In 2007, Saul Griffith won the MacArthur Fellowship—the “genius grant”—for his invention of a low-cost printer that can mold prescription lens within minutes. He intended for this device to be used primarily in the developing world where eye care services and resources are often limited. While a highly sophisticated and innovative device, the printer was not needed in these regions since Chinese factories were already manufacturing low cost lenses and shipping them worldwide inexpensively. Paraphrasing Griffith, David Owen writes, “The real problem with eyeglasses in the developing world isn’t making lenses, he told me; it’s testing eyes and writing accurate prescriptions for people with little or no access to medical care—a matter of politics and economics rather than technology.”(1) This situation demonstrates that designers of new technologies must go beyond technological innovation. They must adapt technologies designed for social impact to local contexts and needs. Design thinking is a strategy for innovation that aims to fulfill these goals.
Design thinking is human-centered and considers context, culture, and consumer concerns. With this focus, design thinking can maximize the implementation and utilization of new technologies in resource- and technology-limited areas. Design thinking operates under the premise that a product’s desirability by consumers and its economic practicality are as important as its technological capacity. John Gage of Sun Microsystems aptly notes, “Technology is easy. People are hard.”(2) Designers must take into account “regional needs, social behavior, economics, infrastructure and real world applications.” With these considerations, designers should incorporate the business strategy of “branding,” making products as personal and attractive as possible.(3) Discussing the effectiveness of nonprofit programs, Kevin Starr, founder and director of the Mulago Foundation, recommends asking the following questions: “Is it needed? Does it work like it is supposed to? Will it get to those who need it and enough of those who do? Will people use it immediately?” This same line of questioning can be applied to new technologies with design thinking to maximize efficacy.(4)
Jocelyn Wyatt, the leader of IDEO’s Social Innovation domain, aptly notes that for Base of the Pyramid (BoP) markets, a design must account for three aspects in particular: affordability, attractiveness, and appropriateness.(5) Wyatt and Tim Brown, CEO and President of IDEO, a human-centered design firm, use an excellent example to demonstrate the importance of design thinking. In Hyderabad, India, one woman continues to fetch low quality water despite the presence of an affordable water treatment facility nearby. This occurs because she cannot carry the 5-gallon jug that the facility requires her to use, and her family does not need the mandatory 5-gallon per day purchase. While gathering clean water from the treatment plant works well for many families, and especially for those with bikes, it does not suit this woman’s needs. IDEO recognizes the importance of prototyping and of customer feedback, which are fundamental aspects of design thinking.(6) Barriers to usage should be solicited and incorporated into the evolving design of a device or program. In an authentic and poignant talk, Heather Fleming of Catapult Design arrives at a similar conclusion as Wyatt and Brown. She states, “The golden rule of design is empathy.” She emphasizes that the development industry must design for the user, taking into account the practicality and appropriateness of a device, in order to maximize impact.(7)
Design thinking requires significant creativity and a willingness to take risks. Non-profits are particularly risk-adverse because they must rely on philanthropic financial support and, thus, want to report only positive outcomes. While design thinking encourages risk-taking, the risk is relatively controlled as each technology or intervention is prototyped before being scaled up. In this way, design thinking is an innovative approach to the development of new technologies and interventions for social impact. It requires a balance between creativity with uncertainty and evidence of efficacy. Importantly, it recognizes that without considering users’ needs, behavior and context, implementation of policies and interventions can be a waste of resources or worse, exacerbate social problems.
PlayPumps International was an organization that designed and subsequently constructed water pumps across South Africa and Mozambique that enabled children to play on a merry-go-round device while pumping clean water into storage wells. The main goal was to bring clean drinking water to communities in sub-Saharan Africa, and the organization boasted impressive outputs. In addition, it was believed that the structure would appear user-friendly and even fun for children. However, the organization failed to assess whether the PlayPumps actually improved the supply of clean water or the amount of time people spent gathering water in villages where they were installed. According to Public Radio International, “The promise of PlayPumps remains largely unfulfilled. In some cases, the PlayPumps actually made situations worse, displacing previous water sources.”(8) Many PlayPumps were unused, while others broke and could not be repaired due to a lack of spare parts. Many villagers reported that the PlayPumps actually made their living situations worse.(9) By 2010, the PlayPumps organization was defunct. This examples shows that instead of delivering technologies that only seem appropriate in theory, organizations should prototype the device in various settings to assess its acceptability and use before spending valuable funding to scale it up.
LifeStraw is a portable plastic pipe that allows individuals to insert the straw into untreated water and to suck up filtered water. Kevin Starr noted that while the device proved to be an excellent water filter, it cost too much and took too long for individuals to use, discouraging widespread adoption by villagers.(10) Although the filter is very effective in reducing waterborne bacteria and viruses, its design is not suitable for many users. A study conducted in Ethiopia in 2009 distributed LifeStraws and then measured its impact over a five-month period, including changes in diarrheal disease prevalence, overall microbiological performance, and device longevity. After the intervention was completed, the researchers examined the use and acceptability of the straw. At the end of the trial period, only 34% of those still using the filter reported having used LifeStraw the week before the survey and of those “current users,” only 13% reported drinking with the straw consistently. Moreover, 54% reported having used the filter only at the beginning of the study, and 30% never used it or discontinued using it within a month of distribution. A majority of the participants reported not using it because it was too difficult to suck the water. Others reported that, because the straw was too narrow, it delivered too little water at a time and took too long to drink through the straw.(11) This study demonstrates that technologies can only make a significant impact if the product’s user-friendliness is considered. Studies such as these can provide information on ways to redesign a product to make it more acceptable to users and, therefore, more widely-adopted and likely to be used.
To a degree, One Laptop Per Child (OLPC) has used design thinking in its development of its XO-1 laptop, a device intended for use by children in developing countries. Ideally, the laptop is seen as low cost, extremely durable under harsh environmental conditions (including high temperatures and humidity), energy-efficient, and capable of multi-tasking (i.e., running several programs at once). Furthermore, the XO-1 laptop possesses a screen that allows for usage both indoors (with full color and full backlight) and outdoors (monochromatic to reflect the sunlight). Moreover, the laptop checks in with a monitored network periodically in order to continue to function; this feature makes the laptops more difficult to sell on the black market so that the children and schools are more likely to retain them.(12)
While the design of the laptop theoretically tailors to the living conditions and needs of children in developing nations, many of the touted features of the laptop turned out to perform at lower levels than they did in a laboratory. In post-distribution evaluations, the wireless mesh networking system was found to be largely dysfunctional, the laptops’ batteries only lasted for a couple of hours, the use of flash memory instead of hard drives resulted in limited file storage, the small interface was difficult for teachers to use, and the lack of external display output support limited the ability of students and teachers to share information. Moreover, the screens are relatively expensive and are difficult to replace, costing $65 in Paraguay and $85 on Amazon. In Uruguay, a 2010 study reported that 25% of the technical problems of the XO-1 laptop involved replacing the screen, and many cannot afford replacement screens. As a result of all of the problems mentioned above, usage of XO-1s have been found to be relatively low. In Uruguay, for example, only 21.5% of teachers report individual student use of XO-1s in class on a daily or almost daily basis, and in Alabama 80% of the students report never or seldom using the XO-1s in school. Discussing the failure of OLPC programs, Warschauer & Ames (2010) states: “Of the many problems with the XO laptop, some are mistakes that were a result of inadequate testing and rushing a product to market, some were the result of incognizance about laptop use in a classroom or home compared to use in a laboratory, and some are intentional design decisions. Yet all of the problems stem from utopianism about how a laptop hastily designed in the lab will perform in the real world and about how children can learn from a machine that, through its design, makes teacher-student interaction difficult.”(13)
Prototyping and design thinking would help improve acceptability, minimize negative effects on existing pedagogy, and reduce corollary problems associated with the technology. These strategies would also help reduce cultural barriers to the efficacy of OLPC. For example, the images on the software - including the painter’s palette, the question mark, and the thought bubble for chat - are relevant to Western cultures but probably not to most other cultures. McArthur recognizes the need for culturally appropriate software and the need to “localize technology.” Designers of electronics mainly aim to push current technological limits rather than improve the cultural relevance and appropriateness of devices. While designers should better consider user acceptability and practicality, McArthur notes that Westerners cannot determine the success of a technology based on its outcomes in the lab. McArthur states that the XO-1 “must be allowed to be a fluid object, capable of being whatever kind of tool its new users need.”(14) Hopefully, more evaluations of OLPC will be conducted and OLPC will learn from the problems found in the evaluations of deployment sites, develop a more user-friendly model as KickStart has with its hand pumps (discussed below), and eventually contribute effectively to improving education and narrowing the “digital divide.”
In 1996, KickStart International (formerly ApproTEC) launched its first MoneyMaker irrigation pump in Kenya to enable small-scale subsistence farmers to develop their farms into profitable agricultural businesses. Before the pump was developed, many subsistence farmers in Kenya could not afford adequate food, healthcare, or schooling. With IDEO, KickStart International developed the human-powered pump that can lift water from wells up to 18 meters deep to 7 meters above the pump, providing irrigation for a half-acre farm. Using human-centered design thinking, IDEO and KickStart have adapted the pump since its initial development to make it more user-friendly and attractive to Kenyan farmers. Four models have been designed based on the needs and concerns of the farmers using the pumps. The final model of the pump can be used barefoot, costs less than $150, is small and light for easy transportation on bikes or public transportation, can sustain harsh environmental conditions reducing its risk for damage, uses materials and production techniques common to Kenya, is easy to use, and requires little to no maintenance.(15) This last point is especially important since many technologies that are implemented in rural African villages eventually break and are left in disrepair—as in the case of PlayPumps and OLPC—due to the lack of mechanics and spare parts. The Founder and CEO of RKS Design, Ravi Sawhney declared that the "pump is a design that impressed all of us deeply through its minimal use of materials, purposeful utility, design for use of local materials, and its ability to be easily transported by bicycle. Its ability to utilize deep well holes that can be readily drilled gives small crop growers the ability to expand the diversity of their crops and greatly diminishes their dependency on seasonal rains. This is an outstanding example of sustainable design that contributes to an increase in the quality of life for many. It truly touched our souls as designers."(16)
Due to design thinking and the incorporation of user input, these pumps have proven to be a high impact innovation. Allowing farmers to expand the amount of land they can farm and to grow and sell as many as 3-4 high value vegetables crops per year, the MoneyMaker Pump enables farmers in Africa to generate $37 million per year in new profits and wages. Currently, there are 45,000 pumps being used by farmers across Africa and 29,000 new salaried jobs have been created as a result.(17) This pump serves as an example of the appropriate and successful design, development, and distribution of new technologies for use in developing countries.
For a concise overview about the ethical considerations of innovative intervention design and implementation, see Ethics of Innovation.
On one hand, some may argue that there is an ethical imperative to reduce the technology gap between developed and developing countries and that technologies should specifically be designed to promote social, economic, nutritional, and physical progress in low- to middle- income countries. Researchers from the Kennedy School of Government at Harvard University, Juma et al. (2001) assert that “in a world that is marked by extreme disparities in the creation of scientific and technical knowledge,” research and development in developed countries should be redirected to address problems affecting the base of the economic pyramid. Approximately one third of the world’s population is “technologically deprived, neither producing their own innovations and technological developments, nor having access to the technologies developed by other nations. Only 15% of the global population provides nearly all technological innovations.”(18) It is imperative that new technologies be made available to developing countries so as not to exacerbate existing global inequalities in wealth and health conditions. On the other hand, new technologies must be developed and implemented in an ethical manner. Prototyping, gathering user feedback, and determining outcomes can help assure that there are minimal unintended negative impacts and consequences. For more information on measuring outcomes, see Outcomes are Essential in Global Health.
The development and distribution of PlayPumps illustrates two ethical dilemmas. First, PlayPumps were constructed rapidly in place of hand pumps across South Africa and Mozambique without evidence of their long-term efficacy and without being built and placed appropriately. Many of the pumps were either built on sites without adequate wells or broke within a few months. Although communities contacted the organization about these dysfunctional pumps, the company was extremely slow in repairing the wells or restoring the hand pumps. As a result, some communities’ water supplies were depleted for six months.(19) The pumps failed for technological and sociocultural reasons. Many of the pumps did not operate well because of flawed water calculations. In addition, local conditions and context were not adequately considered in the design of the pump. For example, some communities did not have many children, and the pump was very difficult for elderly women to spin. Moreover, children might be less likely to play on the pump during the rainy season or in times of need such as in the morning. Instead of eliminating barriers to water, PlayPumps did just the opposite, leaving communities without water for months, due to poor design and implementation.(20)
Secondly, even though PlayPumps had not conducted sufficient research on its efficacy or cost-effectiveness, it solicited donations from all over the world. WaterAid issued a statement for why it did not support PlayPumps, including the following reasons: its “high costs ($14,000, excluding drilling), the complexity of the pumping mechanism (making local operation and maintenance difficult), the reliance on child labour, and the risk of injury.” However, other individuals and foundations were not aware of the severity of these issues. PlayPumps received more than $60 million from the US government, Jay-Z, and DJ Mark Ronson.(21) Despite the reported failures and problems, PlayPumps continued to try to reach its goal of 4,000 pumps installed by 2010 in order to satisfy donors.(22) Not only were millions of dollars wasted on a design that did not work, but additionally, the money was spent on a technology that actually caused further harm to those whom it was intended to benefit. Considering the detrimental and unethical consequences resulting from the installation of PlayPumps in place of previously operating and more cost-effective hand pumps, PlayPumps International should not have continued to solicit donations or scale up the technology.
Although OLPC honorably aims to reduce the “digital divide” between developing and developed countries, the continued widespread distribution of the XO-1 laptop may not be ethically defendable. Warschauer & Ames (2010) remark that the low-income countries that OLPC is trying to work with cannot realistically afford the laptops or the training and maintenance necessary to ensure their effective usage. Rather, the funds of OLPC should be used to build schools, train teachers, provide books, increase teacher and student attendance rates, and subsidize school fees. Like PlayPumps, documentation indicates that the XO-1 laptop is being deployed without adequate evaluation, and the opportunity costs of this development and deployment are too great. Warschauer & Ames (2010) state that “Given the demonstrated social and educational benefits of other low-cost programs versus the uncertain benefits of OLPC, it is neither realistic nor desirable that governments or donors would make the kinds of investment necessary for distribution of laptops to all children in low-income countries without evaluating the benefits of OLPC.” In fact, no studies have found measurable increases in student performance in reading, writing, language, science, or math due to participation in an OLPC program.
Moreover, in a situation similar to the case of PlayPumps, maintenance has proven to be a significant barrier to use. Many OLPC distribution sites - including Peru and Birmingham, Alabama - have experienced problems with large numbers of broken or otherwise unusable laptops, resulting in the discontinuation of program funding and support.(23) In the Alabama program, approximately 60% of the laptops were nonfunctioning nineteen months after they were distributed. Soliciting and using philanthropic funding without proof of efficacy is ethically problematic in the case of OLPC since the funding could have been used to scale up educational interventions already proven effective, or to address more pressing problems for children such as diarrheal disease and parasites. With poor health, students are less able to concentrate in school, to reach their academic potential, or even to attend school. Therefore, aid can be used to combat such health issues affecting child education before untested technologies are distributed.
(1) Owen, David. “The Inventor’s Dilemma.” The New Yorker, 17 May 2010.
(2) Haqqani, Abdul Basit, ed. The Role of Information and Communication Technologies in Global Development: Analysis and Policy Recommendations. Geneva: United Nations, Department of Economic and Social Affairs, 2005. GoogleBooks. Accessed on 22 February 2011.
(3) Young, Paul. “Designing the Future.” Design 21: Social Design Network, 11 August 2008. Accessed on 23 February 2011.
(4) Stepanek, Marcia. “Exploring Failure.” Stanford Social Innovation Review, 3 November 2010. Accessed on 24 February 2011.
(5) Brown, Tim. “Tim Brown urges designers to think big.” Ted Talks, July 2009. Accessed on 14 February 2011.
(6) Brown, Tim and Jocelyn Wyatt. “Design Thinking for Social Innovation.” Stanford Social Innovation Review 2010. Accessed on 14 February 2011.
(7) Fleming, Heather. “The Human Factor: The Designer’s Approach to Societal Change.” TEDxSoMa, 2010. Accessed on 14 February 2011.
(8) “The Promise and Perils of PlayPump.” Public Radio International, 7 July 2010. Accessed on 13 January 2011.
(9) “Troubled Water.” PBS Frontline World: Stories from a Small Planet, 29 June 2010. Accessed on 14 September 2010.
(10) Stepanek, Marcia. “Exploring Failure.” Stanford Social Innovation Review, 3 November 2010. Accessed on 24 February 2011.
(11) Boisson, Sophie, Wolf-Peter Schmidt, Tsegahiwot Berhanu, Hencock Gezahegn, and Thomas Clasen. “Randomized Controlled Trial in Rural Ethiopia to Assess a Portable Water Treatment Device.” Environmental Science & Technology 43(2009): 5934-5939.
(12) McArthur, Victoria. “Communications Technologies and Cultural Identity: A Critical Discussion of ICTs for Development.” IEEE Toronto International Conference – Science & Technology for Humanity ’09, 27 September 2009.
(13) Warschauer, Mark and Morgan Ames. “Can One Laptop Per Child Save The World’s Poor?” Journal of International Affairs 64(2010): 33-51.
(14) McArthur, Victoria. “Communications Technologies and Cultural Identity: A Critical Discussion of ICTs for Development.” IEEE Toronto International Conference – Science & Technology for Humanity ’09. 27 September 2009.
(15) “MoneyMaker Deep Lift Pump For KickStart (Was Approtec): A Human-Powered Irrigation Pump.” IDEO, 2011. Accessed on 23 February 2011.
(16) Underwood, Scott. “ApproTEC MoneyMaker DeepLift Pump.” IDSA.
(17) “Micro-Irrigation Technologies.” KickStart. Accessed on 23 February 2011.
(18) Juma, Calestous, Karen Fang, Derya Honca, Jorge Huete-Perez, Victor Konde, and Sung H. Lee. “Global Governance of technology: meeting the needs of developing countries.” International Journal of Technology Management 22(2001): 629-655.
(19) “Troubled Water.” PBS Frontline World: Stories from a Small Planet, 29 June 2010. Accessed on 14 September 2010.
(20) Chambers, Andrew. “Africa’s not-so-magic roundabout.” Guardian, 24 November 2009. Accessed on 28 February 2011.
(22) “Troubled Water.” PBS Frontline World: Stories from a Small Planet, 29 June 2010. Accessed on 14 September 2010.
(23) Warschauer, Mark and Morgan Ames. “Can One Laptop Per Child Save The World’s Poor?” Journal of International Affairs 64(2010): 33-51.