Three Ways USAID Can Advance Value-Based, Human-Centered Health Care
How to enhance these approaches through a lens of diversity, equity, and inclusion
USAID celebrates its 60th birthday this year, and this month we are focused on diversity, equity, and inclusion (DEI). This Agency-wide commemoration feels particularly apt, given broader national discussions and our own reflections on how to be more inclusive in our global health work.
We are pleased to see how value-based and human-centered care principles that put people at the heart of our work are gaining increasing support, building on USAID’s long history of promoting inclusive development. Further elevating the expertise and lived experiences of people around the world, especially those with historically low access to opportunities, can not only help us live our values of diversity, equity, and inclusion, but also further USAID’s global health impact.
In value-based health care systems, human-centered care can help deliver better outcomes at a better cost. Value-based care centers metrics, delivery methods, and payment models around the outcomes that matter to people. Human-centered design uses empathy-focused methods to understand what really matters to people and co-develops solutions with them.
Moreover, the principles of diversity, equity, and inclusion call into sharper focus the importance of including all key stakeholders in these approaches, such as young women of color, ethnic minorities, or other historically marginalized groups.
USAID’s new DEI strategy pushes us to make the principles of value-based and human-centered care common practice. Keep reading for examples of three best practices we are applying to our work.
1. Flip the development script to recognize the people we serve as the true experts
Adolescent girls and young women account for nearly three fourths of new HIV infections among adolescents in sub-Saharan Africa. The HIV prevention pill known as oral pre-exposure prophylaxis — or PrEP — can empower young women to control their HIV status, but has faced low uptake and adherence due to stigma. USAID partners applied a human-centered design approach to HIV prevention in South Africa and Zimbabwe.
By directly listening to and designing solutions with young women, we re-imagined oral PrEP from a stigmatizing medical treatment to an empowering form of self-care known as “V”.
“V” includes a pill case designed to look like a lip balm case that is both discreet and easy to use. By consulting with a diverse group of key influencers in young women’s lives like parents, partners, and friends, we designed informational materials that spark conversations to increase acceptance of HIV prevention.
We were honored to have this work highlighted by Administrator Samantha Power in her remarks at the UN’s Behavioral Science Week.
2. Focus on the “metrics that matter” to patients, not programs
Over the past five years, mortality caused by TB nearly doubled in India despite doubling the money spent on TB. Adherence to TB treatment, typically a nine month regimen, is low due to issues with side effects, stigma, and depression.
USAID partners applied a value-based care approach to TB treatment in India. By directly listening to patients and providers, we discovered what really mattered to patients: symptom control, mental wellness, ability to work, choice, convenience, social support, a sense of hope, and being treated with dignity.
Through the development and application of a tool to measure this expanded set of “metrics that matter,” we can better understand a patient’s daily concerns that drive treatment adherence and redesign care to better meet their needs.
This approach expands the measurement of global health program performance beyond traditional clinical outputs to include care experience and factors beyond the clinic walls. We are starting to work with partners to provide more holistic care, including for mental health. We can only change what we measure, and redefining success to address a whole person’s diverse needs can ultimately drive better health outcomes.
3. Intentionally identify and address implicit biases
New technologies like artificial-intelligence (AI) can enable better access to and quality of care. But these technologies also bring risks and could lead to unintended consequences without diverse voices at the table. AI enabled health technologies can be used to develop machine learning algorithms that identify patterns and relationships in high-dimensional and non-traditional data sources (for example, social media, telecommunications, traffic, private sector records), an area of great promise as increasingly complex datasets are available to inform public health decision-making.
The potential applications are wide-ranging — for example, integrating predictive models into client-level electronic medical records has the promise to solve one of our most pressing problems in HIV service delivery: How can we prioritize the highest risk clients to more optimally intervene before clients’ care is interrupted?
The impact, if replicated and scaled, could mean improved services and health outcomes for the 6.4 million people USAID currently supports with life-saving HIV treatment. Yet, many existing data sets are reliant on white patient data, which can reduce effectiveness and risk harming patients of color.
USAID’s Office of HIV/AIDS and the Center for Innovation and Impact (CII) are building on the Agency’s leadership in AI, including opportunities for AI in global health and for advanced analytics in HIV service delivery, to develop a roadmap for scaling machine learning in HIV programming. We are designing the roadmap with potential limitations in mind and including best practices for intentionally identifying and addressing biases.
These approaches highlight the importance of listening to and following the lead of the people we serve to promote a more inclusive and equitable future for the next 60 years of USAID’s global health programming.
About the Authors
Emily Harris is a Health Science Specialist in USAID’s Office of HIV/AIDS. Monisha Ashok is a Senior Advisor on Market Access and Innovative Finance in the Agency’s Center for Innovation & Impact.
