Krista Donaldson on D-Rev and Social Impact Design

caption for the image 2


Images: D-Rev; portrait by Jason Madara


To usher in PUBLIC’s growing coverage of product and service design for the greater good, Asssistant Editor John Cary spoke recently with Krista Donaldson, CEO of D-Rev, a groundbreaking nonprofit technology organization uniquely focused on people living on less than $4 a day. Among many other associations and accolades, Donaldson is a lecturer at the Stanford, was recognized among Fast Company’s 50 Designers Shaping the Future in 2013, and has spoken at top thought leadership events, like the Aspen Ideas Festival, Clinton Global Initiative (CGI) Annual Meeting, PopTech, and TED.

What were some early influences or experiences in your career?

I’ve always been amazed how things are built, so product design and engineering rather naturally became my fields of study. (If you look around, everything is designed by an engineer, designer, or architect!) It was during my undergraduate years at Vanderbilt University that I was exposed to social justice and what it means to contribute to a community. It went beyond just volunteering: Working for better communities was instilled as a central part of one’s life. My mom was a social worker and my dad is a doctor, so this type of thinking was a natural fit.

What wasn’t as clear to me early on was how to use engineering and design to serve the public good. When I was in university, there wasn’t yet Engineers Without Borders or opportunities of the type. And if you look at the lineage of engineering, there have been very few overt links between design and service. Historically, it’s been much more about technology than people. But why do professions exist in the first place? To serve people.

I went to Stanford for graduate school and found my tribe in product design. It was there that I first learned about the appropriate technology movement that started in the late 1960s. This was pre-Wikipedia, so I read everything I could about it in the library. It was mind blowing. It directly informed everything that I did after and was the basis for my Ph.D. research in mechanical engineering design at Stanford.

How did you translate that understanding into work opportunities?

I had met Martin Fisher, co-founder, KickStart International, when he gave a talk at Stanford as a returning alum. After some convincing him that ApproTec — what KickStart was called then — needed an intern, I later moved to Kenya as their first engineering intern. KickStart takes a market-based approach to creating irrigation tools for small-scale farmers. Their work begs the question, “How can product design lift people out of poverty?” I see products as tools. It’s thus critical to understand the connection between products and the people using them. And it hinges on those users getting the product consistently, and with consistent high quality. In our line of work, if we screw up, we’re really hurting people, because they do not have disposable incomes. It’s not like here: When my iPad breaks, that’s not stopping me from putting food on the table. Living in Kenya during my tenure with KickStart,I saw so many failed big-money aid projects. For a great read, see Binyavanga Wainaina’s [Harper’s] piece “Pure Product,” from 2007; it is still relevant today. Even today, it’s as if poor people are the testing ground for sexy ideas from the West. So my career and D-Rev are laser-focused on people and what serves them best.

Donaldson at Al Quds Power Plant near Baghdad

KickStart is a form of aid, but what about the bigger system of international aid?

During my time working on the ground with aid recipients, one of the biggest frustrations was with the deployment and practices of foreign aid. Yet I realized I didn’t know a whole lot about aid as a system or even the larger motivations, so I decided to go into government. I knew good people go into aid to help, but I found most overcome by the system and bureaucracies.

So much in aid is disconnected and siloed, even conflict and post-conflict aid, where you think there would be a well-thought-out continuum of strengthening systems to support creating economic independence. So I took special interest in post-conflict reconstruction and went to the U.S.Department of State as an American Association for the Advancement of Science diplomacy fellow focused on Iraq. The country was supposed to be post-conflict by the time of my arrival, but it wasn’t. I initially thought that U.S. Agency for International Development (USAID) would be leading reconstruction, but it had actually just been moved from the Department of Defense to the State Department.

My job was basically to be a worker bee in the system trying to get, and keep, Iraq’s power system running. The big lesson for me was that reaching political goals for electricity reconstruction wasn’t necessarily aligned with understanding what people, the Iraqis, wanted.They want electricity. They wanted to have lights, air conditioners that turned on when they got home from work. The demand for power surged with new electronics coming in the country after the end of sanctions. If the U.S. government had focused on meeting demand, instead of arbitrary power generation metrics, security, an ultimate goal, could have been a lot better for everyone there.

With electricity reconstruction, specifically, there wasn’t a lot of systems thinking, as in what happens between the power plants and the switch on someone’s wall. It reinforced, for me, that product development is not about the product, for example, the power plant or the water pump; it’s much bigger than the product. It’s about all of the things that go into the product, like fuel, and all the things that must happen for the product to solve a problem, like reaching the user and working the way it is supposed to.

Today, I’m really happy that USAID is more deliberately recruiting engineers and scientists into government, bringing crucial technical expertise and understanding.

Donaldson checking Brilliance at a hospital in Chennai
Brilliance in use in Philippines

So what brought you to D-Rev?

D-Rev was co-founded in 2007 by Kurt Kuhlmann and Paul Polak. I was recruited in 2009 by longtime D-Rev board member Jim Patell, founder of the’s popular “Entrepreneurial Design for Extreme Affordability” course. At the time, D-Rev was more or less a skunkworks with cool technical projects, but the projects weren’t really going anywhere. D-Rev had a lot of very technology-centric stuff, such as a low-cost microscope for diagnostics, a project that ultimately exemplified a need that existed, but one without demand. We think of these all as good failures because we learned from them. As an organization, we firmly believe in being transparent, so even projects that don’t go anywhere or we decide to kill are on our website.The one good thing that I did very early on at D-Rev was cancel projects. D-Rev is committed to developing products that serve needs and demand.Without demand, where is the accountability? There’s little requirement to deliver the value that users truly need if demand is ignored. I would like to see more projects in the sector canceled for not meeting user, system, and market requirements.

So what distinguishes D-Rev’s approach today?

D-Rev operates on three big principles. The first is that we’re user-obsessed. I really believe in this. Most products have an array of users, so we map out that ecosystem of stake holders, the context, market, and price points. With most new product ideas trying to get traction, the user diligence process is too short and overly focused on the intended end users. Understanding all user needs takes time. For example, we spend a lot of
resources understanding if and how users buy products, and we learn critical insights that dictate approaches. We’ve seen that clinics, even low income ones, will often refer to purchase a higher priced product through a trusted local distributor, rather than directly online at a lower price. The reason: They want to have the confidence that they have access to maintenance support.The second principle is that our products need to be world-class. That means they must perform on par or better than the market. The prevailing thought in the aid world seems to be that a low tech product is good enough for the poor. That doesn’t cut it for us, and it shouldn’t for others.Our third principle is that our model and products are market-driven. We determine a price point, based on user capacity, and then we design to that. It forces us to iterate. Only if there is demand can it scale to every user that needs it. This reality holds us accountable to our customers.

A distinguishing aspect of D-Rev seems to be its focus on impact. Tell us about that.

We’re obsessed with impact. Unfortunately, the philanthropic sector doesn’t incentivize truly transparent impact assessment, which is critical for iteration. It’s often little more than, “Oh, you didn’t meet your targets.” We need much more depth to determine and understand impact. I love it when organizations post their impact data. The next thing I always wonder, though, is:Where do those numbers come from? And what do they really mean or indicate? Most impact assessment is still very old-school, resource intensive, report-heavy, and not necessarily lean for startup organizations, like D-Rev. One notable tool exception is the Progress Out of Poverty Index, an initiative of the Grameen Foundation, which has short surveys focused on country-specific needs of the poor. I’m also enormously proud of D-Rev’s Impact Dashboards that have clear and up-to-date data and definitions.Impact informs everything we do. I’m very pragmatic about it. We are often pressured by the global health funders to do clinical trials, which are needed to test new products relative to the status quo. It’s a practice that I reject for most of our products, which are built on previously proven science, but more than anything because it often asks us to submit already vulnerable patients to sub-standard care.

Agung - Bali
ReMotion Knee sketches

“I see products as tools. It’s thus critical to understand the connection between products and the people using them.”

"We happen to be in the business of focusing on problems that are not traditionally profitable, but it's still design."

Amputee being fitted for ReMotion Knee in Bali

This type of work has many names: public interest design, social impact design, etc. What term most resonates with you and D-Rev?

Design is design. We happen to be in the business of focusing on problems that are not traditionally profitable, but it’s still design. I like design for social impact, but isn’t that redundant? I also struggle with the labeling. It’s like the term “developing country.” There’s no really good term — what makes a place “developing,” or “developed”? — which is why we use frequently use the term “low-income regions.” One term that doesn’t resonate with me, however, is “resiliency,” at least from a product- development standpoint. The intent is good, but it connotes a determined “sticking with it.” Instead, I see design as iterative, user-centered, and evolving, not eternal.

What do you see as the next frontier for the field?

I’m excited about the next wave in design. If appropriate technology movement is the second wave, after Marshall Plan–style foreign aid, then the rise of social entrepreneurship, albeit more pragmatic/business focused, shifted toward user thinking. Now we are finally in a new phase focused on impact. I really believe that everyone’s intentions have been good and sincere along the way, but in figuring out problems, a lot has gotten lost in the details and ideologies. Both for design for impact as a field and for us as an organization, I also see intellectual property as a huge issue. I want to emphasize that we protect our IP. We have to as a market-based organization, and I think it is critical for supporting scale and ensuring the highest quality products reach our customers.I also see lots of bright spots, particularly in global health. It’s not the traditional big groups on the stage, but instead small, highly effective user-centered groups, like Wild4Life, delivering high-quality healthcare in rural Zimbabwe, or Health in Harmony in remote Indonesia and Borneo.Health in Harmony recognized that local people were cutting down the rainforest to pay for basic health services. By addressing people’s medical needs they enable the local population to protect the forest and local diversity.

What is going to get us there, to that brighter
future where impact is front and center?

I would love to see funders empowering grantees to take educated risks. I’d also love to see much greater accountability in the funding sector, tied to transparency in impact reporting and incentivizing iteration. I’d love to see investment in groups that are actually making a measurable impact, and not just generating a lot press or great at writing proposals. If the impact isn’t clear or positive, then I want to see discussions about what was learned.The other thing that’s really needed is multiyear funding; product development and delivery doesn’t happen in a year. We have seen foundations abruptly change direction. Those changes are incredibly hard on organizations like ours. I also see a lot of entities, including bilateral aid programs, stuck in the first two waves of history: traditional foreign aid and technology driven, instead of people-driven, innovation. They most often invest in consortiums and university research, even though we know that neither is structured to bring products to market or solutions to scale.


In closing, what would you say to someone just starting out in the field?

D-Rev receives many requests for informational meetings with students in particular. We love the interest in the sector and try our best to respond to, encourage, and support everyone. What I tell students is to get involved with service projects at your school, in your community, in product development, but more importantly with impact assessment. Early-stage work of figuring out solutions has the appearance of being more fun and sexy, but I really think late-stage product development and impact assessment are where it’s at.