Broad Agency Announcements: A New Approach to Solving Global Health Challenges
The USAID Health Research Program is committed to finding innovative solutions to global health challenges, especially those facing women, newborns, and children.
In the fall of 2016, the Health Research Program launched an initiative to address possible serious bacterial infections (PSBI), or sepsis, in young infants. PSBI, or sepsis, is one of the leading causes of death among young infants in low and middle-income countries. The “gold standard” treatment, hospitalization, and 7-10 days of injectable antibiotics, is not always feasible in low resource settings. In 2015, the World Health Organization (WHO) released new guidelines for the treatment of PSBI based on the results of a series of coordinated trials in Africa and Asia. The new guidelines recommend a simplified treatment administered by trained health workers, when hospitalization is not possible. Further research is needed to understand how best to introduce and scale up the simplified treatment regimen in real-world settings in USAID priority countries. To accomplish this objective, the Health Research Program initiated a procurement using the USAID Global Health Broad Agency Announcement (BAA).
The BAA is a procurement approach used by USAID to generate, test, and scale-up innovative solutions to development challenges using collaborative, co-design.2 The BAA is different from other procurement processes because it emphasizes stakeholders working collaboratively to create solutions. Through this procurement, the Health Research Program aimed to test systems approaches to scale-up and sustain management of sepsis in young infants at the community level, when referrals are not possible. The BAA is a multi-step process that begins with the release of a call for expressions of interest, and culminates in an award based on a concept developed and refined using collaborative design and co-creation processes. The graphic below shows the BAA process utilized by the Health Research Program
The Health Research Program BAA Process
Working Together to Develop Strategies for PSBI Management
A hallmark of the BAA process is its co-design approach to identify the most innovative and promising solutions to development challenges. In January 2017, the Health Research Program invited selected implementing partners who submitted expressions of interest (EOI) to a co-creation workshop in Lusaka, Zambia. Researchers, implementers, policy makers, and technical experts from nine countries shared their experiences with PSBI, exchanged ideas, and collaborated to develop and refine country-specific concepts for implementation research on the introduction and scale-up of simplified regimens for PSBI management in young infants. Key to the co-creation process was the use of human centered design (HCD). HCD is a participatory approach to developing interventions that are grounded in a deep understanding of and empathy for the needs and experiences of beneficiaries (or end users). Placing people at the center of the design process provides first-hand insights on the social, cultural, and behavioral factors that contribute to the development challenge to be addressed. Further, designing from the end user’s perspective increases buy-in and helps to ensure that interventions and services will be used.3
Over the course of five days, participants were guided through an HCD inspired co-design process which includes five phases: discovery, ideation, prototyping, formulation, and reflection.4 Participants were introduced to the concept of designing based on empathy for and understanding of user experiences through the development of “personas” for key stakeholder groups (e.g, family, frontline health worker, district health manager). Based on these needs and experiences of these groups, country teams generate new ideas for PSBI management. Participants then completed a series of exercises to select the best ideas and developed prototypes. Prototypes were revised feedback from technical resource partners and other country teams. Teams then used workshop activity outputs to begin developing concept notes.
“The co-design approach also provided ample opportunity for South-to-South exchange and learning from other country experiences, which was helpful given the range of country experiences with introducing the simplified regimen for PSBI management.” Sara Sulzbach, Senior Advisor for USAID’s Health Research Program
PSBI BAA Co-Design Process
Learning about the people or for whom you are designing through observation.
Brainstorming as many ideas as possible based on what was learned about the needs and interests of end users.
Developing a simple prototype or “mock-up” of the idea to get feedback.
Using feedback to develop the best version of the design.
Thinking critically about the design process to identify strengths and areas for improvement.
Value Add of the BAA Process
The planning and implementation of the PSBI BAA co-creation workshop was a first-time experience for the Health Research Program and partners. Despite the novelty of the approach, feedback from a variety of the participants suggests that the workshop was valuable and helped to generate innovative concepts for PSBI management in select USAID priority countries. In addition to enhancing the original concepts, the workshop offered participants a chance to increase their technical knowledge of PSBI, newborn health, and health systems, engage in cross-country collaboration, and gain exposure to an innovative design approach. Participants shared ideas and experiences with teams from other countries and developed new partnerships. A few participants also noted plans to share their learnings on co-creation and HCD with country colleagues.
“There has been a lot of valued added. We have been able to reach people who have worked in this area before, we have learned from them, we have learned from the experts, we have altered some of our initial over-ambitious aspects of our proposal to more realistic, doable, implementable, ideas. And for us, we have met other …..participants [from our country] and ultimately ended up blending and synergizing. So, had this workshop not happened, we wouldn’t have met and wouldn’t have done this blending together…. the value added is certainly there.” – EOI participant
Given the success of the PSBI co-creation workshop and the benefits of the approach, the Health Research Program is committed to using the BAA process in the future to identify and support promising solutions to other global health challenges in maternal, newborn and child health, and potentially other priority areas.
1WHO (2017). Ending Preventable Newborn Deaths and Stillbirths. Retrieved from: http://www.who.int/maternal_child_adolescent/newborns/every-newborn/newborns-stillbirths-75percent-preventable.jpg?ua=1)
2USAID (2016). Broad Agency Announcements Retrieved from the USAID website.
3USAID (2017). Possible Serious Bacterial Infections Broad Agency Announcement Co-creation Workshop Process Report.
4IDEO (2015). IDEO’s Six Steps to Human Centered Design Process: How to Make Things People Want. Retrieved from: https://www.usertesting.com/blog/2015/07/09/how-ideo-uses-customer-insights-to-design-innovative-products-users-love/