We began by assembling a diverse team of international and local partners. First, IHI brought MASS Design Group on as a global technical partner. MASS offered experience in human-centered design, as well as a background designing and implementing maternal-newborn health projects. We issued Requests for Proposals (RFPs) in Ethiopia and Bangladesh to identify architectural and engineering firms that could contribute local expertise and resources to the process and – through the project – build experience in HCD that they could replicate in future projects throughout the country. After a competitive bid process, the team selected Fasil Giorghis Consult and International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) as our local technical partners in Ethiopia and Bangladesh.

In order to support global buy-in, applicability, and accessibility, IHI then convened a Global Goods Steering Committee comprising representatives from the World Health Organization, World Bank, PATH, UNICEF, Save the Children, NEST360, and the WHO Quality of Care Network.

These individuals offered decades of experience and expertise to inform the direction of the project and the Global Goods we were tasked with producing. They were joined by representatives from the Ministry of Health in Ethiopia, the Ministry of Health and Family Welfare in Bangladesh, and from the project funders– all of whom brought unique perspectives to the project.

Participating sites were selected through engagement with the local Ministries of Health in Ethiopia and Bangladesh. Two hospitals and two health centres were selected in each country. The criteria for selection included: how closely the facility reflected existing standards and the condition at other facilities of a similar scale, the opportunity for replicability across the context, the amount of space available, and opportunities for expansion. After a consultation process, facilities in the Amhara and Afar regions were selected in Ethiopia, and facilities in the Jashore and Munshiganj districts were selected in Bangladesh.

We conducted a literature review in order to leverage existing evidence about the relationship between the built environment and quality of care. The literature review was aimed at expanding the team’s understanding of current childbirth care practices in Ethiopia and Bangladesh. We also collected lessons learned from past initiatives to improve maternal-newborn care in other LMICs, including user experience, space, and systems redesign projects.

We then turned our attention to planning how we would assess existing facilities in Ethiopia and Bangladesh and engage a range of stakeholders to understand the needs and opportunities for improved maternal-newborn care. We were tasked with crafting a human-centered approach to capture women’s experiences and attitudes toward perinatal care and developing a process that could be replicated by others.

We drafted a set of tools that leveraged a broad range of engagement strategies, including interviews, focus groups, simulations, shadowing and observation, and co-design workshops. We realized that it would be important to engage a diverse group of stakeholders in the process, from mothers, family/companions, providers, and community members to facility administrators and MOH representatives. During this time, we also developed tools to conduct detailed engineering assessments at the health facilities we planned to visit. IHI submitted our protocol to secure Institutional Review Board (IRB) approval in both counties. The Engagement and Assessment Tools were then translated into Amharic and Bengali.

MOH representatives participated in the refinement of the tools and coordinated with the selected health facilities and communities in preparation for immersion. Additionally, the MOH helped to secure and share construction documents of the existing facilities with our team as a basis for assessment and redesign.