Innovation for culturally relevant health care

In Indonesia, family members commonly serve as family caregivers, providing essential physical and emotional care to members of their family who have medical conditions. However, the mental and emotional burden of family caregivers is rarely discussed. This study aims to explore the mental and emotional burden of family caregivers in Indonesia. The current study uses qualitative design applying focus groups with semi-structured topic guides. There were a total of 53 family caregivers aged 25 - 66 from 32 cities in 15 provinces in Indonesia and cared for people with various medical conditions such as non-communicable diseases, tuberculosis, disabilities, autism, pregnancy, and many more. This study resulted in four themes and 14 categories covering family caregivers' physical challenges, mental and emotional burden, social construct and relationships, and coping mechanisms. Despite the significant amount of mental and emotional challenges, there is limited support available for the caregivers within the health system. The Care Companion Program (CCP) in Indonesia introduces Basic Caregiving Skills as part of its health education contents to empower family caregivers with the skills to provide psychological support for people with medical conditions. 
Keywords: Family caregivers, qualitative studies, Indonesia, mental and emotional burden, health policy

Traditional evidence hierarchies often privilege quantitative data while marginalizing community-derived insights and cultural knowledge. Project RISE (Ritual to Improve Service Delivery and Empower Health Workers) is a paradigm that integrates human-centered design with mixed-methods research to understand and enhance the performance of ASHA (Accredited Social Health Activists) in Bihar, India. Rather than imposing external frameworks, we employed expansive ideation processes that positioned ASHAs and communities as co-creators of knowledge, rather than merely as data sources. Our three-phase approach (Discover, Define, Create) systematically transformed local insights into actionable solutions through design-led synthesis. The Cultural Ecology of Health framework mapped the liminal position of ASHAs between biomedical and traditional systems, revealing how their dual identity as community members and health workers creates unique challenges and opportunities. Through collaborative workshops involving researchers, designers, ASHAs, and community members, we developed a ritualization framework that leverages existing cultural practices rather than replacing them. This approach yielded ten culturally resonant solution concepts that addressed ASHAs' support needs, community relationships, and health system tensions. Critically, we established an open-source knowledge repository that democratizes access to findings and methods, challenging traditional academic gatekeeping. Project RISE demonstrates that meaningful evidence emerges not only from hierarchical research designs, but also from recognizing multiple forms of knowledge-cultural, experiential, and embodied-as equally valid and valuable. By repositioning community health workers from research subjects to knowledge producers, we created solutions that are scientifically rigorous and culturally authentic, ultimately improving maternal and child health outcomes.

Ensuring high-quality malaria service delivery requires not only training but an understanding of behavioral and contextual drivers that shape provider practices. Breakthrough ACTION and the U.S. President's Malaria Initiative (PMI), in collaboration with the National Malaria Control Program (NMCP), piloted a new Malaria Service Delivery Assessment Tool in six health facilities across Kongo Central and Haut Katanga provinces in the Democratic Republic of the Congo (DRC). The tool combines structured interviews, observations, and document reviews to systematically identify factors contributing to service delivery challenges. Providers were directly involved in reviewing and synthesizing the results and recommendations. 
The pilot revealed common gaps across facilities: misaligned financial incentives encouraging use of microscopy over WHO-recommended rapid diagnostic tests; over-prescription of anti-malarials despite negative malaria test results; non-adherence to directly observed therapy for intermittent preventive treatment in pregnancy; frequent stockouts of commodities; and poor record-keeping practices. Providers also reported limited supervision, unclear roles, and inconsistent policy messaging. By incorporating a behavioral lens, the tool surfaced rational provider adaptations to systemic constraints-such as treating severe malaria cases despite lacking referral capacity-and highlighted actionable solutions that facilities, districts, and partners could adopt. 
The pilot demonstrated the feasibility of the tool in diverse types of facilities, its ability to generate actionable insights without disrupting service delivery, and its potential to strengthen supervision, data quality, and provider support. Broader application could help ministries and partners not only identify gaps but also address underlying behavioral and systemic drivers of malaria service delivery performance. 

Globally, governments recognize the value of behavioural science to design social and behaviour change (SBC) interventions and strengthen programme outcomes across various sectors. UNICEF India has advanced this agenda by establishing decentralized Behavioural Insights Units (BIUs) across six states. These BIUs are designed as government-anchored platforms to generate participatory, evidence-based solutions rooted in behavioural science for SBC programming across various sectors. For example, the BIU in Gujarat generated SBC solutions to reduce anaemia in the state within its State Health Systems Resource Centre, leveraging government budgets. This approach to SBC programming contributes to better outcomes for children and mothers in India, as it ensures that these beneficiaries are central to, and co- creators in the solutions that are meant for them and respond directly to their needs. This abstract contributes to the Summit's sub-theme of Evidence Generation by offering a model of how evidence- based SBC solutions can be scaled using BIUs in middle income countries like India. The presentation will showcase how the BIUs are being institutionalised in India through six 'building blocks' - Institutionalization, Evidence Generation, Funding, Capacitation, Ownership, and Visibility. This model demonstrates that to develop SBC interventions rooted in behaviour science, platforms like the BIUs are essential within government systems. Furthermore, to ensure BIUs' sustainability, systems strengthening, capacity within government systems and fostering government ownership are imperative. It is then that government programmes can truly respond to the nuanced requirements for the uptake of positive behaviours and practices among beneficiaries, leading to better outcomes.