The key to better primary health care? Human-centered design

August 30, 2019 by Kelly Huffman

Human-centered design is an approach to problem-solving that puts people first. Their needs, their constraints, their contexts and their perspectives. It focuses on users—not necessarily what designers, researchers, or others think users need.

RG451934-edit-2000px.jpg Tanzania healthcare workers working on mobile digital devices. Photo: PATH (BID/digital health via Hallie)

A health worker in Tanzania enters data into an electronic immunization registry. Feedback from health workers played a critical role in refining the software to make it more effective. Photo: PATH.

At PATH, design thinking is in our DNA. For more than 40 years, we’ve used it to create some of our most noteworthy products, including the Nifty Cup, Caya Diaphragm, and Uterine Balloon Tampenade.

But this approach doesn’t only propel product development. We believe it’s the path to primary health care that meets the needs of every community around the world. Primary health care is the most basic package of essential health services and products. Its purpose: prevent disease, promote health, and manage illness. To be effective, it must take a people-centered approach, placing individuals, patients, and caregivers at the heart of service design and delivery.

People-centered data innovation: The Better Immunization Data Initiative

Immunization is the backbone of primary health care services. In Tanzania and Zambia, PATH’s Better Immunization Data (BID) project worked with people at every level of the health system—community health workers, facility staff, district and provincial managers, and national-level staff—to develop electronic immunization registries. The goal: improve immunization programs and increase the number of children they reach.

In keeping with human-centered design principles, BID took an iterative, evolutionary approach to creating the new registries. User advisory groups provided critical input that helped define data needs, refine innovations, and plan rollout strategies. Over the first five years of the project, BID tested four different software platforms in order to finally arrive at the two solutions now used in both countries.

They [BID] didn’t just give the equipment; they solicited our opinion. We share our views and if there is something that should be adjusted, they do it.
— Beatrice Owawa, Medical Attendant, Usa River Health System, Tanzania

The new systems replaced stacks of paper records with tablets and other electronic tools. On immunization days, health workers simply scan a barcode or QR code on each patient’s health card and update their record in the registry. The system automatically tracks immunization records and notifies clinic staff when children in their catchment area are due for immunization; which vaccines they need; and how much stock and supplies the clinic requires.

By giving health workers and parents the data they need to deliver the right vaccine at the right time, the new registry puts people at the center of primary health care.

In Tanzania, 344 health facilities in the Tanga Region have already shifted to a paperless immunization system. More are slated to follow suit this year. Tanzania plans to scale their EIR nationally and to integrate it with other health information systems with the goal of accelerating progress to timely immunization coverage for all.

Designing best practices: self-injectable contraception

People-centered care means shifting care to the community, and even bringing it directly to individuals when possible. And the Sayana® Press (DMPA-SC) puts health directly in women’s hands. It’s an all-in-one contraceptive device that combines a plastic bulb of medication with a single-use needle. A single injection—which can be administered by women themselves—prevents pregnancy for three months.

Previous research by PATH and partners has found that women can self-administer DMPA-SC safely and effectively, that they like doing so, and that self-injection enables them to continue using the method longer than injections from providers.

But how do women best learn to self-inject outside of research studies, in routine primary health care settings? Uganda paved the way, becoming the first country in the world to offer contraceptive self-injection outside of a research setting. Taking a human-centered design approach to identify best practices and user needs, as well as health system realities, we began by reviewing the previous studies to design “best guess” models and created journey maps to highlight client and provider perspectives through every step of the program.

With this framework in place, we facilitated workshops and interviews to solicit input from stakeholder groups: clients, facility-based providers, community health workers, district and ministry of health leadership, and implementing partners. After incorporating their feedback, we launched a three-month “rapid pilot” at four clinics. Intensive monitoring and interviews enabled us to test and refine our approach.

I am in charge now. I inject myself from home, in the bathroom, or anywhere. If I ever have another child, it will be because I want one.
— DMPA-SC [Sayana Press] self-injection client, Uganda

After the rapid pilots, self-injection was offered across delivery channels in four Ugandan districts: public-sector facilities, community-based distribution, and safe spaces for young women and adolescent girls. In the first year of the project, more than 7,000 women began self-injecting through this program. In late 2018, self-injection became a new option in select private sector clinics, drug shops, and pharmacies.

Now several other countries are beginning to offer self-injection, including the Democratic Republic of the Congo, Madagascar, Malawi, Nigeria, Senegal, and Zambia.

By leveraging human-centered design principles, we can reimagine primary health care to improve lives with systems that put people where they belong: in the center.