Strengthing Health: HCD & Community-Led Equity

South Africa's Tuberculosis (TB) epidemic continues to be a major public health challenge, with low testing uptake, stigma, and delayed care contributing to ongoing transmission. Prior to 2023, TB communication was fragmented and lacked a unified national voice. In response, the National Department of Health (NDoH) developed the End TB Campaign aligned with the National TB Strategic Plan and the TB Recovery Plan , aiming to strengthen TB case finding and test five million people annually. To support this objective, the NDoH co-created a people-centred Social and Behaviour Change Communication (SBCC) Strategy and Toolkit that promotes TB testing, raises awareness, reduces stigma, and improves community support. The strategy aligns with the WHO Integrated, People-Centred Health Services framework and draws on behavioural models including COM-B, the Socio-Ecological Model, and the EAST framework. Through extensive stakeholder engagement (government sectors, provinces, TB survivors, civil society, clinicians, youth groups, and Traditional Health Practitioners), the process produced a unified SBCC framework and message architecture grounded in collaboration and shared ownership. Pilot testing and refinement strengthened usability and implementation readiness. The resulting strategy is being rolled out across all nine provinces and comprises key interventions such as My TB Story (digital storytelling platform, Traditional Health Practitioners engagement, youth mobilization, community activations, capacity-building among implementers, and social media and digital campaigns. This collaborative approach demonstrates how co-creation can transform TB communication into a people-centred national ecosystem, connecting systems, stories, and stakeholders in pursuit of a common goal: Ending TB.

Adherence to maternal micronutrient supplementation, specifically Iron Folic Acid (IFA) in Ethiopia is generally considered low. Factors affecting adherence include forgetfulness, heavy household workloads, misinformation and service delivery constraints. To improve adherence to IFA and Multiple Micronutrient Supplements (MMS) among pregnant women, we applied a Human-Centered Design (HCD) process, rooted in a five-step Design Thinking framework (Empathize, Define, Ideate, Prototype, Test) to co-create and iteratively refine low-cost, culturally appropriate Social and Behavior Change (SBC) tools with pregnant women, husbands, health workers and community volunteers. Several prototypes were initially proposed including gamified tools, community reminder approaches and several job-aids. However, iterative testing produced two final tools: a bright household dangler as a daily visual cue and a simple information sheet for women and husbands that can also be used as a counseling aid for health workers. Pre-testing (distribution at ANC, 10-day follow up interviews and observations) found the materials to be easy to use, visually engaging, and showed signs of improving counseling interactions and increased husband engagement. Following a four-month implementation period and a more rigorous evaluation, adherence to both IFA and MMS showed significant improvements of 10.5% and 11.8%, respectively. The HCD approach produced nimble SBC products rooted in local lived experience and service realities, demonstrating a replicable model for adapting SBC interventions.

RajPusht- a cash-plus program that combined maternity cash benefits with Social and Behaviour Change Communication (SBCC) strategy, recognises that addressing maternal undernutrition requires an approach tailored to the community realities and grounded in the lived experiences. Extensive formative research conducted across five tribal districts of Rajasthan revealed key gatekeepers, deep-rooted cultural beliefs, prevailing myths and misconceptions related to food items, household intra-dynamics, food allocation practices and gendered decision-making. These insights were utilised to develop an SBCC strategy prioritising equity, inclusion, and community-owned messaging. 
Under RajPusht, co-creation of evidence-backed SBCC interventions with local communities were drawn on positive traditional practices, challenging restrictive norms targeted to create an enabling environment for pregnant women to practice healthy behaviours. Furthermore, engaging husbands, mothers-in-law, and frontline workers as allies fostered shared responsibility for maternal nutrition. Lastly, appropriate platforms to deliver SBCC messaging were identified to ensure optimum coverage, last mile reach, high engagement levels and culturally acceptable content. 
Findings from the implementation of the SBCC interventions showed increased awareness of maternal nutrition, busting of myths and taboos related to food items, and overall improved maternal diet diversity. These findings suggest that developing SBCC interventions informed by communities successfully shift the needle by enabling a positive ecosystem to practice healthy maternal behaviours. RajPusht supports evidence that placing community knowledge at the centre of designing SBCC strategy leads to more inclusive, sustainable, and impactful solutions to persistent nutrition challenges. 

Lafia's solutions are designed to support any health provider who is willing to integrate technology into their practice, whether they work in a national referral hospital, a peri-urban health center, a private clinic, or a community drug shop. We do not replace existing systems; we enhance them by assisting providers in delivering more personalized, responsive, and supportive care.