Health System Delivery Reform in Multi-Country Contexts (Africa and East Asia)
The World Bank Group’s Health, Nutrition and Population Group and GFF in Africa and East Asia
This project supported the World Bank Group’s Health, Nutrition & Population, the Global Financing Facility, and government partners across Chad, Niger, Côte d’Ivoire, the Democratic Republic of Congo, Pakistan, Lao PDR, India, and Bangladesh in applying human-centered design and systems thinking to large-scale health system reform. Tangerine Lab was engaged as an oversight and evaluation partner, as well as a technical HCD advisor, guiding and strengthening the work conducted by an in-country design firm and their local partners. The initiative focused on Service Delivery Redesign (SDR), aiming to improve the quality, accessibility, and equity of care by rethinking how services are organized, delivered, and experienced—particularly for underserved populations.
Rather than approaching health challenges as isolated technical problems, the project addressed them as complex systems shaped by infrastructure, policy, social norms, and everyday human behavior. Through a combination of qualitative research, data analysis, and participatory methods, Tangerine Lab helped ensure rigor and consistency in how insights were generated and translated into design opportunities across diverse country contexts. This included advising on research quality, synthesis processes, and the integration of system-level analysis into human-centered design workflows.
A core contribution of Tangerine Lab was bridging lived experience with system-level design. By supporting multi-stakeholder engagement—including patients, frontline workers, community leaders, and policymakers—the team ensured that solutions remained grounded in real needs while aligned with institutional priorities. This role was critical in maintaining coherence across countries and enabling locally led design efforts to produce solutions that were both contextually relevant and strategically aligned.
The work emphasized designing at two levels simultaneously: the overall service delivery model and the specific interventions that enable it. Tangerine Lab provided technical guidance to ensure that these two layers remained aligned—supporting teams to rethink how care is organized (e.g., referral systems, service distribution, and facility roles) while also shaping the tools, workflows, and community engagement strategies needed for effective implementation.
Importantly, Tangerine Lab also played a key role in embedding adaptive learning and evaluation into the process. By reviewing iterative testing cycles, structured reflection, and cross-country learning, the team helped refine solutions in real-world conditions while building a shared evidence base. This ensured that approaches remained flexible, feasible, and scalable within resource-constrained environments.
Beyond specific interventions, the project contributed to a broader shift in how health systems are designed and improved. Through its advisory role, Tangerine Lab helped strengthen local capabilities in human-centered and systems-based approaches, fostering new ways of problem-solving within government and partner teams. The result is a more resilient, responsive, and people-centered foundation for ongoing health system transformation.