Our work is supported by rigorous scientific research, in partnership with leading academic institutions, NGOs and charities on the ground.
The planetary health concept describes the relations between health and climate. The inequities thatconnect these two domains are experienced most by low-resource and vulnerable populations, e.g.the impact of drought on subsistence livelihoods and associated mental health issues. Climate justiceand health justice are framed through capabilities and integrated with ecofeminist approaches.Spatial justice is introduced as the ability to conceptualise how these interconnected injusticesare mediated through environments. The integration of these theories can provide a justice-basedplanetary health approach that could overcome several barriers. Design and spatial practice offerprocesses and tools to understand the complexity of planetary health across scales, systems andrelations; and to generate design solutions that promote equity and justice. Practical examplesof Global South design projects are presented that connect health and climate. The example of amaternal health project in rural Kenya shows how a conceptual design framework for a justice-basedplanetary health can contribute to the planetary health.
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.
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.
Health systems in low resource settings operate under a growing burden of health needs. The utilization of resources in an innovative, efficient and integrated way is becoming more important than ever to accomplish the goal of achieving UHC, contributing to health equity and improving access to quality essential health-care services. Despite rapid advances in technology, design and social innovation, these do not always translate into sustained or improved health outcomes.
Since the launch of the SDGs in 2015, researchers and policy-makers around the world have been trying to find strategies to achieve high-quality, accessible and culturally appropriate health interventions. However, there are still more than 400 million people globally that lack access to essential health-care, mainly in low and middle-income countries. Resource availability is not enough; we must think beyond this towards health systems innovation.
Although innovations have been positioned as essential to overcoming health inequity, they must be informed by the local context, and involve the full participation of those receiving it; otherwise, indiscriminate use of technology may reinforce social inequities. They must be designed for and coordinated with the community, considering their perceived needs to ensure acceptance, effectiveness and sustainability.
To bridge theory and practice we have developed a framework that is simultaneously context-specific (and patient centered) and internationally relevant/comparable. It brings together academic literature, field work and case studies. It starts from the assumption that only with the support and motivation of community members can we achieve a sustainable change by recognizing their social and cultural norms while maximizing the efficient use of local resources. It connects three fundamental dimensions: a people-centered and integrated health system, the local health systems constraints and barriers, and adequate, available and accessible innovations. By tackling each dimension and maintaining the communities at the center we are bridging the gap between evidence and implementation, and thus contributing to sustainable health systems towards UHC.
This is a first step in the development of a decision-support system that bridges academic and practical, local and global, as well as public and private spheres to optimize health service provision. With an exponential increase in health innovation, there is a need to coordinate actions from researchers, entrepreneurs, policy-makers and the private sector to interface global innovation with the cultural, social and economic variability between contexts.