Quality Health Care and Clean Water

After decades of hard international work and billions of dollars in humanitarian aid, the people of eastern Democratic Republic of Congo (DRC) had no consistent access to the vital services that life depends on. Water systems installed by nongovernmental organizations (NGOs) would dry up as quickly as the grants that funded them. Disease-specific charity clinics had to get by with whatever medications their donors sent them, no matter what their patients actually needed.

Even worse than the lack of basic services was the lack of basic dignity. Too often, well-meaning aid programs met bare-minimum standards of quality — just “good enough” for the world’s poorest people, but nowhere near acceptable for anyone who had a choice.





In 2013, a partnership began to transform humanitarian funding into lasting improvements to essential services, human dignity and economic prosperity in eastern Congo.

Asili (the Swahili word for “foundation”) is a social enterprise — a business with a purpose — that is a co-creation of USAID, Alight,, Eastern Congo Initiative, and most importantly, Congolese families. It is a business model that reinvents humanitarian aid as startup capital for self-sustaining essential services, operated by and for the people who need them.

Alight — an international nonprofit — approached and USAID with a bold challenge: How might they build a community-owned, for-profit business in eastern DRC to support better health and improved livelihoods? USAID provided critical seed funding, along with strategic guidance on the location, viability of certain ideas and long-term variables to ensure success from startup to scale. The design team at used human centered design throughout the processes of inspiration, ideation and implementation, engaging USAID, ECI, Alight and especially the local community, to help design all aspects of the Asili system. Since that time, Alight has been embedded in the community to ensure that Asili stays completely centered around the customer while engaging with and USAID throughout the entirety of the process.

The partnership addresses a range of urgent societal issues that are familiar to people in impoverished places worldwide: lack of quality health care, scarcity of clean drinking water, shortage of meaningful economic opportunities and a history of low-quality humanitarian aid that injures human dignity.

In the eastern provinces of the DRC, Asili businesses sell world-class health care and clean water at prices Congolese communities can afford. The long-term goal and short-term objectives of the partnership are the same: to co-create a radically new solution to the persistent lack of trustworthy essential services. To that end, Asili was designed as a business startup that takes the approach of long-term sustainable development using the time-tested principles of customer-focused business.

The partnership is unique on two fronts. First, Asili puts customers, rather than financial partners, at the center of the partnership. Second, its underlying social business model is designed to succeed in low-resource settings such as the DRC. Co-created in collaboration with Congolese families, the project puts the community in charge of its operations.

The heart of the Asili model is transforming how to think about people who live in the world’s poorest places. Aid recipients have no choice but to take whatever they are given, no matter the quality. But customers have a choice: They can choose to spend what money they have on higher-quality services, and they will refuse to pay for water that isn’t pure or health care that isn’t effective. Asili members are customers, and they keep every Asili business radically accountable for world-class quality, reliable and welcoming service, and competitive pricing.

About 90 percent of the people in the areas the partnership serves can afford Asili water and health care services. Third-party benefactors subsidize water and health care fees for people who can’t afford them on their own. This structure guarantees universal access to essential services without subsidizing the businesses that provide them. Every Asili water kiosk and health clinic must earn the business of every customer, every single day. And they do.


After five years in operation, Asili water kiosks had become self-reliant by 2019. That year:

  • Twenty-eight Asili retail water points sold 43 million liters of clean water.
  • Four Asili health clinics cared for 10,919 patients.
  • Asili services reached an average of 120,000 customers every day.

Today, the partnership is well on its way to serving 500,000 people by 2023, and it is piloting new service lines in sanitation and clean energy. As it expands in the Democratic Republic of the Congo — and someday beyond — ECI and its partners are transforming the whole idea of humanitarian aid.

The Faculty Insight

Public-private partnership like Asili are utilizing design thinking to build locally sensitive, human-centered solutions to what designers call “wicked problems.” In doing so, they show why and how inclusion provides a powerful path to sustainable value creation. Perhaps offering a new model for 21st century NGOs, Asili combines big-picture thinking and individual understanding to bring clean water, health care and solid agricultural production to small village “zones” in the Congo. Inviting the villagers themselves into the design process, Asili gives those facing massive problems like poor health, malnutrition and dysentery a voice in addressing those problems in ways that respect the local intelligence they bring.

While design thinking originated in the business world, this IDEO project — and hundreds of other community design operations like it around the world — demonstrate the power design has to improve lives in the social sector. By inviting local community members into the process, engaging the knowledge they bring and then working with them to co-create solutions, design thinking uncovers higher-order solutions that work far better than those outside agencies and consultants can envision alone. Using design thinking as a set of tools to foster dialogue that uses difference to find better solutions, Asili finds the best of both worlds — combining local input with state-of-the-art technical knowledge from global partners. In doing so, it succeeds in building a self-sustaining enterprise that transforms Congolese communities from beneficiaries of aid into entrepreneurs and customers who can, and do, shape their own futures.

Asili’s work also shows how important it is to think systemically and to visualize not only individual problems and solutions, but pathways that provide end-to-end solutions to what designers think of as “journey maps” of those they serve. Each community-run Asili business boasts a local farming cooperative that loans seeds and fertilizer while providing a guaranteed market for crops. Supported by income from that co-op, local families can afford Asili’s other two prime services — clean-water kiosks and health care at well-stocked clinics. Local citizens buy monthly Asili memberships that allow access to services at reduced prices, plus produce a dedicated, local workforce, which ensures both local buy-in and continual cash flow.

With the first Asili completing its fifth year of operation and now self-sufficient, it models a kind of partnership — one that puts local communities, rather than funders, at the center of idea creation.

The Darden School of Business’ Institute for Business in Society partners with Concordia and the U.S. Department of State Secretary’s Office of Global Partnerships to present the annual P3 Impact Award, which recognizes leading public-private partnerships that improve communities around the world. This year’s award will be presented at the digital Concordia Annual Summit 21–25 September 2020. The five finalists will be highlighted on Darden Ideas to Action on Fridays leading up to the event.

This article was developed with the support of Darden’s Institute for Business in Society, at which Maggie Morse is director of programs.



About the Expert

Jeanne M. Liedtka

United Technologies Corporation Professor of Business Administration

Liedtka is an expert on the hot topic of design thinking and how it can be used to fuel innovation and organic growth.

Liedtka’s most recent books are The Catalyst: How You Can Lead Extraordinary Growth (named one of Businessweek’s best innovation and design books of 2009), Designing for Growth: A Design Thinking Tool Kit for Managers (winner of the 1800 CEO READ best management book of 2011), The Physics of Business Growth (2012) and Solving Business Problems With Design: 10 Stories of What Works (2013). Her latest book, Design Thinking for the Greater Good, studies design-led innovation projects in government and social sectors.

B.S., Boston University; MBA, Harvard University; DBA, Boston University