Bangladesh Co-Creation Leads to Innovative Solutions in Health Care Coverage

When Abdullah Akbar, a contracting officer at the USAID Mission in Dhaka, Bangladesh, first heard about the problem-solving exercise known as “co-creation,” he wasn’t convinced that the collaborative process would work.

Today, he’s a true believer in the technique of bringing together a variety of sometimes competing potential partners to come up with solutions—in this case, to universal health care problems.

The 10-day co-creation workshop––which followed a Broad Agency Announcement (BAA) for prospective partners––resulted in a $90 million program to provide self-sustainability for a network of nearly 400 health care clinics.

“In the beginning, I thought the co-creation process took too long to get things done, but I have become sold on it,” Akbar said. “I realized that we at USAID need to get partners involved early in the process.

“I’m a strong advocate now, and I push for co-creation in our Mission as much as I can.”

The workshop leading to an award through 2022 was a difficult process, primarily due to the number of participants—about 20. The size was dictated not just by the experts in the room, but also by the need to get buy-in from both the national and local governments.

The exercise aimed to develop solutions for a social enterprise company to take over the numerous NGO-run health clinics and develop them into self-sustaining facilities as part of the Bangladesh government’s Health Care Financing Strategy. The government was spending more on health care, primarily because those living in poverty are unable to afford to pay for services.

“There was a time I was concerned whether we would even come out of the workshop with solid concepts,” Akbar said. “It wasn’t until the second week that the groups came together, resulting in two concept directions.”

Describing the ebbs and flows of the process, Akbar acknowledged that it was tense in the beginning.

“Some participants viewed it as a competition,” he said. “We explained we wanted them to work on this in collaboration. Each day, after the sessions, we would change the agenda to get them to work together.”

One of the most important aspects of the process, in Akbar’s view, was that all the partners eventually felt that they had a stake in the outcome because they were part of its design.

“They have reputations to protect,” he said. “Once they realize that they are part of a solution, they devote their resources and want to get good results as much as we at USAID do.” 

Co-creation is one of the pillars of the New Partnerships Initiative, through which USAID seeks to engage with partners who have had limited or no experience working with the Agency.

The most important ground rule is that everyone present—whether local or international participants, resource personnel, or USAID staff—is treated as an equal and as a legitimate discussion partner.

Based on the attendees’ evaluations and observations, the facilitators came to these conclusions:

• Co-creation improves the creativity of technical solutions. 

• Co-creation promotes unconventional partnerships. 

• While the participants should lead in developing solutions, USAID has an important and visible stewardship role.

• The workshop structure and sequencing of modules should follow a design logic and should be shared with the participants before the workshop to gain their understanding and buy-in from the start.

• The expectations of the participants should be managed from the outset. They need to understand the premium placed on co-creation comity and recognize that concept notes will be an end result.

“This was the first time we had initiated a BAA in the Mission,” Akbar said. “It’s a process. It’s like we were research scientists trying to get something done for the first time, in a unique space. Universal health care is definitely a complex issue.”

Now, having gone through the process of issuing calls to potential partners and winnowing applicants down to the most qualified, he is convinced that co-creation is the future in addressing difficult issues. 

“I think the Agency realizes that we don’t have all the answers to problems we face, and we have to be open to looking outside and promoting collaboration, innovation and true partnerships.”