Using Human Centred Design approach to create targeted Maternal and Newborn Health SBCC interventions for urban slum mothers: Lessons from Kampala, Uganda
Summary:
The Kampala Slum Maternal and Newborn Health (MaNe) project is an implementation science project geared towards testing innovative approaches to address demand and supply side barriers affecting care seeking, effective referral, and provision of quality Maternal and Newborn Health (MNH) care equitably, for the urban poor, for better MNH outcomes in urban slum settings of Kampala city. Maternal and newborn deaths remain a major health challenge in Uganda which requires targeted SBCC approaches to create the desired impact. In March and April 2019, MaNe applied the Human Centred Design (HCD) approach to understand target audiences and design targeted SBCC interventions specific to urban slum mothers. During the HCD process, three distinctive phases of the Hear, Create and Design, were conducted. Under each phase, target audience representatives were actively engaged to create data-driven interventions. Subsequently, four broad prototype interventions were designed including adoption of client-centred services, targeted demand generation, strengthening of the referral system and accreditation of suitable health facilities. Community representatives identified specific SBCC techniques that would help to reach them better. These include: roadside market sensitisation, toll free lines for complaints on MNH, sharing MNH information in churches, mosques, and prayer groups, targeted community dialogues on MNH, training providers on customer care, among others. Because of its participatory approach, using HCD to inform SBCC interventions is critical in designing effective and successful interventions with targeted audiences. Their participation in identifying key challenges and solutions increases the likelihood of suitability, practicability and acceptability of the health seeking behaviours.
Background/Objectives:
Maternal and newborn deaths (343 and 27/100,000 live births respectively) remain a major health challenge in Uganda (Uganda Demographic and Health Survey, 2016). With rapid urbanisation, urban health especially for the urban poor remains miserable with most interventions majorly prioritising rural areas. The urban poor in Uganda are estimated to have higher maternal and newborn mortality rates than rural populations, despite physical access to health facilities. This paper describes how The Kampala Slum Maternal and Newborn Health (MaNe) project employed the Human Centred Design (HCD) approach to create targeted SBCC interventions for improving maternal health for urban slum mothers.
Description of Intervention and/or Methods/Design:
In March and April 2019, MaNe applied the principles of the HCD process; Hear, Create and Design to understand target audiences and design targeted SBCC interventions specific to urban slum mothers in two divisions of Kampala which host Kampala's biggest portion of informal settlements. The participants included adolescent mothers and fathers, older women and their partners, pregnant women, health providers, proprietors and local leaders. In the Hear phase, MaNe conducted an extensive formative research study to understand the underlying factors that influence health seeking behaviour of urban slum mothers. In the Create phase, participants suggested solutions to the issues identified. During the Design phase, two co-design workshops were conducted to refine solutions to prototypes which could be implemented to improve MNH service provision for the urban poor within Kampala city. Later, these prototypes have been tested and iteration continues during project life.
Results/Lessons Learned:
The stakeholders selected four broad prototypes to be implemented. These include adoption of client centred MNH services, targeted demand generation for MNH services, strengthening of the referral system and linkages between health facilities, and accreditation of suitable health facilities where women can go for MNH services. Additionally, male involvement, empathy among providers in public health facilities, and need for community savings systems were flagged to need SBCC interventions. The SBCC interventions include: roadside market sensitisation on MNH, toll free lines for complaints on MNH, sharing MNH information in churches, mosques, and prayer groups, targeted community dialogues on MNH, training providers on customer care, among others.
Discussion/Implications for the Field:
HCD is a highly participatory approach making it critical to designing successful SBCC interventions tailored to the needs of target audiences. HCD cultivates empathy among implementers which breaks preconceptions and allows for efficient programming of SBCC interventions. Additionally, working with target audiences to design interventions ensures that the suggestions implemented are acceptable, viable, effective and desirable to these audiences. Whereas it registers excellent results HCD is an expensive, labour and time intensive approach, thus with inconsistent donor funding, implementation of brilliant approaches may be affected. Teams that utilise HCD approaches should work within government structures to increase behaviour change outcomes.
Abstract submitted by:
Mabel Naibere
Elizabeth Kemigisha
Henry Kaula - PSI
Andrew Magunda - PSI
The Kampala Slum Maternal and Newborn Health (MaNe) project is an implementation science project geared towards testing innovative approaches to address demand and supply side barriers affecting care seeking, effective referral, and provision of quality Maternal and Newborn Health (MNH) care equitably, for the urban poor, for better MNH outcomes in urban slum settings of Kampala city. Maternal and newborn deaths remain a major health challenge in Uganda which requires targeted SBCC approaches to create the desired impact. In March and April 2019, MaNe applied the Human Centred Design (HCD) approach to understand target audiences and design targeted SBCC interventions specific to urban slum mothers. During the HCD process, three distinctive phases of the Hear, Create and Design, were conducted. Under each phase, target audience representatives were actively engaged to create data-driven interventions. Subsequently, four broad prototype interventions were designed including adoption of client-centred services, targeted demand generation, strengthening of the referral system and accreditation of suitable health facilities. Community representatives identified specific SBCC techniques that would help to reach them better. These include: roadside market sensitisation, toll free lines for complaints on MNH, sharing MNH information in churches, mosques, and prayer groups, targeted community dialogues on MNH, training providers on customer care, among others. Because of its participatory approach, using HCD to inform SBCC interventions is critical in designing effective and successful interventions with targeted audiences. Their participation in identifying key challenges and solutions increases the likelihood of suitability, practicability and acceptability of the health seeking behaviours.
Background/Objectives:
Maternal and newborn deaths (343 and 27/100,000 live births respectively) remain a major health challenge in Uganda (Uganda Demographic and Health Survey, 2016). With rapid urbanisation, urban health especially for the urban poor remains miserable with most interventions majorly prioritising rural areas. The urban poor in Uganda are estimated to have higher maternal and newborn mortality rates than rural populations, despite physical access to health facilities. This paper describes how The Kampala Slum Maternal and Newborn Health (MaNe) project employed the Human Centred Design (HCD) approach to create targeted SBCC interventions for improving maternal health for urban slum mothers.
Description of Intervention and/or Methods/Design:
In March and April 2019, MaNe applied the principles of the HCD process; Hear, Create and Design to understand target audiences and design targeted SBCC interventions specific to urban slum mothers in two divisions of Kampala which host Kampala's biggest portion of informal settlements. The participants included adolescent mothers and fathers, older women and their partners, pregnant women, health providers, proprietors and local leaders. In the Hear phase, MaNe conducted an extensive formative research study to understand the underlying factors that influence health seeking behaviour of urban slum mothers. In the Create phase, participants suggested solutions to the issues identified. During the Design phase, two co-design workshops were conducted to refine solutions to prototypes which could be implemented to improve MNH service provision for the urban poor within Kampala city. Later, these prototypes have been tested and iteration continues during project life.
Results/Lessons Learned:
The stakeholders selected four broad prototypes to be implemented. These include adoption of client centred MNH services, targeted demand generation for MNH services, strengthening of the referral system and linkages between health facilities, and accreditation of suitable health facilities where women can go for MNH services. Additionally, male involvement, empathy among providers in public health facilities, and need for community savings systems were flagged to need SBCC interventions. The SBCC interventions include: roadside market sensitisation on MNH, toll free lines for complaints on MNH, sharing MNH information in churches, mosques, and prayer groups, targeted community dialogues on MNH, training providers on customer care, among others.
Discussion/Implications for the Field:
HCD is a highly participatory approach making it critical to designing successful SBCC interventions tailored to the needs of target audiences. HCD cultivates empathy among implementers which breaks preconceptions and allows for efficient programming of SBCC interventions. Additionally, working with target audiences to design interventions ensures that the suggestions implemented are acceptable, viable, effective and desirable to these audiences. Whereas it registers excellent results HCD is an expensive, labour and time intensive approach, thus with inconsistent donor funding, implementation of brilliant approaches may be affected. Teams that utilise HCD approaches should work within government structures to increase behaviour change outcomes.
Abstract submitted by:
Mabel Naibere
Elizabeth Kemigisha
Henry Kaula - PSI
Andrew Magunda - PSI
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: PSI