# How to design decision-support tools for primary healthcare using a human-centred design approach: the processes and experience of PHISICC in three Sub-Saharan countries

## TL;DR

This paper describes how to design healthcare tools using human-centered design in three Sub-Saharan countries to improve frontline workers' decision-making.

## Contribution

The study introduces a human-centred design process for creating responsive health information systems in primary healthcare.

## Key findings

- A human-centred design approach was successfully applied to develop paper-based health tools in Côte d’Ivoire, Mozambique, and Nigeria.
- Iterative user testing and feedback improved the design of health information systems for frontline workers.
- Multidisciplinary collaboration and user involvement are critical for effective health system design.

## Abstract

Healthcare delivery should be based on evidence-informed decisions in the clinical, public health, managerial and policy domains. Data are gathered at the point of care via routine health information systems (RHIS). The Paper-based Health Information Systems in Comprehensive Care (PHISICC) project shifted the paradigm from data collection to decision-making, especially decision-making at the point of care by the frontline health workers. We used a human-centred design (HCD) approach to re-design a RHIS that is responsive to the needs of frontline health workers.

The PHISICC research programme took place in Côte d’Ivoire, Mozambique and Nigeria and included the design and testing of a suite of paper-based RHIS tools. We report here the results of the HCD process. This was structured into three phases: (1) setup of co-creation group, (2) concept exploration and (3) detailed design phase.

The concept exploration included a brainstorming session and produced ‘quick paper mock-ups’, such as ideas to follow-up patients’ healthcare. The output of this ‘concept workshop’ was a design hypothesis of the health information system. A follow-up workshop identified the healthcare areas to prioritise. The first round of design developed a version of several tools. The second round consisted of user testing in the three countries. Several iterations were implemented, incorporating health workers’ feedback. Tools were pilot-tested and then produced and distributed for use in a cluster randomised controlled trial.

The design phase of PHISICC combined HCD with clinical and public health domains. RHIS should be designed by qualified designers, content experts and users who focus on aiding decision-making of frontline health workers, applying a user-centred approach, from problem identification up to solution testing, multidisciplinarity, flexibility, teamwork and trust. We call for researchers, designers, healthcare providers, healthcare authorities and funding agencies to propose and pilot quality standards for the implementation and reporting of HCD in global health.