Adaptive SBC: Reaching People in Complex & Changing Contexts

Generating equitable impact requires adapting and redesigning delivery systems, messages, and engagement channels to reach those excluded by geography, mobility, or socioeconomic barriers as well as to meet expressed community needs. We often collect data on health service users' preferences and needs, but still only meet them half-way, failing to adapt and reach them where they are.
Guided by the principles of equity and inclusion across multiple contexts, we generated understanding on community structures, barriers and enablers to health seeking behaviour and service preferences, including in Nigeria's malaria high-transmission zones, and in nomadic, remote and conflict and flood affected communities in Chad, South Sudan, and Uganda, and took malaria prevention that extra mile.
In Nigeria, Seasonal Malaria Chemoprevention (SMC) campaigns are house-to-house, but our distribution approach was failing in urban settings. We engaged faith leaders and local congregations, partnering with churches as trusted spaces to give children life-saving medicines in the churches. In South Sudan, teams co-designed mobile strategies and pre-positioned stocks with displaced and flood-affected communities, ensuring access to SMC despite shifting settlements.
In Uganda, under-served groups were still being missed. Malaria outreach engaged nomadic and semi-nomadic groups aligning with their seasonal movements through social networks so that children in transient households did not miss out on SMC.
And in both Nigeria and Uganda, our Be In A Net project seeks to transform usage of Insecticide -Treated Nets (ITNs), addressing net discomfort by engaging communities to choose their preferred net type.

When you  think of Human-Centered Design (HCD), you might picture empathy, co-creation, and deep listening - a process that puts people at the heart of every solution. 
But what happens when time runs short, fear runs high, and the world around you is shifting by the hour? 
Human-Centered Design has become a buzzword in global health and humanitarian response, often associated with creativity and empathy. Yet in emergencies, when systems are strained and decisions must be made fast, traditional notions of "deep" design rarely fit. Drawing on experience from the Mpox and SEA response efforts in East Africa, this story explores how HCD can stay human even when time is short. The key lies not in doing more design, but in being ready to design: investing in local capacity, trusted partnerships, and flexible systems before crises hit. Rapid behavioural prototyping during the Mpox response showed that readiness, iteration, and fit, not novelty, enable meaningful co-creation under pressure. When design mindsets are embedded in local systems, they can adapt in real time, shaping solutions that are credible, scalable, and rooted in context. This talk reimagines HCD not as a luxury that emergencies can't afford, but as a practical discipline that helps people navigate uncertainty with empathy, evidence, and agility.

Health chatbots offer a promising approach to improve referrals to care for individuals not yet engaged with the health system. To be effective, the chatbot experience must be fluid and frictionless. The askNivi chatbot has reached more than 2 million users across five countries with goal-oriented journeys on multiple health topics. Despite the reach, conversion rates at key points remain suboptimal. This abstract addresses conversion challenges and user-centered solutions.
Although users onboarded in large numbers, significantly fewer reached the intent detection question, which identifies user needs and routes them to appropriate resources. The initial question assumed users were interested in finding a provider, receiving contraceptive counseling, or learning about a method. Given the low conversion rate, Nivi analyzed 9,714 user messages for key themes and priorities. Results indicated the intent detection question did not correspond to users' priorities. Instead, users were asking about specific contraceptive methods (22%), side effects and safety (10%), general reproductive health information (7%), and emergency guidance (5%). Users weren't navigating the system as assumed; they were asking direct questions in their colloquial language.
Nivi updated the experience to align with user needs and intuitive patterns. The menu was updated: "Find doctor," "Choose method," "Learn options," "Urgent help," "Post-abortion support," "Side effects." Improved conversion was immediate, jumping from 63% to 77%, a 38% improvement in user retention.
Being grounded in user feedback is essential for creating products that treat feedback as a loop for innovation and align design with users' intuitive behavioral patterns.