Designing with the experts: End users

November 10, 2021 by Joyce Bayona and Celina Kareiva

A leading-edge partnership with the Government of Tanzania uses human-centered design to craft more user-friendly digital health systems.

_T9C0873.jpg A woman in Africa looks at her mobile phone.

A nurse uses her phone at a health facility in Arusha, Tanzania. Photo: PATH.

In Dodoma, Tanzania, a small group of people have come together to test a new digital health tool that will make it easier to track and improve the performance of health facilities.

Comprised of key health actors, software designers, and engineers, the group is using a process called the Collaborative Requirements Development Methodology (CRDM) to map the current paper-based system and redefine workflows with a digital system in mind (PATH has used and adapted the CRDM process developed by the Public Health Informatics Institute extensively over the years).

Together, they are developing a new digital health system that will make it easier to track how well health facilities are performing against their targets and where there may be areas to improve the quality of care.

Ask the experts

As the group navigates the development process—which will include the creation of dashboards for health managers and disease-specific digital checklists for supervisors to evaluate health facility performance—PATH staff ask these key health actors questions about their experience: What are the pain points within the current paper-based system? When and where do you struggle to get quality data? What kinds of digital functionality would save you time while caring for patients or supervising clinics? And so on...

“Digital tools are only as powerful as the health workers using them,” explains Oswald Luoga, Product Development Lead for the Data Use Partnership initiative at PATH, a government-led initiative designing, developing, and implementing a series of new digital and data tools to strengthen Tanzania’s health system. Luoga continues, “Strong digital health systems must be designed with their end users in mind, by engaging them throughout the development process. Otherwise, the system will collect dust on a shelf.”

Human-centered design

PATH champions human-centered design (HCD) approaches to develop digital systems that are more user-friendly, intuitive, and effective. HCD focuses on co-designing a tool or system with its intended users to ensure a more engaging and seamless digital experience. It requires software designers and implementers to co-create tools and systems that truly address people’s pain points and needs, instead of prescribing solutions based on assumptions.

“Health workers are experts at their jobs and know how digital tools can best meet their needs.”
— Oswald Luoga, Product Development Lead, PATH

“HCD involves shifting how we work with health workers during the software development process to account for the behavioral aspects of adopting digital tools,” says Luoga. “It recognizes that end users—in this case, health workers—are experts at their jobs and know how digital tools can best meet their needs.”

There are many tools for employing HCD—including developing user personas to understand the different people who come into contact with a system, participatory research methods, and focus group discussions. A leading approach for PATH has been the formation of User Advisory Groups composed of health actors at different levels of the health system. This can include everyone from providers and patients, to the health managers reviewing compiled reports; the district administrative officers allocating facility budgets; and the health dispensary employees restocking clinic shelves.

“Health workers are more likely to use a system that is responsive and designed for the relief of pain points they encounter in their daily jobs. Instead of having software engineers who don’t understand the cultural context, business process within the health care system, and daily job responsibilities of a health worker hypothesize about the challenges they encounter, PATH’s approach is to involve them in the design process from the outset,” said Eden Tarimo, Digital Health Lead for the DUP initiative at PATH. “Health workers are more likely to use a system they had a role in making.”

Reflecting user feedback

A critical part of any HCD approach, is reflecting user feedback within the design of new digital systems and tools. These inputs strengthen the final product and ensure it meets the diverse needs of its users.

For example, when the DUP team was designing the Afya Supportive Supervision system (part of Tanzania’s digital health platform), it asked health managers about the obstacles they used to face with a paper-based supervision system. They learned that it was often difficult to verify if a visit had been conducted. Supervisors sometimes falsely reported visiting health facilities and paper-based systems did not allow for any means of verification.

After hearing this concern in a UAG meeting, the DUP team worked with software engineers to design for this challenge within the future AfyaSS system. The result is a digital feature that requires users conducting supervisory visits to log their start and end coordinates. The system then maps those coordinates against local health facilities to confirm health facilities were actually visited and evaluated against their performance targets.

In this way, HCD approaches can improve health service delivery by recognizing and centering the lived experiences and expertise of the health workers our sector seeks to support.