They were everywhere — blown-up condoms flying around as balloons in a small village in southern Kenya. A day earlier volunteers from an international NGO came to the village to promote family planning. They held a daylong workshop for women and thoroughly described the risks of lack of sexual protection. The next day, the volunteers left, and the village was covered with flying condom-balloons. It was 2007 and I was just about to learn how typical that story was. In the months that followed, I saw cookstoves being used as shelves and mosquito nets as football goals. So what went wrong?
Reframe: It’s not just a technical challenge
The stories above outline a pattern in international development: Challenges to service delivery are often considered technical problems, which require a clear, technical solution. In technical challenges, such as a road project, the problem is clearly defined and well understood, the solution is clear, and a body of knowledge has been amassed to successfully address the problem. No systemic or behavior change is required.
Successful service delivery solutions, however, also require changes in people’s values, attitudes, or habits. Family planning, health care, and energy projects are examples of what Ronald Heifetz from the Harvard University calls adaptive challenges. Even if the problem is defined, a solution is usually unclear. Many conflicted stakeholders are involved. Most importantly, solving such challenges requires shifting deeply held beliefs and worldviews.
Changing people’s behavior is what brings success or failure to the adaptive challenges of service delivery. Successful enterprises approach service delivery problems as adaptive challenges: They identify the behavioral change required, engage stakeholders, and constantly iterate on the solution. These enterprises use behavior change at two distinctive levels: to design effective products or services and to build community engagement, ownership and sustainability at the implementation stage.
Design: “Fix” the context, not the person
Successful enterprises design products and services that take into account existing human behaviors, values, and biases. Instead of trying to “fix” a person, they focus on changing the, so called, choice architecture – the context in which the decision is made. Operation Asha, for example, substantially eases the process of tuberculosis treatment for its low-income patients. This social enterprise opens treatment centers in places people already go, such as supermarkets. It also sends SMS-based reminders and follows up with home visits if a patient misses an appointment. The model increased the treatment success rate to 87% — more than double the government’s success rate.
SMV Wheels, on the other hand, addresses “present bias,” a tendency to give higher value to the pressing needs of today than what might arise in the future. The enterprise understood that present bias prevents rickshaw drivers from buying accident insurance — a must on the busy streets of Varanasi, India. Hence, the company made it a default option. Each of the 3,260 drivers who uses SMV Wheels’ services is automatically enrolled in an insurance plan.
Engage: Put the local stakeholders in the driver’s seat
Solving an adaptive challenge requires shifting ownership of the challenge to the primary stakeholders. Successful enterprises use a range of techniques, from human-centered design and co-creation to participatory design, to put their beneficiaries in the driver’s seat. They build long-lasting ownership and create new social norms.
Some of the most successful enterprises serving the poor go a step further and create new social norms by engaging a community at all levels, including children, parents, local religious or political leaders, and many others. They tackle a range of issues, such as bringing unschooled rural girls to school (Educate Girls), supporting female hygiene management (Aakar Innovations), or changing agricultural tactics among farmers in Africa (Digital Green). More on social norms in my previous World Bank blog.
