Harnessing a Human-Centered Design approach to Boost Vaccination uptake in Rural Communities, South West of Cameroon: Insights from Rural Doctors’ Experience
Authors: Ghangha Jamin G., MPH, Shifu Ismail N. MD, Nkengfua Samuel MPH, Ngalame Abigail MPH, Mambi Tchoye A.. (ECID) Sangwe Bertine A. (MPH(C))
Introduction
In the rugged terrain of Cameroon’s Southwest, where rivers carve through hills and roads vanish with the rains, a silent crisis persists: children in Ekok and Tombel are growing up unprotected against diseases the world has tools to prevent. Despite government efforts and global partnerships, these districts remain a stark example of how geography, conflict, and systemic barriers interact to keep vaccines out of reach. Here, health workers trek through sparse settlements, navigating crumbling infrastructure and seasonal floods, only to find that even when supplies arrive, hesitancy and distrust often stand as a barrier to get their children vaccinated. Yet, amid these challenges, a quiet revolution is taking place. Rural Doctors has begun using the Human-Centered Design (HCD) to influence immunization dynamics in these areas, an approach that listens first, designs with-not for-communities, and tackles barriers from the ground up. The stories of Rural Doctors reveal how empathy, local partnership, and creative problem-solving can transform the uphill for vaccination into a journey of hope and resilience.
This article dives into the process and lessons learned from the HCD process showing how putting people at the heart of the process is not just changing minds, but saving lives, one community at a time by driving vaccine demand.
The HCD Approach
The team started by identifying two communities with the high numbers of Zero dose and under-vaccinated children notably Tombel and Ekok in the South West region with special interest in 6 community types (religious groups, ethnic minorities, remote/rural populations, displaced populations, urban slums, and conflict-affected populations) with representatives from these communities to serve as users. The different categories of users of vaccination services were parents, healthcare workers, community & religious leaders and community health workers while the facilitators for this exercise were programmatic staff from Rural Doctors. Influencers were selected by the community members during a community diagnosis which took place prior to the cocreation workshop. It was about empathizing with “users”, defining problems, ideating solutions, prototyping, and testing to create innovative and effective solutions that met “users” needs. By focusing on human experiences and perspectives, Human Centered Design1 (HCD) fosters creativity, collaboration, and experimentation to develop solutions that are functional, sustainable, and desirable. Rural Doctors used this approach in the Tombel and Eyumojock Health Districts in the influencer-led Social and Behaviour Change Communication for vaccination uptake where personas2 identified from the analysis of data collected about vaccination challenges was used to facilitate problem identification more problems and design-creation of intervention models for testing.
The Co-creation Process
The team started with a mixed study where in knowledge, attitudes and practices of community members were evaluated in the quantitative part. Insights to understand community behaviour towards vaccines and identification of community influencers was explored through focus group discussions with the representatives of the different community groups.
During the cocreation workshops, the “users” of vaccination services who were parents, community health workers, health care providers, community and religious leaders constituted different groups. Based on personas developed from community feedback during the qualitative, discussions were facilitated with users to validate these problems. while extensively discussing vaccination roadblocks as pertains to the community. The users went ahead to add more to the problems depicted by the personas hence validating them and designing solutions to the problems. This was followed by prioritization of the problems into high, moderate, and low impact. The solutions obtained were then prioritized according to their level of impact and feasibility which then led to prototyping. Prototyping saw the creation of tangible, often simplified versions of the product or service which included health education and advocacy messages, voice records for health education, sample reminder/follow up messages to explore ideas, test functionality, and gather user feedback. It served as a bridge between imagination and community realities, allowing users to transform concepts into testable artifacts that users can interact with. Prototyping was important in developing tangible solutions, products or services to support the implementation of the feasible and impactful solutions for 5 personas. These personas were then validated by the community influences who were then drilled by the Rural Doctors team on how to effectively put them to use for behaviour change.
1. Human-centered design (HCD) is an approach to problem-solving and design that places the needs, experiences, and perspectives of real people at the center of every stage of the development process.
-
A persona is a fictional yet realistic representation of a typical or target user of a product, created based on user research to embody the goals, behaviors, motivations, and contexts of real users.
Preliminary lessons learnt from the co-creation process.
Here is what we learned from conducting HCD in the communities in Eyumojock and Tombel;
- “Nothing about us without us”
By placing parents, midwives, and community leaders at the heart of solution design, interventions emerged by the people for the people. Co-designing with community members, through Community workshops empowered local influencers and health workers, fostering ownership of community initiative.
2. Workshops that sparked ownership
The HCD co-creation sessions were not just meetings, they were revolutions. Local health workers left with prototypes they had built themselves with guidance, from context specific messaging to influencer led advocacy squads.
3. One Problem, many Solutions
In Eyumojock, influencers demanded attention-grabbing alerts for example; “Shout it like a market crier!”. In Tombel, communities craved emotional storytelling: “Show us a child saved by vaccines.” HCD taught us that context is key.
4. The power of community stakeholder collaboration
Furthermore, the workshops improved communication and collaboration between community health workers (CHWs), healthcare providers, local leaders, and religious leaders which helped addressed gaps in knowledge and service delivery, reinforcing consistent messaging and support.
Acknowledgement
This work would not have been fruitful without the support of the Faculty of Health Sciences, University of Buea and the regional EPI team of the South West region.
Sources
1.Ewang BF, Eyong ME, Cumber SN, Nkfusai CN, Yankam BM, Anye CS, Achu JR, Suh BM, Nkeng MN, Nzoyom RB, Tsoka-Gwegweni JM, Akum EA. Vaccination Coverage Under the Expanded Program on Immunization in South West Cameroon. 2020.