In hard-to-reach areas where previous investments in SBC have yielded limited results, engaging the community in identifying, co-designing, and co-delivering local solutions is critical. All too often, we, as SBC implementers, lead with preconceived notions of what interventions are needed and then adapt packaged interventions to work in a local context, instead of going into a community and truly co-designing interventions with the community they will serve.


In Uganda, large investments have been made to increase demand for and use of family planning (FP) in the Karamoja region, with limited results. In 2019, FCDO/Reducing high fertility rates and Improving Sexual Reproductive health outcomes (RISE) began working in Karamoja to increase demand for FP services in response to its high total fertility rate and single digit contraceptive prevalence rate. Through co-design sessions with women, men, youth, and community leaders, RISE gained deeper insights into how to work in Karamoja and what interventions were needed to successfully increase demand for FP services. These insights revealed key barriers to FP uptake include social and gender norms around men's FP decision-making authority and a lack of culture of FP use, as well as the need to engage elders as community gatekeepers and influencers. 


This presentation will provide an overview of the process used to co-design and co-deliver successful community mobilization through elders, its impact on increasing FP use in project districts, and how this approach can be used in other contexts.

Malaria prevalence in Guyana is highest among men and in the hard-to-reach hinterland regions, where mining and logging activities create favorable environments for mosquito breeding and where malaria testing and treatment services are limited. Formative research conducted by Breakthrough ACTION Guyana and the Ministry of Health found that malaria treatment adherence and risk perception are low among miners. Various insights were identified, including negative perceptions of complicated treatment regimens and not knowing that they can eliminate malaria parasites from the body by following the entire treatment regimen.
Breakthrough ACTION Guyana convened the Ministry of Health (MOH), PAHO Brazil, USAID, the Guyana Food and Drug Department (FDD), and the Materials Management Unit (MMU) in Guyana to better understand the feasibility of creating new packaging for malaria medication in Guyana. Various low-fidelity prototypes were co-designed and tested with end-users using a human-centered design approach. The final prototype for testing consisted of three water-resistant envelopes visualizing the treatment regimen and diminishing parasites in the body for P. falciparum, P. vivax, and mixed malaria infection with images.
Preliminary results from this intervention show that envelopes have successfully simplified complicated treatment regimens, increased awareness that malaria can be cured, and motivated adherence among miners. Multi-sectoral and international collaboration was critical to ensure viable repackaging and bring light to the feasibility and sustainability of this intervention in Guyana prior to full-scale implementation.

Partners in the immunization supply chain ecosystem have created a wealth of guidance for the immunization and immunization supply chain (iSC) community, including Expanded Programme on Immunization (EPI) managers, supply chain actors, and implementing partners. However, it is unclear if and how these guidance documents are used. If the guidance provided in these documents are not being applied by their intended audiences, it is not clear why or what strategies could be implemented to translate guidance into action.


This activity implemented a human-centered design (HCD) approach to analyze insights gathered from consultations with EPI managers and co-create solutions to address the challenges related to developing, sharing, and utilizing global guidance documents. 

The activity demonstrated the potential for HCD approaches to influence sustained adoption of new behaviors through the participatory design of resources. Next steps are to test new approaches for creating and disseminating guidance resources that improve the adoption of best practices, techniques, and approaches for immunization supply chain management.

Despite being a crucial factor in controlling hospital-acquired infections, the global compliance rate for hand hygiene is low. Direct supervision and feedback can help in behaviour change, but are difficult to sustain in resource-constrained settings. Some studies indicate that artificial intelligence (AI) can be used instead but in countries like India, technology can exacerbate structural disadvantages if it is not deployed with care. We therefore employed human-centred design to explore how AI may be implemented in public health facilities, where hierarchy is rife.
A two-part AI-enabled system was installed in seven hospitals. Health workers received live feedback on their hand washes through a display monitor at the basin. This data was anonymised, aggregated, and made available to the management through a dashboard. In our foundational research we found that handwashing, and the uptake of new technologies are affected by individual and organisational factors such as awareness, motivation, and team support to name a few. So the final set of interventions focussed on the AI system and its larger milieu. These interventions were developed through an iterative process with regular inputs from our end users. 
Through this project, we have learned that communication design; proper onboarding; grievance redressal; and data visualisation go a long way in improving the uptake of any new machine. Automated feedback can also be empowering in facilities where learning is afflicted by fear and embarrassment. But for AI to land well, as it forays into new domains, deep contextualisation is key.