The Facility and the Joint Learning Network for Universal Health Coverage organized a webinar on "Design Thinking as a strategy for innovation in Public Sector Health Schemes". In this webinar, we showcased the successful application of Design Thinking to redesigning the renewal process for the National Health Insurance Scheme (NHIS) of Ghana. Presenters: Dr. Lydia Dsane-Selby (NHIA Ghana), Shilpi Nanda (ILO Fellow with NHIA Ghana), David Hutchful (Design Thinking expert and co-founder of Bloom Impact) and Ashlee Tuttleman (Design Thinking expert and consultant). Moderator: Lisa Morgan (the ILO's Impact Insurance Facility).

1. Design Thinking as a strategy for
innovation in Public Sector Health
Schemes
Project Focus: National Health Insurance Scheme, Ghana
The ILO’s Impact Insurance Facility
Webinar – 10th January 2018

2. 2
“Design is not just what it looks
like and feels like.
Design is how it works.”
Steve Jobs

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4. Introduction to the ILO’s Impact
Insurance Facility
The ILO’s Impact Insurance Facility’s mission: to enable the private sector,
governments, and their partners to realise the potential of risk pooling
mechanisms (such as insurance or other coverage plans).
• Achieved through a strategy of stimulating innovation and unlocking capacity
• Our work is guided by three principles:
• 1) solutions are people-centred;
• 2) they are driven by both evidence and experience-based learning; and
• 3) collaboration among various stakeholders is necessary to deliver results.
Our project, focused on improving the renewal process of the National
Health Insurance Scheme (NHIS) of Ghana, is made possible with the
generous support of Agence Française de Développement (AFD).
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5. Introduction to the Joint Learning
Network for Universal Health
Coverage (JLN)
The Joint Learning Network for Universal Health Coverage (JLN) is an
innovative, country-driven network of practitioners and policymakers from
around the globe actively engaged in exchanging tacit knowledge on
challenges faced and co-developing practical solutions to extend health
coverage.
• Resulting tools equip countries with the how-to’s of designing and implementing
efficient, equitable and sustainable healthcare systems, while contributing to
global knowledge resources for achieving Universal Health
Coverage (UHC).
Ghana is a founding member country of the JLN.
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6. Agenda
Introduction to NHIS Ghana
Why Design Thinking?
The Design Thinking Sprint at NHIA
1
2
3
Innovation Outcomes and Benefits of Design Thinking4

7. 7
Design Thinking as a strategy for innovation
in Public Sector Health Schemes
Presenter:
Dr Lydia Baaba Dsane-Selby
Deputy Chief Executive
(Operations), NHIA
Presenter:
Shilpi Nanda, Actuary
ILO Impact Insurance
Fellow, NHIA
Presenter:
Ashlee Tuttleman
Consultant and Design
Thinking Expert
Presenter:
David Hutchful
Co-founder of Bloom
Impact, Consultant and
Design Thinking Expert
Facilitator:
Lisa Morgan, Health
Actuary
Impact Insurance
Facility

8. Dr Lydia Baaba
Dsane-Selby
Deputy Chief Executive
(Operations), NHIA
1. Introduction to NHIS Ghana

9. NHIS in Ghana
• NHIS was established in 2004, and has a goal of
universal healthcare in Ghana
• NHIS offers comprehensive healthcare scheme to
all citizens of Ghana and is subsidised by tax
(National Health Insurance Levy)
• The scheme is distributed via a network of 165
branches
• The scheme penetration attained 40% in 2014
and has stayed relatively flat since
• In 2017 NHIS, with support from ILO Impact
Insurance Facility, started a project to digitalise
the NHIS renewal process aimed at accelerating
population coverage
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40%
2014 - 2016
11%
2006
NHIS Statistics
165
District Offices
c.3,000
Branch Staff
11.2m
Active Members
NHIS Comprehensive Healthcare Benefits
NHIS Population Coverage
In-patient Out-Patient Medicines Diagnostics
c.4,000
Healthcare Providers
31%
2010

10. NHIS – Strategies and Project
Objectives
10
Expand Population Coverage and drive
towards Universal HealthCare
Reduce Operational Burden and Costs
Design an efficient digital renewal
process that delivers a desirable user
experience to NHIS members
Expand adoption of biometric identity
authentication to align interests between
healthcare providers and NHIS
Design digital solutions that relieve
operational burden at district offices
and can be scaled at low cost
Design inexpensive and compatible
identity and validity authentication
solutions at healthcare provider sites

11. Shilpi Nanda, Actuary
ILO Impact Insurance
Fellow, NHIA
2. Why Design Thinking?

12. Why Design
Thinking?
In case of NHIA, substantial internal
and external research into member
behaviour already available!
But research did not propose
concrete process innovations
based on insights
Design Thinking was chosen at NHIA as a substitute
for standard user-research and pilot launch for following reasons:
Standard User
Research
Pilot Design Thinking
Outcomes User Insights
Production Ready
Solution
User Insights and
Prototypes
Time 1 to 4 weeks Up to 6 months
1 week
to finish first
prototype test
Cost
Varies
depending on
scale and nature
of research
Substantial as
actual systems built
before launch
Minimal
Research and
Prototyping done
with in-house tools

13. Ashlee Tuttleman
Consultant and Design
Thinking Expert
David Hutchful
Co-founder of Bloom
Impact, Consultant and
Design Thinking Expert
3. The Design
Thinking Sprint
at NHIA

14. What is
Design Thinking?
14

15. Applying Design
Thinking at NHIA
15
Design Thinking in practice can play
out as a 6-9 month long process or
it can be shortened to deliver quick
results.
We tailored the Google Ventures
Sprint Methodology for NHIA.
www.gv.com/sprint

16. The NHIA
Process
Overview
16
Day 1: Expert Confessions
Day 2: User engagement
Day 3: Reframing problem & Ideation
Day 4: Building prototypes
Day 5: Prototype testing
Day 6: Iteration based on feedback

17. Day 1: Expert Confessions
17
Methods
5-Whys
Mapping the User Journey
Re-Defining User ‘Categories’
Tackling Expert Mindsets
Outcome
Uncover bias based on
knowledge, not understanding

18. Day 2: User engagement in the Field
18
Outcome
Beginning to move from
knowledge to understanding,
from categories to people
Methods
Gathering insights at urban and peri-urban
locations.
Diverse mix of users; Unscripted Interactions.
Focus on broader relationship with healthcare and
insurance.

19. Day 3: Reframing problem & Ideation
19
Methods
User Personas
Affinity Maps
Re-framing the Problem
Inspiration; 8-Fold technique; Ad Gallery
First Design Proposal
Outcome
• Two problems instead of 1
• Validation of existing research
• Thinking outside the box

20. Day 4: Build Prototypes
20
Methods
Build Prototypes for Free!
Aim to replicate user experience
Scripts for IVR calls
Use Marvel, Lookback and Windows Paint (!)
Phones to record communication prototypes
Outcome
• Two sample USSD apps
• Radio show script

21. Day 5: Prototype testing
21
Methods
Test prototypes with users at new locations for
diversity in insights
Unaided interactions with prototypes; Watch for
verbal and non-verbal feedback
Record interactions on Lookback (if applicable)
Outcome
Quick, low-cost feedback from
diverse users and user suggestions
for improvements

22. Day 6: Iteration based on user feedback
22
Methods
Download and interpret testing insights to
redesign solution
Develop revised prototypes for testing
Risk analysis
Action Plan for future iterations
Outcome
Deepened empathy,
organizational awareness and
design changes

23. Shilpi Nanda , Actuary
ILO Impact Insurance
Fellow, NHIA
4. Innovation Outcomes and Benefits
of Design Thinking

24. Importance of Design Iterations
• Design of Desirable User
Experience/Product is only the
start of the design process
• Real value of design thinking is
persisting with iterations and
evaluating technical and economic
feasibility of the design
• Stress Testing is recommended!
24
Feasibility
What is
technically and
organisationally
feasible?
Viability
What is
financially
viable?
Desirability
What is a
desirable user-
experience?
START
INNOVATION

25. Outcomes
25
Communication PrototypeAuthentication PrototypeRenewal Prototype
• USSD based renewal process
which requires little more than
a feature phone, payments via
mobile money
• Education and Awareness
component
• Airtime incentives for group
renewals
• USSD based authentication of
policy validity
• Offline biometric
authentication using NHIA
biometric card or upcoming
Ghana Universal ID (match on
card)
• Authentication device at a price
point that enables national
scale-up across the wide
network of hospitals
• Radio call-in and spot adverts
• Addresses real doubts in
people’s minds e.g. ‘what is the
point of insurance’ or
‘traditional medicine vs modern
medicine’ or ‘generic medicines
vs branded medicines’
• Tackles mis-information
propagated by other parties

26. Benefits from Design Thinking as
Approach to Innovation
26
Senior Management Buy-In
Prototypes quick and easy to
demonstrate
Prototypes more impactful than
presentations and process maps
Solve more problems than
one
Design Thinking framework allows
for reframing of problem statement
based on user-insights
Outcomes from design thinking at
NHIA were process and
communication prototypes, with
insights regarding role of staff
Change Management
Design Thinking immerses staff
deeply into user needs
Promotes user empathy within the
team

27. Benefits from Design Thinking as
Approach to Innovation
27
Save Money and Time
The entire sprint exercise was
covered in 6 days. Subsequent
iterations took a day each
Communication prototype has been
recorded and tested by staff in 3
languages
Reduce Rejection Risk
Prototype testing relatively risk-free
compared to full-scale launch or pilot
Key when reputational risk is high
Can be used when time for
regulatory approval is long
Inputs from Diverse Groups
Design Thinking works best with
diverse skills
Exercise allowed us to invite
feedback from other government
agencies, peers and wide cross
section of staff

28. Factors to ensure long term success
• Continuous Iteration
• Identify clear ownership within organisation
• Not a silver bullet, part of broader organisational context and should be
part of systems approach
• Innovation is difficult part-time, but also important to not ring-fence all
innovation to one dedicated team >> make it part of organisational DNA
28

29. 29
Design Thinking as a strategy for innovation
in Public Sector Health Schemes
Q&A Session
Presenter:
Dr Lydia Baaba Dsane-Selby
Deputy Chief Executive
(Operations), NHIA
Presenter:
Shilpi Nanda, Actuary
ILO Impact Insurance
Fellow, NHIA
Facilitator:
Lisa Morgan, Health
Actuary
Impact Insurance
Facility
Presenter:
Ashlee Tuttleman
Consultant and Design
Thinking Expert
Presenter:
David Hutchful
Co-founder of Bloom
Impact, Consultant and
Design Thinking Expert

30. 30

31. Thank you!
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Panelist Organisation Contact
Lisa Morgan The ILO’s Impact Insurance Facility morgan@ilo.org
Shilpi Nanda The ILO’s Impact Insurance Facility shilpi.nanda@gmail.com
Ashlee Tuttleman Consultant ashleerose.tutt@gmail.com
David Hutchful Consultant david@hutchlabs.com
For more information, please visit:
The ILO’s Impact Insurance Facility
www.impactinsurance.org
The Joint Learning Network
www.jointlearningnetwork.org
Get in touch with the panelists: