STEMA proposes an alternate approach to thinking about innovation in healthcare. Through locating our work in low-resource settings, we have found that interventions and innovations that improve health or access to healthcare often develop outside of the formal or dominant health system, and often draw on resources and factors not usually considered components of healthcare innovations, such as the wider determinants of health.
Here we will present two of our case studies, a health clinic in a remote village in Northern Sierra Leone and a series of community health posts/pharmacies in the Peruvian Amazon, and initial insights into working between design and health research in low-resource settings.
Purpose: To improve health and/or access to healthcare in low-resource settings through conducting community-led focused research and design, developing a framework for building community resourcefulness with regards to health.
Methods: A mixed methods and exploratory approach was taken, conducting a health systems needs assessment at the different levels of the existing formal system and participatory research and co-creation activities with the communities to discover how they access care through employing people-centred design techniques such as ‘user’ journeys of care and other visual exercise to understand people’s perceptions of ‘good’ health.
Results: Our initial findings indicated that communities rely on a multitude of informal systems to provide care, and accessing formal health services is difficult due to both distance and cost.
In Peru, the medicine-delivery spaces are being co-designed with a local architect and the communities and offer both a community and social space as well as a secure, clean storage place for medications. The physical design will be accompanied by a training programme and evaluations of access to essential medicines.
In Sierra Leone, the existing clinic is being modified to provide a private, clean space for giving birth and to meet necessary state regulations around birth spaces. This is to be accompanied by training for the community health workers and health education programmes.
Conclusions/Implications:
We propose that an integrated and place-based health system should be co-created to form connections between the multiplicity of health systems, building trust, cohesion and sustainability which are essential factors of increasing universal health coverage and improving the wider determinants of health. Furthermore, interventions become most innovative when they are able to mobilise locally-available resources to develop the resourcefulness of the community.
