Jalin was designed to use co-creation platforms to identify, incubate and implement locally developed solutions to address barriers and enhance opportunities for better MNH outcomes. Through these platforms, the project seeks to facilitate a match between stakeholders, roles, actions, and processes so interventions are “fit for purpose” and are on a causal pathway for scalability and sustainability and more likely to be effective and sustainable.

Co-creation comes in many forms and can be hard to define in simple terms as it is primarily framed by principles that emerged from two recurrent lessons; 1) A challenge always has multiple perspectives and solving it from just one perspective is less optimal, and 2) When people are engaged in a process they tend to commit to/feel ownership in the outcomes.   From a development perspective, especially complex social challenges like improving maternal and neonatal health outcomes that are multi-faceted, dynamic (the factors are moving and affecting each other), and cannot be solved with simple technical fixes, using co-creation processes/platforms makes a lot of sense.  The challenge for a practitioner is that co-creation is often defined by specific method or tool, that from a wider systemic change perspective are not appropriate for every challenge.   One framework that might be helpful as a guide to decide how to go about co-creation is shown below in the graphic (adapted from the https://www.youtube.com/watch?v=7-KE3XZHe5E). 

Essentially, the framework focuses on two critical factors related to the process of co-creation.  The first is who participates.  For some challenges it is critical to focus on specific expertise or knowledge such as in case of developing quality of care standards for mid-wives.  For example, to be able to develop specific medical care protocols and practice guidelines, it will be essential to understand midwifery service delivery models, incentives around mid-wife service providers, and expertise in maternal and neonatal care.  Other examples, could be the development of a specific financial product around community health savings accounts or defining a business expansion strategy for a given hospital that wants to expand into underserved markets. In these types of challenges, co-creation is best served by using defined selection criteria around the challenge for who participates as having the right expertise and knowledge base in the room is essential to get at a positive and effective outcome.  In other challenges, it is better to have a wide range of perspectives especially for challenges that are more multi-faceted where a a durable solution/outcome would need to work for the majority of the stakeholders.  In these cases, it requires input from as many perspectives as possible.  For example, the overall challenge of midwifery quality control has many stakeholders beyond just the development of technical protocols such as incentives around the business/livelihood of midwife service provision, patient incentives, patient access to services, private hospitals, public hospitals and clinics, public health officials, private investors, etc.  There is value in working through a co-creation process with all these stakeholders around systemic constraints and opportunities.  Another example could be testing a new IT application like a midwife shared-economy model where independent midwifes that are certified can be accessed through a common IT platform.  The platform could even include patient feedback on their experience as an additional way to control for quality.  Testing the intuitiveness of the app and the ease of use for a wide range of the population might require a co-creation process with wide range of test users.

The second factor is related to the ownership of the potential outcome.  This factor has a substantial effect on incentives related to action.  For example, if the likely drivers of expanding access to underserved are commercial and there are known and active entities already investing, then framing the co-creation process around those private sector actors that can own and use the co-creation process to grow their business to serve those population would be a good use of co-creation.  At the same time, there may not be a lot of known actors expanding into underserved markets, but there is case to raise awareness and get some test cases moving.  In this case, a co-creation process that challenges any interested party to participate in a process that hones down to a cadre of best business cases for expanding into underserved markets.  Take again the the specific example of medical practice standards for mid-wives around maternal and neonatal care.  In this case it might make sense for Jalin to use the outcome of a co-creation process around midwife protocol/guidelines for care to frame a challenge that targets midwife services providers around implementing the new standards.  This in this context, Jalin could use a co-creation process around group of experts to develop the protocols, and then use another co-creation process around coalition of stakeholders to test the commercial/operational application of those standards.   In the end, for standards to become normalized around a service provision, there needs to be some quality control of the standard itself, but there also needs to be shared interest in the organizations/service providers applying the standard that adhering to the standards is good for them and their patients.   Using the framework can be useful in defining why, who and how to apply co-creation tactics within a systemic change approach.