Demand for Health Services Field Guide: A Human-Centred Approach

"No expert has more knowledge than a caregiver, nurse, or a community health worker about how to solve their most pressing problems. The methodologies in this toolkit acknowledge this by focusing on collaboration and designing with - not for - the people we seek to serve."

The global health community has increasingly highlighted the need to pay greater attention to demand and the human factors that often determine the successes or failures of programmes. This field guide is a response to the elevation of focus on demand for basic health services. It is centred on the recognition that increasing demand requires understanding the perspectives and needs of both the people using the services and the health workers who provide them. The resource was developed with case material and field testing in the context of immunisation service delivery but is applicable to all health services that are trying to increase use.

The United Nations Children's Fund (UNICEF) Programme Division, Health Section, Immunization Unit C4D team created the guide to help colleagues apply human-centred design methodologies informed by insights from the behavioural sciences. It is a featured component of the more comprehensive UNICEF Human Centered Design 4 Health website, which guides users through why and how to use human-centred design via posters and workbooks, presentation kits, and tools for planning and facilitating a training.

Human-centred design is a "bottom-up" problem-solving process that begins with understanding the context surrounding a challenge and works directly with users - the intended clients or consumers of services - to develop solutions that are viable and appropriate in that context. Some of its elements are: planning with a wide systems view, using participatory methods, focusing on in-depth interactions with people, being inclusive, thinking critically, generating innovative solutions, planning in advance for adaptation, and designing to hand off (local ownership).

The resource provides a methodological toolkit to address situations where health services are available but a subset of the intended population of clients are not actively seeking them. The approach provides a structured process for working directly with users (i.e., caregivers) to address demand-related challenges associated with the acceptability, responsiveness, and quality of services. It consists in:

• Part I. Introduction - provides an overview of the purpose of the resource, an introduction to the methodology, and advice on how to get the most out of it.
• Part II. Guiding Principles - outlines evidence-based principles - "small is big", "knowing is not enough", "intentions are not actions", "truths are buried", "context comes first", and "attention is elsewhere" - and offers a way of thinking about users differently.
• Part III. Five Big Questions - presents five general steps to move through when investigating and responding to challenges involving users: What is our objective? What do we think we know? What stands in our way? How could we respond? How could we improve?
• Conclusion - offers additional resources and background information for reference.