Expanding a project to a new country requires a careful blend of strategic planning, collaboration, and a deep understanding of the local context. This year, Living Labs introduced our human-centered design (HCD) approach to new geographies, including Ethiopia. The goal was to provide technical assistance that would not only enhance the capacity of local stakeholders but also ensure that the tools and services were better equipped to meet the needs of the communities they serve.
Strategic approach to expansion
As we initiated HCD activities in Ethiopia, we recognized that the Ethiopian Ministry of Health has already championed this effort, creating guidelines that incorporate HCD into immunization programs—an achievement that no other country in the region has done.
Our approach was to blend virtual and in-person support to provide comprehensive, flexible assistance. Initially, we relied on virtual meetings to introduce the concept of HCD to stakeholders. These sessions included detailed case studies, an introduction to the PATHOS toolkit, and discussions about how HCD could be applied in the health sector, particularly in immunization.
The virtual sessions allowed us to start a conversation and build a foundation of knowledge. As the project progressed, we identified areas where additional support was necessary, leading us to organize in-person workshops to deepen the capacity-building efforts. The workshops provided an opportunity for practical, hands-on experience in using HCD tools and developing the mind-set essential for its application in real-world contexts.
Capacity-building workshops
Co-creation session with community leaders in Addis Ababa. Photo: PATH Living Labs
Our first in-person workshop in Ethiopia occurred over four days. It included representatives from the regional health bureau, subcity administrators, health care workers (HCWs) from facilities, and our partners, including the Clinton Health Access Initiative (CHAI), PATH Ethiopia, and the Ethiopian Health Education and Promotion Professionals Association.
The workshop followed our 4D HCD process: Discover, Define, Dream, and Design. During the Discover phase, we introduced tools to help participants develop empathy, such as practical observation exercises. These activities helped them understand the lived experiences of users and stakeholders, building the foundation for effective problem-solving.
In the Define phase, we helped participants synthesize the findings from the Discover stage and begin to articulate the core problems. We quickly introduced Miro, a vitual collaboration tool that we use for affinity mapping, which the partners quickly embraced. They loved the ability to visually organize and prioritize insights collaboratively.
During the Dream/Design phase, the participants learned to translate those insights into solutions, which they could practically apply in their work. At the end of the workshop, participants received certificates acknowledging their newfound skills in HCD. This built their capacity and empowered them to become champions of HCD within their organizations and communities.
From concepts to solutions
The team posing for a group picture after the human-centered design capacity-building workshop. Photo: Clinton Health Access Initiative Ethiopia team.
With support from our team, CHAI led the co-creation workshops, which resulted in six initial concepts—two for each user group: mothers and fathers of zero-dose children, community leaders, and HCWs. During the prioritization workshops, to narrow down the solutions to one per group, they integrated a strong focus on understanding how gender dynamics shape the lives of different user groups. To do this, they did an exercise where participants mapped out the user groups’ daily lives, highlighting their different roles, available time, and responsibilities.
Through reflective exercises, the CHAI team realized that the root causes of the prioritized drivers were the same across the three user groups. The root causes were primarily related to vaccine access, supply, and vaccine-preventable diseases. Upon realizing this, they combined the three concepts into a single intervention: the Community Vaccination Hub. This comprehensive approach includes activities such as ensuring access to vaccinaiton sites through discussions with caregivers, the Woreda administration, and the responsible health center. It also features a demand-creation component and the establishment of role model mothers to encourage vaccination.
To implement this intervention, the Community-Health Facility Partnership Technical Group was established. This group, comprised of caregivers of zero-dose children, community leaders, and health facility representatives, aims to bridge the gaps between the community and health facilities.
Challenges and looking ahead
Awarding Dr. Dejene Duguma, CHAI Vaccine Program Coordinator, a certificate after the HCD capacity-building workshop. Photo: PATH Living Labs.
One of the most common misconceptions we encountered was that HCD is solely about community engagement. This limited perspective overlooks the broader applications of HCD, such as improving service delivery, enhancing data quality, and fostering a systemic mind-set that incorporates all aspects of the health sector.
Drawing on the experience in Addis Ababa, we are developing a playbook for the CHAI Ethiopia team to train other staff. The playbook addresses the challenges of incorporating HCD within the Ethiopian context, particularly in the next two sites, which may face language barriers in pastoral communities and have safety and security issues. Expansion to these sites will happen in early 2025, with both reaching the piloting phase.
Stay tuned for more updates as we catalog our experiences expanding the Living Labs model in Ethiopia and to other geographies. We will announce shortly, the new subrecipient awards to partners from our application request. We are excited to see how the lessons learned in Ethiopia, and in these new geographies, will inspire future work in other countries, ultimately contributing to more effective, people-centered health systems across the region.
