Applying human-centered design principles for
improved social and community norms around
maternal, newborn and child health
Community Benefits Health
Upper West, Ghana
Dela Bright Gle
Senior Program Manager
Outline

Overview of Community Benefits Health

Project Design: How human-centered design was used

Design Influence on Project Outcomes

Lessons
About Community Benefits Health
Research project (Oct 2013 – Jun 2016)
Three-arm, quasi experimental design
52 communities (12 + 22 + 18) in 3 districts (Jirapa,
Lambussie and Wa West)
Upper West Region, Ghana
Project Aims
Community Benefits Health creatively uses non-monetary
incentives to cultivate communities’ commitment to improving
maternal, newborn and child health
Shifts in social norms
encouraged
• Communities are empowered
to improve health behaviours
• Social support is improved to
achieve healthy behaviours
• Self efficacy is strengthened
Healthy behaviours adopted
• Early first antenatal care visit
• Four antenatal care visits
• Postnatal care visit within 48
hours
• Early initiation of breast
feeding
• Exclusive breast feeding 0-6
months
Design Thinking Journey
ESTABLISHED
THE
PROJECT
INTENT
DESIGNED THE
RESEARCH
APPROACH
CONDUCTED
DISCOVERY
INTERVIEWS
MADE SENSE OF
THE RESEARCH
GENERATED IDEAS
FOR THE INCENTIVE
APPROACH
TOOK THE IDEAS
BACK TO VILLAGES
FOR VALIDATION
AND DEVELOPMENT
DESIGNED A
SYSTEMIC
FRAMEWORK FOR
IMPLEMENTATION
Understanding the Problem
Environment
Nutrition
and
Food security
Economic
security
Relationships
and
influences
Cultural
beliefs
Practice and
customs
Economic
structure of
the
community
Knowledge
and
Education
logistics
Work and
family
responsibiliti
es
MNCH
Quality of
care
Women’s Journey: ANC & PNC
I attend
mothers to
mothers
support group
I don’t tell my
husband I am
pregnant
because if it
turns out not
to be true he
will call me a
liar
Women do not report
early for ANC because
they are afraid they will
lose the baby
We do not go to antenatal care because our
babies are still young and
other women will laugh at
us . Husbands could give
time for our babies to
grow older before we get
pregnant
Any time we visit the
health care centre, the
nurses are able to tell
them the period of their
pregnancy. Also tell them
what to eat and give them
medicine
She received
mosquito nets and
ANC from health
workers in the
second month
If I am using
contraceptive I
can not tell if I
am pregnant
Because of poor
transport referrals
are difficult
She visited
the clinic after
delivering the
baby
Women find it difficult
to attend to ANC and
PNC because of
farming commitments
during the rainy
season
Women prefer to go
to the CHPS with
women rather than
husbands
Experienced women
DABO
Travelling for delivery
is stressful for women
if they have no money
or food
PNC, teaches
me the benefits
of only
providing
breast milk to
the baby
We celebrate
first sip of
water day
DABO
I do not say
when I am in
labour because
enduring the
pain of labour
is a sign of
strength
Intent
Women’s
Health
Broader
Village
Economy
Hypothesis: the incentive will amplify the intrinsic interdependence of
women's health and the broader village economy, encouraging
behavioural change
Intent
Women and babies
are able to better
engage with health
services.
MNCH health targets
are met
Evidence of
improved social
support and
behavioural change
Desired
outcomes:
Resources
& self-efficacy
are strengthened,
increasing capacity to
engage with health
services
Community
incentive
is awarded
Intent
Focusing question for the design of the incentive
How can we design an incentive approach that
supports communities to embrace the idea that
women’s health during pregnancy, child birth and
the first year of a babies life is a good investment
that will strengthen the economy, happiness and
culture of the whole village?
Influence on Women’s Health
All household decisions need to be approved by
the husband including accessing ANC
Villages Ideas for Incentives
Initial ideas for incentives generated by the villages
Dry season farming
Grinding mill
Water at the CHPS
CHPS upgrade
Transport for the CHO
A feeding program at School
A motor king
Light at the CHPS
2 Incentive Concepts
The challenge in designing the incentive is to ensure that there
is a clear link between the incentive and health behaviours.
Communicate and Educate
COMMUNICATE AND EDUCATE TO DRIVE THE CHANGE
Traditional forums are harnessed to communicate the vision: durbars and women's singing. Hierarchies
and traditional power structures are harnessed to give credibility to the message .
ProNet
Durbar to communicate
the vision for change
Whole village
Chief communicates the
vision to the community
Governing
committee
Leaders promote the
vision
ProNet supports
education curriculum
ProNet attends the
celebration
A community event
celebrates the intent to
change
Women compose songs
Leaders promote vision
to community groups
Communication
Challenge
There is a high
rate of illiteracy
among women
Design Influence on Project Outcomes

Social norms around male support for pregnancy changing





more men accompany wives for ANC, family planning without
being teased
communities savings towards transport and health expenses for
pregnant women
Key influencers including chiefs championing maternal and
child health issues and acting dramas
Early ANC registration is increasing
Communities frown on home delivery
Lessons




Using human-centered design principles (HCD) has
contributed in changing some social and community
norms around pregnancy, women and child’s health
HCD has enabled project team to develop greater
understanding and empathy towards beneficiaries and has
improved project implementation
HCD has enhanced sense of involvement, active
participation and ownership among beneficiaries
HCD helps to develop more tailored, unique
interventions for greater results in programming