Stanford Social Innovation Review: Optimizing on the Edges

The global health community has made remarkable strides in improving access to services. The cost of vital commodities such as HIV treatment, insecticide-treated bed nets, and basic immunizations has dropped, their availability in remote areas has expanded, and clinical effectiveness has strengthened. Yet gaps remain between the availability of these services and effective use among patients. HIV treatment, for example, is only effective in controlling the infection and preventing transmission if taken consistently every day—a goal that only about three-quarters of patients achieve. These types of behavioral barriers detract from progress in ensuring that the full impact of medical advancements reaches the people that could most benefit.

Top-down technology solutions and rigid program-operating models cannot solve subtler behavioral gaps. Instead, smaller facets of the patient experience determine how effectively patients will engage with public health services. Once proof-of-concept for a model is established, there are huge advantages to leveraging interdisciplinary tools—such as those available from design thinking, behavioral science, and evaluation—to optimize “around the edges” to maximize effectiveness for each population programs aim to serve. The impact of using HIV treatment as a prevention tactic, for instance, depends not only on the clinical effectiveness of the medication, but also the contextual and behavioral barriers at play.

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