Improving Prenatal Nutrition in Burkina

Improving Prenatal Nutrition in Burkina Faso

with Busara Center for Behavioral Economics, Nudge Lebanon and UNICEF Burkina Faso

Background

In Burkina Faso, child health and nutrition is still a major cause for concern despite efforts made in recent years by the government and its partners. The 2020 Smart National Nutritional Survey showed that 24.9% of children under five still suffer from chronic malnutrition, while the rate of low birth weight in hospitals was 9.8% (2020 Statistical Yearbook). In partnership with Nudge Lebanon and UNICEF, the Busara Center for Behavioral Economics conducted a study in Burkina Faso to gather insights about the significance of maternal health and nutrition amongst pregnant women and their communities. The aim of the study was twofold: a) to explore the structural, social, and behavioural factors limiting the access and uptake of continuous antenatal care facilities by pregnant women; and b) to understand the knowledge, attitude, and willingness of pregnant women towards the uptake of multiple micronutrient supplementation (MMS) during the course of their pregnancies.

For the research phase, my role as a Qualitative Research and Behavioral Design Consultant was to assist the team in the design of qualitative research tools (Key Informant Interviews and Focus Group Discussions), analysis, recruiting and training field officers in Burkina Faso, presenting key insights and behavioural map to UNICEF, as well as building relationships with local implementing partners and NGOs. All communication was done in French.

For the second phase, I led the process of designing impactful interventions following the double-diamond human-centered design approach; from ideation to iteration to prototype stage. In this case study, I will only cover the design phase.

Phase 1: Intervention Design

The research phase resulted in a detailed behavioural map of pregnant women attending ANC and consuming MMS. I used this map to plan a 5 day series of co-design workshops with our team internally, our partner Nudge Lebanon and UNICEF. I designed the Miro board (shown above) that the teams would use during the workshops and I followed the double-diamond framework as demonstrated below:

Step 1 - Ideation

I conducted an internal rapid brainstorming session with gender and nutrition experts at Busara to generate "How Might We" (HMW) questions to turn barriers into opportunities for each stage of the behavioural map. The team then generated as many ideas as possible that answer the ‘How Might We’ questions to move us closer to our ideal target behaviours. We generated brand new ideas and others inspired by positive results from previous projects.

Step 2 - Falsification

We clustered ideas generated into emerging themes. Then, the team started the process of prioritization and elimination by judging our ideas based on: 1) feasibility and 2) impact potential.

At level 1 of falsification, the exercise was done individually by placing a triangle for feasibility and a circle for impact. This exercise allowed the team to complete the first round of prioritization by eliminating all ideas that didn’t receive a vote for feasibility or impact.

At falsification level 2, I guided the team to continue the elimination and prioritization exercise by discussing each idea and judging it based on the following 8 falsification questions:

Is the idea practical to implement in Burkina Faso?
Is this a low-cost idea? (explore potential costs)
Is this idea relevant and respectful of the local culture?
Is this idea desirable to the target stakeholder?
Can this idea reach the last mile beneficiary?
Will this idea cause a lasting, sustainable impact on the beneficiaries' behaviour regarding maternal health?
Will this influence a ripple effect in positive behaviours?
Is there substantial evidence supporting this idea?

The results led to mapping of the ideas on the following prioritization graph based on the level of feasibility and impact potential.

At falsification level 3, I led a discussion with UNICEF to discuss the impact and feasibility of the ideas on the right quadrant of the graph (high impact, high feasibility). UNICEF helped us to narrow down the ideas even further before moving on to the next stage of the design process.

Step 3 - Iteration & Ideation

After the feasibility discussion with UNICEF, we narrowed down to 4 main intervention areas that we could continue to flesh out. The interventions areas were:

Visual Communication & Messaging
Community Mobilization & Capacity Building
Additional Documents on Bluebook / MMS Sleeve
Buddy / Intercommunity Pairings

In order to facilitate further ideation and iteration on these intervention areas, I developed 'How Could We' (HCW) questions for each intervention. For example, for Visual Communication & Messaging, some HCW questions were:

How could we mobilise leaders to advocate for ANC attendance?
How could we develop a catchy phrase in Mooré as a slogan in a fun and contextually relevant way?
How could we address all key actors within the mobilization (mothers-in-law, husbands, other wives)?

I lead the team through another workshop to generate as many ideas as possible to answer the HCW questions.

Step 4: Decide

After the second round of ideation and iteration, we found that we had generated a lot more specific ideas for each intervention area. To facilitate a decision on the final ideas that would move on to prototyping, I led the team through a final voting session.

To make sure our final ideas were well-rounded, I led the team to answer the following questions:

What is the idea?
Who does the idea target?
What barrier is it solving?
What are the different components?
What are the distribution channels?
How do we know the idea is sustainable?

Reflection

This was a very interesting project to work on. I learned a lot from interacting with different stakeholders, the pregnant women and communities in Burkina Faso, all while using two different languages (English and French). Our partner, Nudge Lebanon prototyped the final interventions and they are currently being tested in randomized controlled trials (RCTs) in two regions in Burkina Faso. It has been an honour to lead the design process that would change the lives of many women and children in Africa.

Upon reflection, I realise that I learned a lot more about the design process. Here are some of my learnings:

Ideas do not equal interventions

As behavioural designers, we tend to focus a lot on encouraging creativity and pushing participants to generate more and more ideas. While there is a time for quantity and out-of-the-box thinking, we need to keep in mind that there's also a place for convergence, where we should think more specifically about impact, feasibility, sustainability, channels, messengers etc. This is where ideas turn into interventions.

We must move at the participants' pace

Sometimes it's easy to forget that many participants in a design sprint or workshop are not familiar with the design process. They may get frustrated at different points or get too attached to their ideas. It's important to not only have empathy for the user but also for the participant, so that we can facilitate the design process effectively.