Cold Chain Maintenance Done Differently: Results from a Human-Centered Design Study in Niger, Kenya and Tanzania

"The HCD [human-centred design] approach has demonstrated its utility and how it can provide insight and fresh perspectives into previously misunderstood challenges."

Cold chain equipment (CCE) is required to keep vaccines cold, yet the equipment maintenance system is often overlooked and underperforming. Immunisation programmes in Niger, Kenya, and Tanzania conducted human-centred design (HCD) studies to better understand the gaps in the maintenance systems and to identify potential solutions from the perspective of maintenance technicians. This cross-national analysis presents the results from each country and identifies similarities and differences in challenges and potential solutions across the countries. It aims to contribute to global thinking of investment priorities for CCE maintenance and to spark ideas for the further development of tailored solutions.

HCD is a methodology that places users of a product or service at the centre of the design process. It seeks to understand the needs, behaviours, and experiences of users to develop solutions that are effective and tailored to their unique challenges through an iterative process. This HCD study focused on stakeholders directly involved in CCE management and maintenance and involved these steps:
 

1. Intent meeting: The research team in each country met to align on objectives and scope, then engaged people who are directly involved in preventive and corrective maintenance in an effort to understand how the maintenance system works and barriers to its being reliable and efficient. The approach included a co-creation workshop for stakeholders to design potential solutions that would be tailored to the country context.
2. Data collection: In 2023, the research team conducted 20 one-on-one key informant interviews (KIIs) in Niger, 50 in Kenya, and 40 in Tanzania with stakeholders directly involved in management and maintenance of CCE.
3. Synthesis: The research team used the "insight generation" technique to review the results of data collection to identify perceptions and actionable insights into the needs, motivations, and behaviours of the participants.
4. Co-creation: The same people who responded to the KIIs were invited to participate in the two-day co-creation workshops, including sub-national level participants to ensure this perspective was provided. The research team first validated the insights with participants to confirm the accuracy and interpretation of the themes and then translated the insights into "How Might We?" questions to allow the focus to stay on the user and the user experience. The results of data collection were transformed into user personas to generically describe the different stakeholders involved in the CCE maintenance and management, highlighting common responsibilities and challenges faced. A process map was developed in each country.
5. Prototype: During the co-creation workshop, participants identified a variety of potential solutions to the challenges of the maintenance system and prioritised the ones they felt would solve the challenges at hand. User-generated ideas for improvements had some similarities between countries, including the desire for a peer-to-peer e-learning and networking platform, tailored technical resources, and a reporting system for maintenance that could create an opportunity for greater agency of technicians to prioritise for maintenance needs. Unique to Niger, participants built out a concept of a "regional maintenance superstar" to create friendly competition among those responsible for maintenance with weekly challenges on preventive maintenance, culminating in an annual recognition for the maintenance superstar. (See Related Summaries below for previously published results specific to Niger.)

Reflecting on the experience, the researchers note: "When looking at the global perspective, the fact that similar insights and solutions were identified by different country teams is meaningful and may imply applicability to other countries. Some iterations of these ideas have been explored and implemented already..."

The next step for these countries is to prototype the identified solutions to fine-tune the idea, to understand the feasibility, and then gauge the level of interest. "These ideas can be the next step to build more efficient and functional maintenance systems. Regardless of the country-specific details, results of this study demonstrate the need for maintenance done differently."

In conclusion, the researchers argue that the ideas that emerged through this HCD experience "reflect the reality on the ground and go beyond the standard solutions often proposed by global stakeholders and donors. Insights and ideas generated by this study may be relevant to other countries' CCE maintenance systems."