facebook communications and branding strategy. This included putting youth-created content at the
pages, and waiting rooms, with the goal of also incentivising staff to forefront of social media channels and building a youth-informed media team to develop and
take more emphatic approaches with young patients. crowd-source content across a variety of media outlets. The strategy also involved launching
an “Ask me anything” campaign on WFO’s Instagram account, with youth responding to
submitted questions about sex and relationships in relatable language.
56 57Shifting Mindsets and Scaling Up
New Approaches.
In addition to co-creating innovative solutions, WFO’s participation in the HCD
process led them to a more intricate understanding of how young people
experience their health services. The WFO plans to scale up these integrated
solutions during 2020-2021 across all their clinics, with the potential to reach tens
of thousands of adolescents and young adults, helping to turn the tide against
Nebraska’s rising rates of STIs and unplanned pregnancies.
“Scope was able to provide in-depth
“Going through the design process with
experience and associated tools, which
SCOPE helped us recognise the importance
resulted in solutions that pushed the
of involving young people at every level
Adolescent Health Project beyond its
and stage of our project for it to be more
current concepts.”
successful.”
- Mary Balluff, Consultant for WFO
- Michelle Zych, WFO
58 59Developed a life course approach
to explore new angles on sexual
and reproductive health challenges
that led to innovative new
solutions.
Programming for women’s and girls’ sexual and reproductive
health often focuses on specific biological moments in their
lives. However, this approach fails to consider the wider scope
of how women and girls experience sexual and reproductive
health in relation to other aspects of their lives, leading to
Core siloed programming that doesn’t fully address women through
their changing health needs.
Human-Centered The Core project sought to rethink these conventional
perspectives by applying a life course approach to explore
Design for Women’s
more in depth how key transition points influence reproductive
health outcomes. The team began by using participatory
design research tools to map critical life transitions with
Health & Well-being. women and girls in Kenya, Tanzania, and India. Stakeholders
in each country selected focus areas within these life course
maps based on national priorities, design research insights,
LOCATION: Kenya, Tanzania, India, Nigeria and dialogue with experts. Scope then led stakeholders
in each country through a human-centred design (HCD)
CLIENT: Bill & Melinda Gates Foundation process, co-creating solutions that holistically support the
needs of women and girls across their lifetimes.
PARTNERS: CSK Tanzania, Project Concern International/India
SRH Adolescent health Gender Digital tools
RESULTS:
CREATES DESIRED IMPACT OUTCOME:
Life course approach: Building Sustainable
Our clients and partners gain new insights and perspectives about issues affecting
1 people’s wellbeing and others’ perceptions, motivations, incentives, and behaviours.
Rather than looking at life Solutions.
3 Together, Scope and the people we work with find compelling, creative, and
innovative solutions and campaigns to prototype, test, and implement.
stages in isolation, the life
course approach involves • Solutions co-designed in Tanzania to help
4 The people we work with and those that the solution is for find the solutions and
campaigns acceptable, appropriate, and feasible. stakeholders in mapping key local government authorities (LGA) to
5 Organisations invest their time and resources to take solutions and policies through to transition points, including better support their adolescent populations
implementation and scale.
biological, psychological, are under review by LGA stakeholders for
or social changes to better integration into their programming.
understand how past • Project Concern International (PCI) India
experiences impact future will integrate the interventions developed in
health outcomes. Bihar, India into their Tara Club Programme
that will be evaluated through a randomised
control trial and potentially rolled out across
the state of Bihar.
60 61Tanzania: Taking a Systems
Approach. Co-designed Interventions
In Tanzania, design research revealed how multiple, interconnected factors shape in Tanzania.
life outcomes for adolescent girls, including individual, network, and structural
barriers. The team helped stakeholders identify how gaps in understanding
resulted from a lack of two-way channels for girls to share their needs with local
government and for officials to respond with tailored programming. To address this TARGETING TOOL
issue, Scope collaborated with adolescent girls, local influencers, and government
officials to co-design a toolbox that includes a feedback mechanism between girls A tool to help local governments
and government and a system for officials to refer girls to appropriate services. identify girls in need of support and
refer them to appropriate services.
SPEAKEASY SERVICE
Allows girls to voice their needs to
local officials through easily accessible
channels.
GAMIFIED COUNSELLING
An engaging tool for organisations
working with girls to provide advice on
topics identified through Speakeasy.
GUIDING STAR GROUP
Provides girls with role models and
mentors to support them in setting and
reaching goals.
GIRLS’ BUSINESS ACCELERATOR
Offers entrepreneurship training,
networking, peer support, and linkages
to financing.
62 63India: Building Skills for Self-Advocacy.
In India, based on insights from research and local partners, the pre-
marriage phase was identified as a critical stage to provide young
women with the skills to advocate and negotiate for their sexual
Co-designed Interventions
and reproductive health. Stakeholders identified adolescent girls’ in India.
groups as a key channel to help girls to develop these valuable self-
advocacy skills. In collaboration with Project Concern International/
India (PCI), Scope led the team in co-designing, prototyping, and THEATRE FOR CHANGE
iterating solutions that enable adolescent girls to experiment and
gain experience with self-advocacy. Through role-playing of life
scenarios, girls identify common
challenges in their social interactions
and collectively develop strategies
to better navigate these situations.
PATHFINDER
Gamified learning tool that enables
girls to express aspirations and
discuss life pathways and risks and
opportunities in a fun and engaging
manner.
EXPANDING HORIZONS
An in-person or digital forum that
allows girls to learn about diverse
role models and gain inspiration
and encouragement from their
experiences.
CHANGE COLLECTIVE
Workshops that enable girls to
identify and prioritise problems in
their communities, plan collective
actions, and iterate their solutions
while implementing them.
64 65Making a Case for Continuing
Curiosity and Creativity.
Kenya: Delving into Gender Beyond impacting the lives of women in the target
countries, learnings and insights from Core have the
Expectations. potential to shift how development professionals around
the world view the causes of, and solutions to sexual and
In Kenya, life course mapping highlighted the complex social and reproductive health challenges. To aid in disseminating
interpersonal factors that influence family planning decisions, and Core’s insights, Scope has designed an interactive tool
led to the development of a need-states framework that explores (available here) to enable partners to explore findings
how each individual’s need to affirm gender identity impacts family from across target countries, as well as to learn how
planning decisions. Scope worked with stakeholders to turn these they can incorporate HCD into their programme design.
needs-state insights into actionable design drivers. By leveraging In 2020, Core launched a new phase in Nigeria. The
these design drivers, health organisations can move beyond team is leveraging previous insights and tools to enable
traditional approaches, which tend to focus only on women’s local partners to apply HCD processes in adapting and
roles in family planning, and take into account the role of men in innovating primary healthcare services in the context of
influencing their partners’ overall sexual and reproductive health. COVID-19 and to transform systems for the future.
66 67Images as Data
Beyond Numbers:
Exploring images
as data.
Conducted photo-documentation of
patient journeys in four countries as
novel approach to understanding local
contexts and sparking discussions
around primary healthcare strategies.
The Bill and Melinda Gates Foundation and Global Good hosted a
meeting on the future of primary healthcare in October 2018.
To help guide the development of primary care strategy, the
Images as Data project collected visual representations of health
centres, patien pathways, and the environments around health
facilities in four countries for exhibition at the summit and to share
online.
Eleswero Model Health Centre, Kakamega County Kenya, 2018.
68 69Countries visited
4
India
Indonesia
Kenya
Uganda
Pathways to care
documented
Jai Prakash Narayan Hospital, India, 2018.
27
Selected & tagged
images on digital
platform
2,252
Siloam PHC Clinic in Nalca, Papua, Indonesia, 2018.
Wazirganj Primary Health Care Centre, Bihar, India, 2018.
70 71Health
facilities
visited
62
Family
homes
visited
27
Line Health Centre, Kakamega County Kenya, 2018.
72 73Scope’s Social
Mission Fund.
The Scope Social Mission Fund is our own funding pool
used to launch projects that are experimental, geared
toward learning, or enable us to advocate in new ways
within our focus areas of health, equality, and gender.
These projects often morph into wider programmes, and
are designed to inform and guide all of our work.
In the past two years, we have used our Social Mission
Fund to create a digital platform that connects expecting
mothers around the world to tackle loneliness during
pregnancy, as well as to launch a global online community
for women’s health advocates and activists to share skills
and expertise.
Our current Social Mission Fund projects include a creative
protest in response to the U.S. reinstating its Global Gag
Rule, developing a mobile solution to improve maternal
mental health in East Africa, and working with young
feminists in Kenya to advance human rights.
74 75The Gag Rule, reinstated and expanded by the Trump
administration in 2017, withholds U.S. funding from foreign
non-governmental organisations that provide legal abortion
services or referrals, or even advocates for abortion law reform.
The policy has led to deep cuts in funding for women’s sexual
and reproductive health services across the world, and has
contributed to adverse health outcomes for both mothers and
babies.
Scope launched #resistgag after seeing the devastating effects
of the Gag Rule first-hand in our work in India and Africa. To
draw attention to the little-known Gag Rule, 40 protesters
took to Senate Square while Trump and Putin were meeting
at the 2018 Russia-United States summit in Helsinki. Half of the
protesters wore Trump masks and artificial pregnancy bumps,
while the other half of protesters consisted of women wearing
gags. Scope established an international press office in New
York for the event and created assets such as press releases,
video/b-roll, images, and background content to ensure vast
media exposure and results.
RESULTS:
#resistgag • Total impressions of #ResistGag: 82+ million
Creative protest
combined across print, broadcast, and social
media.
• Coverage by major news outlets including ABC,
during Trump-Putin AP News, Al Jazeera English, NBC, BBC, as well
as all relevant Finnish press and in countries
Helsinki Summit in
such as Russia, China, Germany, UK, Japan,
Canada, and many others.
response to Global
• More than 40 volunteer activists and feminists
engaged in #ResistGag within a few days.
• Protest artifacts added to National Museum of
Gag Rule. Finland permanent collection.
• Energised and expanded Scope’s political
activism credentials.
2018 • Industry awareness of protest.
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