Fran Díaz

Ashoka Fellow
Illustration of a person's face depicting a fellow
Fellow since 2020
This description of Fran Díaz's work was prepared when Fran Díaz was elected to the Ashoka Fellowship in 2020 .

Introduction

Fran is empowering every child in the world in need of protheses and orthopedic supports to become the protagonist in the identification of their needs and the design of their solutions supported by a multidisciplinary community.

The New Idea

Fran is creating a global movement where children are enjoying newfound autonomy, social inclusion, and a sense of power thanks to self-created orthopaedical supports which allow them to do simple yet essential activities that give them a sense of independence and inclusion. In Fran´s model, the child is the center of the process, inspiring a community of parents, doctors, teachers, engineers, designers, makers and 3d printing labs. The community and the child co-create cost effective designs, prototypes and products in open source code that are shared, downloaded and 3D printed all around the world.

Children suffer from many ailments, illnesses, and difficulties but their input is very often overlooked when designing medical solutions. Fran turns this problem on its head, focusing not on the practical nature of orthopedics which is already well-covered but on emotional health factors and underlying needs such as the idea of belonging, being independent or being “special.” Only the child can explain their needs and Autofabricantes (self – builders) has created a methodology which allows the design and production of personalized orthopedics that the child or the family need. They are not a standard imitation or a “real hand”, they are specific gadgets that allows the child to do what he or she loves to do, from skipping to shooting a bow and arrow or simply being able to eat a yoghurt, drink water or stand unaided. These are the solutions that give children joy, self-esteem, and independence.

Fran´s vision is to shift the health system´s focus to patient-centered design. He is working towards radically changing the standard approach within the medical system via medical validation and disrupting the current orthopedic monopoly. His ultimate goal is to blur the lines between those who produce prothesis and medical aids and those who receive them, by bringing the fablab mindset to what was until now a purely medicalized environment. In order to do this, Fran has recruited key allies and advocates including the National Association for the Disabled, public health hospitals and universities where he shares his methodology and results, inspiring change across the board.

The Problem

Health is increasingly no longer conceived merely as the absence of disease, but as the ability of patients to adapt and self-manage, yet so many areas within healthcare are still unidirectional and outdated like the orthopedic and health aids industry. The literal idea of one size fits all has been the industry standard for design solutions. This means that very little research and development has gone into a less intrusive form of prosthetics, less invasive to the body and more useful in terms of tasks it allows the person to do. The Spanish public healthcare catalogue of health and orthopedic aids hasn’t been updated since the year 2000, and only in the past 5 to 10 years have they offered a range of skin colors.

Prothesis are very expensive, in Spain costs range from 2,000€ to 20,000€, (Fran´s solution costs somewhere between 200€ – 500€) and the public health system has limited resources to cover the demand of the 88,000 people that need some kind of prosthetic support in Spain. User needs are not taken into consideration and the offer is very much standardized, expensive, invasive and with limited functionality.

The focus on standard products for non-standard problems means that many families are not receiving a solution. The solutions offered by the national system are heavy, old fashioned and don’t respond to their needs and consequently tend to be rejected by users, especially children. In many cases children are forced by their parents to use the traditional prothesis because they have made a big investment.

It is estimated that over 50% of traditional prothesis are left unused due to the difficulties experienced. Making children feel like mere recipients of a medical solution reinforces the idea that they have a problem, or a disability and the inherent problems of social exclusion and self-esteem are exacerbated rather than resolved.

The health aid and orthopedic system continues to be product and not need-based, and this is the essence that Autofabricantes is passionate about changing.

The Strategy

Creation of multisectoral communities to empower the patient

The key elements of his model are, on one hand, the creation of a community of trust, a non-medicalized environment where children are at the heart of the conversation which leads to practical and scalable solutions. For many children it is the first time that they view their diversity under the prism of autonomy, empowerment, and control over their own needs. On the other hand, Fran´s organization creates expert volunteer communities who work together to co-create accessible orthopedic solutions.

Autofabricantes has a large bank of specialist volunteers, primarily product designers, makers, design students, academics, occupational therapists, orthopedic specialists, and physical therapists. Fran has also developed relationships with NGOs focused on functional diversity among children.

Together with the different NGOs, they scope out potential projects and then proceed to launch a call for interested patients/participants. Once patients have been identified, Autofabricantes creates a community with the volunteer group and the patients and family.

The process begins with a kick-off workshop where the co-creation team meets families and children, hear their needs, and evaluate the situation. The methodology used here to extract the real needs of the children based on their experiences, passions and the concrete circumstances is a vital defining part of the project. This is the essence of community creation for personalized solutions.

In Spain before Autofabricantes existed, families were on their own, dependent solely on the state for help. In Fran´s model more than one child participates in each group, so that children can play with other kids in similar situations and families can get together, acting as a support group. The kids and their families become ambassadors of Autofabricantes, and new families become part of the community because of their recommendation.

These “creative creation” workshops occur every 3-4 months and in the period between each workshop the volunteer team researches, develops, and prototypes solutions to be presented to the families and to be tested on the children. The process is iterative in nature and each step is documented.

There is a follow up with the children and their families on a regular basis to establish whether the solutions are still effective and the impact they have on the child´s emotional and physical welfare. Fran´s vision is not product based, his objective is to create networks of support and knowledge. That means that one solution can be relevant for multiple contexts – for example, a prothesis that helps a girl play with a skipping rope in Madrid could be used by a boy to water a vegetable patch in Colombia. This can be done via a simple system of knowledge transfer and mutual support, interconnected and adaptable yet autonomous and independent.

Research, Open Source and Scientific Validation

Autofabricantes follows a strict research process with an open-source focus. Over the past 18 months, Fran has dedicated time and resources to document the whole process, creating written manuals, training workshops, and contacting with key allies to replicate their work worldwide. The open source approach encompasses the results (the “products”) but more importantly covers all the methodologies and learning processes and they are presented under Creative Commons licenses or open source software like GitHub.

This process results in a Scaling Pack which allows the project to be replicated with minimal instruction covering the three key areas; a) the network of partners and volunteers needed b) how to develop the listening process to understand the underlying, often hidden and almost always emotional needs and c) the specificities of the designs and materials.

Fran has already measured the impact of his work and he is now working towards medical validation to be included as part of a health service prescription. To achieve this, he has initiated a PhD program to prove the health and wellbeing benefits of his model. In parallel, Autofabricantes has been accepted into one of the most prestigious acceleration platforms in the diversity sphere, espacIA, fostered by Fundación Once (the biggest Foundation in Europe working with and for people with functional diversity) and PWC to explore and select the best option for achieving medical homologation, meaning the approval of the Autofabricantes products within the catalogue of orthopaedical aids.

Changing the system

Fran´s organization has evaluated the different elements of the system that need to be reached to make his medically validated process a mainstream option.

He is working with local and national associations focused on children with functional diversity to create awareness of the methodology and to invite them to participate in workshops. As noted above he has already consolidated a strong relationship with the largest third sector organization in this arena in Spain.

To establish buy in from the public health system, he is working hand in hand with the Coruña hospital for validation, with the children´s hospital in Spain on creating a pilot case and has begun to approach the School of Traumatologists (the specialists who in the future would prescribe this kind of solution) to create awareness and also to define further hurdles that will need to be overcome.

He has established a working partnership with the Spanish Association of Manufacturers and Distributers to present Autofabricantes to a new public administration initiative called “Innovative Public Purchasing.” This initiative is a tool to promote innovation from the public sector, specifically through the acquisition of innovative solutions or solutions in the development phase.

Autofabricantes’ work has been a focus for both academic and scientific research by many volunteers and university departments. Fran has also convinced universities to engage in the project in different ways: by introducing their design students into his research community as part of the university work curriculum and accessing the university’s labs and materials for his purposes. Autofabricantes´s methodology is in the process of becoming part of a design degree of Barcelona´s public university with the medium-term objective of including patient-centered design as a module in all product design degrees. Fran is convinced that the inclusion of Autofabricantes’ work for design students as work experience will result in a mindset change in the medium term. Over 200 students have applied, and 100 have actively collaborated on the projects.

Due to Autofabricantes’ work and conversations with Fran and his team, the principal orthopedic companies are beginning to reconsider their approach to design and to update their processes.

Structure

Autofabricantes is a non-profit association. The project has 15 team members with another 10 external members that provide occasional technical support. All members are volunteers. They obtain funding through grants and donations, and occasionally offer workshops for a fee. Fran is currently working on new lines of financing, philanthropy or return through training services. The organization has low overhead costs as they work with existing technological structures (Council citizen labs, FabLabs), have pro-bono agreements with tech suppliers and the multifunctional teams are all volunteers. Supported by Fundación ONCE, they are working on new lines of financing, philanthropy and return through training services.

Fran has worked himself directly with 50 families which represents 10% of the affected population in Spain, to test and designing his methodology, and they have created over 20 tried and tested prothesis, all of which have been uploaded online and can be 3D printed and used. His designs have been downloaded and used +2000 times all around the world. His three-year goal set at creating awareness in the totality of the affected population and creating personalized solutions for 50% to 75%. There will always be a part of the population who do not want any kind of prothesis at all.

In terms of geographical expansion, the methodology has been replicated in three different regions in Spain and has been exported to Colombia, Italy, Brazil, Morocco, and Uruguay. Fran has begun to work with victims of landmines, normally children employed in agriculture who lose one or both hands (6,000 people per year worldwide). These children are stigmatized and marginalized, leading Fran to work on special designs and color, and prototyping his solutions in Colombia and Mali. Autofabricantes approach is to offer their methodology to specialized organizations already on the ground and to that end, they are currently working to generate alliances and strategic collaboration with AECID (Spanish Agency for International Development), the Red Cross, Vicente Ferrer foundation in India, and others.

The outcomes of the project show that children take less than a week to master their new prothesis and 6 months later 100% of the participants continue to use their Autofabricantes prothesis. Of the participants, 100% of the kids declare to have more autonomy and after two weeks of using it they have generally found up to three new tasks that they can complete with their prothesis.

All participants without exception recommend the Autofabricantes process and community and 60% continue their relationship with Autofabricantes after one year. Most importantly 95% of participants declare improved self-esteem and better social integration. On a qualitative level, families report that participants take their new prothesis to school and out to play without hiding it.

The Person

Fran was born in a small rural village with 2,000 people, in Extremadura, a region in the west of Spain. He was chess champion in his school when he was eight years old, and he won the Mathematics Olympics of Extremadura when he was fourteen.

His upbringing was simple and straightforward in a close knit, agricultural community. Fran describes that upbringing as the essence of his adult aspirations – wherever he is he feels the need to build a community, share knowledge, consider the common good rather than the individual.

Fran has always had an appetite for innovation and technology. When he was a child, he opened and tried to fix all the broken appliances at home, he liked to understand how they worked and asked himself why it was so difficult to repair them or make your own devices. This need to repair and create for Fran was always a collaborative process, whatever was created had to be shared and he soon learned that solutions or ideas were always better when conceived in a group or a team. This led him, at fifteen to convince the municipal government to donate a space to him and his peers so that local youth groups could use it as a creative and explorative space.

At the age of twenty-two, (when he was studying architecture), he projected a complete refurbishment of the local theatre and movie theatre. Fran only understands architecture as a collaborative experience, and so he organized a public event with the whole town present to share the proposal and listen to their feedback. In this process, Fran learned that his proactivity, active listening, and ability to engage different agents would be key skills in creating successful collaborative projects.

In 2012, whilst completing his undergraduate degree in architecture in the University of Sevilla, found his community in the FabLab laboratory. It was there when he discovered the world of new technologies and new materials, and the potential impact they could have on current R&D methodologies. He found out that these new tools could help make technological solutions much more efficient, transformative, and coupled with his collaborative focus, far more successful.

In 2015, a close friend had a baby girl, Paula, born without a hand. This led to the creation of his first big project “Exando una mano” (Giving a Hand), where he worked alongside the family, learning with the child, and creating gadgets that were not only accessible but useful and empowered the child.

This interaction and the grant given to the newly formed Autofabricantes led Fran to create a bigger organization, to reach more families in need and create a community.