A Theory of Change for Guiding the Integration of Human-Centered Design Into Global Health Programming.

The goal of this theory of change is to provide funders, implementing partners, and designers a tool to increase the understanding and application of human-centered design (HCD) as an approach that enhances global health programming. The theory of change also aims to communicate the potential for HCD to introduce new and disruptive mindsets, practices, and techniques to global health programming and to clarify HCD's potential value from the funding application process through to implementation. We seek to answer the key question: how do design and traditional global health practices and mindsets integrate to drive more people-centered, innovative solutions to health challenges and achieve common health sector and global health ecosystem goals?

Methods and Benefits of Measuring Human-Centered Design in Global Health.

Monitoring and evaluation (M&E), a new frontier for human-centered design (HCD), is still largely unexplored. In global health, M&E is considered essential to good practice, and evidence and data are critical tools in program design, performance monitoring, impact evaluation, and adaptation and learning. As HCD is increasingly integrated into global health practice, designers and global health practitioners are learning as they go how to integrate measurement into design and adapt traditional M&E approaches to design-influenced global health projects. This article illustrates some of the tensions inherent in the way global health and HCD practitioners approach measurement, using several cases to illustrate the ways in which tensions can be managed. Using framing introduced by the MeasureD project, which aimed to audit measurement practices in HCD (called social design in the MeasureD project), we explore 3 recent examples of design-influenced global health interventions: 1 focusing on products, 1 on behavior change, and 1 on service improvement, to extract learning about how teams used measurement, for what purpose, and to what effect. In comparing these examples and recent experience, we report on the steps being taken toward greater alignment in the use of measurement to advance human-centered global health programming.

Country perspectives on improving technical assistance in the health sector.

Background: This paper presents learnings from the Re-Imagining Technical Assistance for Maternal, Neonatal, and Child Health and Health Systems Strengthening (RTA) project implemented in the Democratic Republic of the Congo and Nigeria from April 2018 to September 2020 by JSI Research & Training Institute, Inc. and Sonder Collective and managed by the Child Health Task Force. The first of RTA's two phases involved multiple design research activities, such as human-centered design and co-creation, while the second phase focused on secondary analysis of interviews and reports from the design research. This paper explores the limitations of current technical assistance (TA) approaches and maps opportunities to improve how TA is planned and delivered in the health sector. Methods: We analyzed project reports and 68 interviews with TA funders, providers, and consumers to explore in greater detail their perspectives on TA, its characteristics and drawbacks as well as opportunities for improvement. We used qualitative content analysis techniques for this study.   Results: The issues surrounding TA included the focus on donor-driven agendas over country priorities, poor accountability between and within TA actors, inadequate skill transfer from TA providers to government TA consumers, an emphasis on quick fixes and short-term thinking, and inadequate governance mechanisms to oversee and manage TA. Consequently, health systems do not achieve the highest levels of resilience and autonomy. Conclusions: Participants in project workshops and interviews called for a transformation in TA centered on a redistribution of power enabling governments to establish their health agendas in keeping with the issues that are of greatest importance to them, followed by collaboration with donors to develop TA interventions. Recommended improvements to the TA landscape in this paper include nine critical shifts, four domains of change, and 20 new guiding principles.

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies.

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria-tetanus-pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement-four direct drivers and two enabling drivers-that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance.

Mapping capacity in the health sector: a conceptual framework.

Capacity improvement has become central to strategies used to develop health systems in low-income countries. Experience suggests that achieving better health outcomes requires both increased investment (i.e. financial resources) and adequate local capacity to use resources effectively. International donors and non-governmental agencies, as well as ministries of health, are therefore increasingly relying on capacity building to enhance overall performance in the health sector. Despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of 'capacity building' and how to evaluate it. This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries. It draws on a wide range of sources to develop (1) a definition of capacity building and (2) a conceptual framework for mapping capacity and measuring the effects of capacity building interventions. Mapping is the initial step in the design of capacity building interventions and provides a framework for monitoring and evaluating their effectiveness. Capacity mapping is useful to planners because it makes explicit the assumptions underlying the relationship between capacity and health system performance and provides a framework for testing those assumptions.