IGDD n.211_frog_Backpack PLUS @designlibrary

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BACKPACK PLUS

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MASILULEKE
Mobile healthcare solution
targeting HIV and TB in South
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“THE WORLD’S LARGEST
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Self Test Kit

Collaborating with local communities

BACKPACK PLUS

EMPOWERING COMMUNITY HEALTH WORKERS

Backpack Plus | Introduction

The vast majority of the seven million children
who die every year never see a doctor.

DESIGN LIBRARY UNICEF BACKPACK PLUS PROJECT

23/01/2014

2


Community Health Workers are the “last mile”
in healthcare and one of the the biggest untapped
resources in global health.


23/01/2014

3


To increase their impact
on child mortality, improve
effectiveness and boost
efficiency, Community Health
Workers need holistic
solutions that address their
daily and long-term needs.
Backpack PLUS offers
an approach towards
a comprehensive and systemic
solution to achieve these
ambitious goals.


23/01/2014

4

Backpack PLUS | Putting CHWs at the Center

HOW TO DESIGN A
COMPREHENSIVE AND
SYSTEMIC SOLUTION
TO EMPOWER COMMUNITY
HEALTH WORKERS AT A
GLOBAL SCALE?
1. Understanding Humans
2. Fostering Collaboration
3. System Thinking
4. Shaping Solutions


23/01/2014

5

1

UNDERSTANDING HUMAN
ASPIRATIONS NEEDS

DESIGN RESEARCH

Investigating CHW
Workﬂow and Needs
We relied on a Human-Centered Design
process to shape solutions for CHWs that
are based on a deep understanding of
their real-world needs.

Backpack Plus | Field Research

UGANDA
Before CHWs, having
medicines to treat malaria
available right in the village
was a daydream.

4 DISTRICTS, 37 INTERVIEWS

CHW SUPERVISOR


23/01/2014



23/01/2014

8


SENEGAL
9/21 June 2013

UGANDA
15/29 May 2013


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9


The main challenge is
sensitizing people to look for
health services to timely treat
their illnesses.
CHW (ASC)

SENEGAL
3 DISTRICTS, 26 INTERVIEWS


23/01/2014
10
7



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11


BACKPACK ARCHITECTURE / 02
BACKPACK ARCHITECTURE / 02

CARRYING LOMG-TERM STORAGE
A bag/backpack to store /carry
CARRYING LOMG-TERM STORAGE
the register and most supplies
A bag/backpack to store /carry
the register and most supplies

RESUPPLY
A chest/container
RESUPPLY
to hold a minimum amount
A chest/container
of supplies (2-3 days)
to hold a minimum amount
of supplies (2-3 days)

CARD SORTING

STORAGE
STORAGE

VISIT AT HOME
VISIT AT HOME

HOUSE-TO-HOUSE VISITS
HOUSE-TO-HOUSE VISITS

RESUPPLY
RESUPPLY

BP+ frogTHINK / KAMPALA, JUNE 4th / 5th
BP+ frogTHINK / KAMPALA, JUNE 4th / 5th

CONCEPT EVALUATION REFINEMENT

REAL TIME PROTOTYPING


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12

FOSTERING COLLABORATION
2 THROUGH CO-CREATION
WORKSHOP SESSIONS

Engaging internal and
external stakeholders
A sequence of co-creation activities to
envision, reﬁne and develop solutions bringing
together experienced knowledge of internal
and external partners and insights coming
from the user research.

Backpack Plus | Workshop Sessions

PROTOTYPING SESSION

The second part of the day was aimed at defining an ideal backpack
archetype by quickly prototyping a backpack.

NEW YORK
ALIGNMENT WORKSHOP

The first part of the day was used to align on the program objectives and
start working on the CHW framework and journey.


23/01/2014
FRAMEWORK OBJECTIVES DISCUSSIONS14


OUTCOMES
# preliminary framework
alignment on a preliminary version of the Community
Health Worker system model.
# preliminary inventory of hard soft components
ﬁrst prioritization of hard and soft elements to be
included in the physical toolkit and in the service vision.
# alternative backpack archetypes
four initial ideas of backpack archetypes that could
facilitate and empower the work of the CHW in his day
by day.


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15


VISUAL DESIGN - EMBLEM SESSION

OUTCOMES

INDUSTRIAL DESIGN - BACKPACK SESSION

# 30+ alternative design for a CHW logo
(to be tested and reﬁned during user research)
# 10+ product architecture for the backpack
and storage box systems

MILAN

23/01/2014
SKETCHING SESSIONS

16

DAYBackpack Plus | Workshop Sessions
1 - FIELD RESEARCH

Day 1: the participants spent a day in the field to observe CHWs, immersing
themselves in the real world problems they encounter day to day.

KAMPALA
IDEATION WORKSHOP

Day 2: the participants discussed the pain points and opportunities emerged
during the site visit to start brainstorming solutions.


DAY 2 - IDEATION SESSIONS

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17


OUTCOMES
# hard soft components
inventories of all the physical objects to be included in
the toolkit + inventory of all the service components
needed to support the CHW journey
# physical objects
two concepts for systemic solutions composed by a
backpack and a storage box (to be evaluated and
developed in Senegal)
# signature experiences
initial ideas of the signature moments of the
experience to be considered as foundation for the
detail design of the solution


23/01/2014

18

SYSTEM THINKING
3 STRATEGY
FRAMEWORK

Mapping and Modeling
CHW Programs
The Backpack PLUS framework is a CHWcentric model that identiﬁes all the
essential physical, digital and service-level
components required to empower
and activate CHWs along their journey.

Framework | The Backpack PLUS Model

TOOLS

SUPPORT

TRU
CAREST

COMMUNITY

HEALTH SYSTEM

CHW

CARE
REPORT

SERVICES

CHWs are crucial links connecting the
communities they serve and the health system.

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Framework | The Backpack PLUS Model
COMMODITIES

DIAGNOSTICS

TOOLS

ENABLERS

INSTRUCT

RESPECT
SUPPORT

SUPPLIES

TRUST
COACH

COMMUNITY

SUPERVISOR

INDIVIDUAL

CHW

ASSESS
TREAT

HEALTH CENTER

DISTRICT

SUPPLIER

REPORT

REPORT

EDUCATE
REPORT

RECRUITING

TRAINING

SERVICE DELIVERY
ASSESS


TREAT

EDUCATE

REVIEWING

RESUPPLY

REWARDING

UPGRADING

REPORT

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8 | MAMA KIT

Framework | Inventory of Hard Components

MAMA KIT

SOAP

HEALTH PROMOTION
MESSAGES

BANDAGES

SCISSORS

HOUSEHOLD
REGISTER

FEEEDBACK
SCORECARD

UNIFORM

TRANSPORTATION
(bike, motorbike,...)

ALCOHOL PADS

ALCOHOL

HOUSE
SIGNAGE

ADVANCED ED.
MATERIALS

TRASH BIN

NOTEBOOK

THERMOMETER

3 | MALNUTRITION

4 | HIV

5,6,7 | ADVANCED SETS

SYRINGE

HIV TEST

DEWORMING
(Albendazole)

RUTF

SCALE

STOCK REGISTER

2 | FAMILY PLANNING

INJECTABLE

PILLS

CONDOMS

PREGNANCY TEST

VITAMIN A
mother

ED. MATERIALS

VITAMIN A
children

MISOPROSTOL

VISIT REGISTER

JOB AIDS

ADVANCED MODULES

1 | PREGNANCY NEWBORN CARE

REFERRAL FORMS

IPT

GLOVES

PARACETAMOL

STOCK REGISTER

SOLAR CHARGER

MOBILE PHONE

TOOLS

BASIC SET
BASIC SET

ORS ZINC

CHLORHEXIDINE

RESPIRATORY
TIMER

ACT

AMOXICILLIN

RDT

COMMODITIES

REFERRAL FORMS

MUAC

DIAGNOSTICS


VISIT REGISTER

PENCILS, PENS

TORCH, LIGHT

JOB AIDS

ED. MATERIALS

RAIN BOOTS

RAIN COAT

TOOLS

ENABLERS

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Framework | Inventory of Soft Components

RECRUITING

TRAINING

SERVICE DELIVERY
TREAT

EDUCATE

REVIEWING

RESUPPLY

REWARDING

UPGRADING

REPORT

Establish clear roles of a
relationship to the CHW
(e.g. how often they see

SUPERVISOR

COMMUNITY
CLINIC
DISTRICT

ACTORS INVOLVED

Set clear
Optimize
roles and
access and
responsabil- system
efficiency

SUPPLIER

INDIVIDUAL

ASSESS

SUPERVISOR

Ensure continuity by
selecting people who are
long-term members of
the community
(resident, married).

DESIGN PRINCIPLES

Support a
continuous
learning
process
Create modular training
plans to enable
incremental learning
and differentiate
competences.

Leverage existing
influential roles that are
already present in the
community.

DESIGN PRINCIPLES

Define
reference
recruiting
criteria

Teach fundamentals of
time/budget
management.

Manage age limits (min
but also max age).
Embrace flexibility to
adapt the criteria to
specific regions (i.e.
nomadic areas,
low-literacy,...).

Provide analog and
mHealth services that
can be access by CHWs
also at the end of the
training period.
Create a moment at the
end of each training
session to certify and/or
celebrate the new
competences aquired by
CHWs.

Improve
guidance
through
integrated
tools
Provide standard
protocols with reference
materials that guide the
assessment through a
series of steps.
Create strong
consistency and
cross-references across
job aids, diagnostics,
commodities and
informational materials.
Include visuals that help
understanding and
sharing the process also
with the patients.

Provide
clear
instructions
follow-up
Provide standard
instructions for dosages
with supporting
reference materials.
Create strong
consistency and
cross-references across
job aids, diagnostics,
commodities and
information.
Support referral at a
system level (i.e.
referred patients are
given priority at the
clinic).

Address restocking by
using data to make
effective forecasts.
Maximize resupply

Provide
tools to
facilitate
education

Improve
Set clear
Optimize
Celebrate
Establish
efficiency by
data Ensure a continuous access and reward
roles and
communicating a clear
collection
the work
career
supportresponsabil- system availability of stocks.
and supervision
and mining ities
of CHWs
path
through meetings at efficiency

Facilitate education
processes through rich
media (visuals, audio,
video).

Celebrate
reward
the work
of CHWs

Establish
a clear
career
path

Enhance the community
perception of the role of
CHWs through branded
materials.

Establish a clear career
path based on personal
inclinations and impact.
Provide incremental
training to enrich and
evolve competences.

Facilitate consistent
data tracking through
clear recording
standards and
protocols.

Optimize content and
materials to address
different situations (1:1,
households, group
sessions).
Stimulate an active
engagement of the
community.

defined Establish clear roles (e.g.Address restockingBring thethe community Establish a clear career
intervals of a
by
Enhance supplies as
using data to make
perception of the role of
path based on personal
supervisor and
effective forecasts.close as possible to
CHWs through branded
inclinations and impact.
relationship to the CHW
materials.
(e.g. how often they see
Maximize resupplyCHWs by leveraging
Provide incremental
each other).
efficiency by
Give visibility to the
training to enrich and

Enable data sharing
across different
stakeholders by
armonizing tools and
optimizing transmission
of information.
Enable data mining by
facilitating aggregation
of information across
tools.
Give value to the
collected information by
giving it back to CHWs
and their communities.

Strenghten follow-up
visits through protocols
and reminders.

Give visibility to the
CHW-enabled outcomes
inside the community.

Set up routine refresher
training sessions to
ensure a continuous
learning experience.

Ensure a continuous
support and supervision
through meetings at
defined intervals (e.g.
weekly meeting).
Include role-modeling
through joint visits with
supervisors.
Include spot checks of
the supervisor with the
community.
Enable the collection of
a clear basic set of data
that supports the
supervisor with
performance
management.

communicating
availability of stocks.

CHW-enabled outcomes
inside the community.

evolve competences.

GRATIFICATION
BY BRANDED KIT

ADDITIONAL
TRAINING MODULES

Bring the supplies as
close as possible to
CHWs by leveraging
existing resources
(shops, private supply
chains, etc.).
Facilitate transportation
(either by
reimbursement or by
providing logistical
support).

Enable the supervisor to
set real incentives in
case of good
performance.

BASIC COMPONENTS
ADVANCED COMPONENTS

BASIC MODULE
ON EDUCATION

STANDARD
PROTOCOLS

STANDARD
PROTOCOLS

REFERENCE
MATERIALS

VISIT
TRACKING

ONE-TO-ONE
REVIEWS

CHW
LIST

BASIC MODULE
ON ICCM

REFERENCE
MATERIALS

REFERENCE
MATERIALS

BEHAVIOR CHANGE
DEMONSTRATIONS

STOCK
TRACKING

GROUP
REVIEWS

INCENTIVES
THROUGH GADGETS

SPECIAL MODULES
(e.g. RDT)

REFERRAL
PROTOCOLS

MOBILIZATION FOR
SPECIAL EVENTS

SPORT PERFORMANCE
CHECK

REIMBURSEMENTS
(e.g. TRANPORT)

CHW
CERTIFICATION

SERVICE ELEMENTS

SELECTION
CRITERIA

REFERRAL
TRACKING

PUBLIC
ANNOUNCEMENTS

REGULAR
REFRESHER

‘LEAVE-BEHIND’
INSTRUCTIONS

EDUCATIONAL
GAMES

HOUSEHOLD
TRACKING

PERFORMANCE
BASED REPORT

ON DEMAND
RESUPPLY (supervisor)

FACILITATION BY
BASIC ENABLERS

CARRIER
PATH

SELECTION
TEST

FINAL
TEST

REMINDER
SYSTEM

COMMUNITY
REWARDING PLANS

COUNSELING
TRACKING

SUPERVISION
GRID

SPECIAL SUPPLY
BY INITIATIVES

CELEBRATION
OF SUCCESS

BADGING
SYSTEM

HOUSEHOLD GOALS
RECOGNITION

PATIENT
TRACKING

ABILITY
CHECK

STOCK-MGM
FACILITATORS

PERFORMANCE
BOARD

FAMILY/COMMUNITY
ENGAGEMENT

HEALTH
CAMPAIGNS

RESUPPLY BY
CONSUMPTION

23/01/2014

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Framework | Sample applications: country mapping

COUNTRY ASSESSMENT


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Framework | Sample applications: mapping private
providers or other actors (Supervisors)

MAPPING OTHER PROVIDERS

COMMODITIES

DIAGNOSTICS

TOOLS

ENABLERS

MAPPING PRIVATE OPPORTUNITIES

HEALTH RELATED GOODS

SUPPORT

SUPPLIES

TRUST

COMMUNITY

COACH

INDIVIDUAL

SUPERVISOR

CHP

ASSESS
TREAT

HEALTH CENTER

SUPPLIER

LG BRANCH

REPORT

REPORT

SERVICES

RECRUITING

TRAINING

SERVICE DELIVERY
ASSESS

TREAT

REVIEWING

EDUCATE

RESUPPLY

REWARDING

UPGRADING

REPORT

MAPPING OTHER USERS

INFORM

SUPPORT
SUPPLIES

REPORT

COMMUNITY

INDIVIDUAL

SUPPORT

CHW

HEALTH CENTER

COACH

SUPERVISOR

DISTRICT

SUPPLIER

REPORT

REPORT

ENGAGE


23/01/2014

25

PRODUCT SERVICE
4 SERVICE DESIGN
TOOLKIT + EMBLEM

From Research Insights
to Holistic Solutions
Starting from core CHW needs highlighted during ﬁeld
research we identiﬁed opportunities to improve
the quality of the solutions they are provided.
Integrating physical tools and mobile-enabled services
into one cohesive experience will positively impact
community health outcomes.

Gaye

Tools | CHW Archetypes

Fatima

HIGHER-SKILLED CHW

LOWER-SKILLED CHW

The health of my community is the most
important thing for me

Maliki
CLINIC-BASED CHW

Without sensitization, people wouldn’t
come to the DESIGN LIBRARY UNICEF BACKPACK PLUS PROJECT
health post

People call me ‘village doctor’

Jassim
CHW SUPERVISOR

I try to visit my CHWs once a month
but often I don’t really have time
23/01/2014
27


Roles and responsibilities of CHWs vary
greatly across programs and geographies,
but common archetypes exist.

LOWER-SKILLED CHW

HIGHER-SKILLED CHW

CLINIC-BASED CHW

CHW SUPERVISOR

HEALTH EDUCATION
TREATMENT (iCCM)
SUPERVISION
Lower-skilled CHWs provide
Health Education to their
communities, and are highly
mobile, operating most of the
time on the go, and focusing
on social gatherings.

Higher-skilled CHWs are
trained to cover iCCM duties.
They tend to operate out of
their homes, hence needing to
also store large quantities of
commodities and tools.


Clinic-based CHWs operate
out of rural Health Posts,
where they support medical
professionals. They usually
have their set of supplies, but
can easily restock at the Clinic.

23/01/2014

Supervisors monitor and
mentor groups of CHWs. They
are or have been CHWs
themselves. They are usually
based out of a clinic, but have
to regularly visit their CHWs.

28


All Archetypes share a common set of needs.
The context they operate in has a strong inﬂuence
on the set of tools they tend to use.

LOWER-SKILLED CHW

HIGHER-SKILLED CHW

CLINIC-BASED CHW

CHW SUPERVISOR

HEALTH EDUCATION
TREATMENT (iCCM)
SUPERVISION

ON THE GO

HOME


CLINIC

23/01/2014

29

Tools | The Backpack PLUS System Overview

TOOLKIT


23/01/2014

30

Tools | Issues Highlighted During Field Research

01

“The job aid is
our Bible”
CHW (UGANDA)

Current tools and process meant
to support CHWs are fragmented,
often affecting effectiveness and
undermining motivation.


23/01/2014

31

Tools | Opportunities: The Backpack PLUS Experience

From a disconnected set of diagnostic tools and
medical commodities to a well-orchestrated experience
that improves CHW effectiveness.
An integrated approach to
information-gathering tools,
diagnostic devices, mobile-enabled
services and medical commodities
will guide service delivery during a
visit, streamlining workﬂows and
increasing patient and community
trust in the indications provided by
CHWs.

Mobile-enabled assessment tools

23/01/2014

Consistent packaging design

32

Referral tools are also integrated


02

“The bag I was given
is big and bulky,
I never need to carry
that much.”
CHW (UGANDA)

Storage and carrying solutions
for tools and commodities
aren’t ﬂexible enough and do
not support CHW workﬂows


23/01/2014

33


From generic storage and carrying
solutions to a system designed to easily
adapt to evolving CHW needs.
A long-term storage solution for
supplies and commodities at home
that’s fully integrated with a
carrying solution for visits on the
go will improve CHW efficiency.
Flexible compartments will support
varying loads, while dedicated
areas for “assessment” and
“treatment” will better support
CHW workﬂows.

A modular home storage system

23/01/2014

Integrated home and on the go solutions

34

Flexible loading capacity


03

“The data collected
here is always
incomplete.”
DISTRICT MANAGER (SENEGAL)

Data that is currently generated
by CHWs and other actors in the system
is not consistent and seldom turned
into useful information.


23/01/2014

35


From one-way data flows to closed
and effective feedback loops that provide realtime access to essential information.

DESIGN LIBRARY

Community performance boards

An integrated information
management approach that
flexibly accounts for analog and
mobile-enabled workflows will
provide timely feedback loops to all
relevant actors in the system.
Real-time stock tracking and
access to patient information will
improve CHW effectiveness while
addressing current stock
management issues.
UNICEF BACKPACK PLUS PROJECT

23/01/2014

Integrated analog and digital reporting tools

36


04

“New training means
that they are investing
in us!”
CHW (SENEGAL)

CHWs are asked to cover an everincreasing variety of health domains,
from iCCM to family planning and HIV
prevention, not always properly supported
by training and adequate tools.


23/01/2014

37


From irregular training sessions to a continuous
learning model that targets CHWs but also accounts
for the need to educate their communities.
A ﬂexible and scalable training
curriculum that combines longer
immersions with ad-hoc modules
will create opportunities for CHWs
to “learn on the go” and constantly
improve their skills over time.
Mobile-enabled media will allow
CHWs to repurpose their training
materials to educate their
communities in return.

Checklists and reminders

Real-time support services

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38

Mobile learning services


05

“These people put in
their own money to do
their job!”
CLINICAL OFFICER (UGANDA)

Current incentive programs
- monetary or otherwise - often fall short
of being perceived as making the
difference in the lives of CHWs.


23/01/2014

39


From fragmented incentive programs to a clear
hierarchy of roles, responsibilities, beneﬁts and
opportunities for growth over time.

DESIGN LIBRARY

Custom home signage

A reward and incentives
architecture that feels like a career
path will help in retaining CHWs,
while motivating them to improve
their performance.
Clearly deﬁned CHW “maturity
models” can help mitigate
differences across programs and
geographies, provide clear
expectations for CHW growth and
improve Supervisor effectiveness.
UNICEF BACKPACK PLUS PROJECT

SUPERVISOR

23/01/2014

Transportation aids

40

Supervisor pin


06

“Why should I walk to
the clinic if then they
don’t have medicines?”
CHW (SENEGAL)

Fragmented or inefficient supply chains
can result in perceived lack of CHW
support, and undermine the level of trust
they need to be effective.


23/01/2014

41


From closed ecosystems to integrated
public and private sector initiatives aimed at
better supporting CHWs and Supervisors.
A system where public sector
programs work in synergy with
private sector initiatives will amongst others - contribute to
reduce the risk of stock-outs, create
opportunities to offer new incentives
to CHWs and offer private
Supervisor programs for improved
management of CHWs.

Guidelines and standards

23/01/2014

Nike backpack production

DHL network distributing commodities


BACKPACK


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STORAGE BOX


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INFORMATION MATERIALS
TYPOGRAPHY

MAIN TEXT

Noto Sans Bold
SECONDARY TEXT

Pneumonia

Noto Sans Bold Italic
Noto Sans Regular

FROM 2 TO 11 MONTHS

Amoxicillin

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COLOR PALETTE

07712345678

MAIN DISEASES

GENERIC DISEASE

07712345678
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ICONS

MAIN DISEASES

Amoxicillin
FROM 2 TO 11 MONTHS

Pneumonia

GENERIC DISEASE


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Emblem | The Backpack PLUS Symbol

EMBLEM


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48


CHW Backpack Plus Phase 1 Report

13/07/23

47

Emblem | The
Title | Subtitle Backpack PLUS Symbol

ADVOCACY

The emblem as a
tangible expression of
the value of CHWs, to
support and sustain
advocacy and large
scale fundraising.

CHW Backpack Plus Phase 1 Report

13/07/23

Emblem | The
Title | Subtitle Backpack PLUS Symbol

ENDORSEMENT

The emblem as a
quality seal, to mark
adherence to common
protocols across
geographies and
providers.


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RECOGNITION

The emblem as an
iconic manifestation
of the essential role
CHWs play in their
communities.

Backpack Plus | Impact

Backpack Plus
Projected Impact
More cases treated

Better quality of care

Higher efficiency thanks to a more
streamlined workﬂow

Reduced error rates thanks to
improved tools and higher guidance

Increased effectiveness thanks to
easier assessment and treatment
tools

Better treatment thanks to enhanced
guidance and real-time support

Increased motivation due to better
support and diversiﬁed incentives
Increased community trust thanks
to better communication

BIOCAT HOW DESIGN THINKING CAN IMPROVE MY BUSINESS?

Higher-skilled CHWs thanks to
continuous training and supervision
Reduced stock outs thank to
improved data management and
private sector partnerships

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IGDD n.211_frog_Backpack PLUS @designlibrary

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IGDD n.211_frog_Backpack PLUS @designlibrary