Human-centered Design (HCD) is a form of inquiry and solution generation that is applied in the conceptual stages of a planning process and subsequent stages of program or product development. The HCD process is described as open-minded, iterative, and human-centered and is intended to result in innovative solutions. It is used to help define problems from the user perspective, explore user needs and desires with respect to a particular issue or problem, and identify solutions to address those needs and desires. In the context of global health, HCD is emerging as an approach to enhance the effectiveness of health program interventions and give voice to clients and providers. From 2012 to 2016, HCD was applied in three MNCH projects in Africa. Case studies were conducted to explore the application and influence of HCD, filling a gap in evidence and understanding of the potential of HCD for improving the effectiveness of global health programming. It was found that there were changes in program implementers behavior: 1. Increased frequency of consultation with health workers and health service clients. 2. Increased prominence given to feedback loops and the importance of user-driven adaptation of program interventions. It was concluded that: Human-centered health program design methods: 1. Are useful for gaining new or deeper insights into health-related or health-service related experiences and behaviors and defining barriers to health solutions. 2. Prioritize the community voice in solution generation and adaptation. 3. Contribute effectively to the acceptability and uptake of public health-focused products, roles and behaviors, creating better “fit.” 4. Offer a fresh approach to program design that goes beyond and may challenge normative assumptions about health worker and health client experience. 5. Humbles health program designers and implementers. This poster was presented at the Fifth Global Symposium on Health Systems Research in Liverpool in October by Anne LaFond

1. HUMAN-CENTERED DESIGN GIVESVOICE TO
COMMUNITIES & COMMUNITY HEALTH WORKERS:
Lessons fromThree MNCH Case Studies
THE QUESTION
Authors: Anne LaFond, JSI Research & Training Institute, Inc. (JSI); Natasha Kanagat, JSI; and Nikki Davis, JSI
JSI: Arlington, Virginia, United States
What is HCD?
Human-centered Design (HCD) is a form of inquiry and solution generation that is applied in the conceptual stages of a planning
process and subsequent stages of program or product development. The HCD process is described as open-minded, iterative, and
human-centered and is intended to result in innovative solutions. It is used to help define problems from the user perspective,
explore user needs and desires with respect to a particular issue or problem, and identify solutions to address those needs
and desires. In the context of global health, HCD is emerging as an approach to enhance the effectiveness of health program
interventions and give voice to clients and providers.
This research was conducted as part of the Innovations for MNCH Initiative, implemented by Concern Worldwide and funded by The Bill & Melinda Gates Foundation. JSI served as the global
research partner for Innovations. Photos courtesy of Concern Worldwide and Emily Stammer, JSI. Poster designed by Suzanne Slattery.
APPLICATION OF HCD
HCD GIVESVOICE TO COMMUNITY LEVEL ACTORS IN PROGRAM DESIGN AND ADAPTION
REFLECTION ON THE INFLUENCE OF HCD CONCLUSIONS
Essential Newborn Care Corps
(ENCC)
Transforming the role of TBAs into
community-based health promoters
and micro enterprise owners. Sierra
Leone.
End users: Traditional Birth
Attendants (TBA)
Community Care Hub (CCH)
Improving the motivation and
job satisfaction of Community
Health Nurses. Ghana.
End users: Community
Health Nurses (CHN)
Community Benefits Health
(CBH)
Improving use of MNCH services
among women through use of a
non-monetary, community-wide
incentive. Northern Ghana.
End users: Women of child
bearing age & community
influencers
ENCC
Using HCD techniques, TBAs defined steps to introduce and ensure their
acceptance in the community as they transitioned out of delivering babies
(which was banned by government) into an official health promotion role.
TBA voices shaped the image and brand of the new health promoter role,
referral procedures, social franchise practices, and their relationship to
government PHC units and teams.
CBH
From HCD implementers learned of community needs (water, emergency
transport) and the type of reward the community would value, and used
this to define the choice of incentive. Learning from HCD also shaped the
use of community governance structures and traditional celebrations to
encourage community acceptance of the incentive scheme.
ENCC
Among TBAs, near 100% adoption and adherence to their new role as
health promoters, in spite of program cessation during the Ebola epidemic.
Acceptance of health promoter role by community and formal health
services. Health promoters provided an important bridge between the
health system and the community.
CCH
CHNs adopted, appreciated and continued to use the CHN on the Go
app. 94% reported that the app met their needs. Use of CHN on the
Go addressed intrinsic and extrinsic elements of motivation including:
workload; self-confidence; perceived recognition by community, supervisors
and peers; feelings of connectedness; and job security.
CBH
Community adoption of their role in managing non-monetary, community-
wide incentive scheme and encouraging increased community engagement
in decision-making for women’s and children’s health.
Changes in program implementers behavior:
»» Increased frequency of consultation with health workers and
health service clients
»» Increased prominence given to feedback loops and the
importance of user-driven adaptation of program interventions
Human-centered health program design methods:
»» Are useful for gaining new or deeper insights into health-related or
health-service related experiences and behaviors and defining barriers
to health solutions
»» Prioritize the community voice in solution generation and adaptation
»» Contribute effectively to the acceptability and uptake of public health-
focused products, roles and behaviors, creating better “fit”
»» Offer a fresh approach to program design that goes beyond and may
challenge normative assumptions about health worker and health
client experience
»» Humbles health program designers and implementers
Study Methods
Explorative, comparative, mixed-method case-studies,
to generate learning on the application of HCD to
MNCH programming within real-world contexts.
Primary and secondary data sources:
1) routine pilot monitoring; 2) rigorous program
evaluation (baseline and endline studies); 3) process
documentation, consisting of in-depth, semi-structured
interviews, group discussion, and observation to
document and assess the proposed and actual
pathways between program intervention and program
effectiveness and to document and explore the
application and influence of HCD.
Limits: Intent was exploration of HCD not evaluation.
Unable to assess the influence of HCD on the pace of
uptake of the intervention.
What is HCD’s role?
From 2012 to 2016, HCD was applied
in three MNCH projects in Africa.
Case studies were conducted to
explore the application and influence
of HCD, filling a gap in evidence and
understanding of the potential of HCD
for improving the effectiveness of
global health programming.
In each project, HCD was applied
to varying degrees in order to gain
insights into health workers and
health service client experience,
needs and desires, and give them
a voice in shaping health program
interventions.
JSI Research &Training Institute, Inc.
HCD was applied at a different level of intensity in each project.
Professional designers worked with implementers in CBH and CCH
projects and in ENCC, implementers introduced HCD independently,
using an HCD toolkit.
HCD techniques included: immersion (qualitative research and
engagement); journey mapping; user persona development; and co-
creation, including rapid prototyping (cycles of iteration to design, test
and redesign different elements of the pilot).
CCH
From HCD exploration of nurses’ workplace experience
emerged 6 opportunity spaces to address motivational
challenges of providing health care in remote
settings that were translated by software developers
and program implementers into the mobile phone
application: CHN On the Go. Nurses played a pivotal
role in adapting early prototypes and formulating
content.“[I am] trying to think of a time when
beneficiaries were involved as actively
as they were in rapid prototyping [in
ENCC]. I can’t think of an instance
when they were so heavily involved
in deciding their ‘identity.’ Of course
other NGOs would ask: ‘What do
you want to be called?’ But actually
putting a marker in someone’s hand
and empowering them in that way is
completely different.”
“So the main purpose [of design
thinking] was… making sure
that we can really understand
the problem of motivation or
demotivation for the nurses
and the reasons why... and
to make sure whatever we
were developing was actually
something they could use and
actually address their problems.”
“Something that is also different
[about design thinking] is getting to
the extent to which we understand
the community perceptions.The
community is part of the decision-
making process, and I think in
standard public health programming
we miss out on that because we are
the experts and we are packaging
and deliver messages.With this
one, it is not our message; it is the
community’s message.”
“I think [the implementers} do feel very invested in
the project and making it work.And making sure
the [end users] are happy, but also performing. So
I think that is something that has come from the
level of engagement that they had with [end users]
as part of the project design.”
Knowing how
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