Hearing about something new can bring about mixed feelings, excitement, the desire to learn more, an opportunity for growth and so many questions!

This perfectly describes the way Tohoa Eli Cummings, a public health nurse and midwife at Aitutaki Islands Hospital, felt on that sunny day when she received communication that she will be attending a Human Centered Design (HCD) Training along with other colleagues from various stations across the Cook Islands.

Her excitement knew no bounds, yet she was struck by an appalling realisation that she did not know much about the subject.

The first thing that crossed her mind was the newness of it all and questions on the relevance of this unfamiliar concept to her daily work.

“I did not have the slightest idea of what the HCD approach was and what it had to do with my job and area of work. It was all very new to me. I asked myself what it was and if it applied to my area of work.”

For Tohoa, whose daily duties are numerous and demand a considerable amount of her time, she was also worried about leaving her duties behind for an entire week.

On a day-to-day basis, her duties to the people of Aitutaki include home visits, clinical duties, managing the smoking cessation programme, maternal, neonatal and child health clinic as well as provision of immunisation services.

Aitutaki, also traditionally known as Araʻura and Utataki, is the second most populated island in the Cook Islands, after Rarotonga. Aitutaki is located in the Southern part of the Cook Islands. It has an approximate population of 1700 people and five health facilities.

Speaking to Tohoa, the passion, dedication, and commitment she had for her work was palpable. It was crystal clear that she would do anything within her power to serve her community, despite challenges along the way.

“Keeping appointments for immunisation is a real issue in Aitutaki. Sometimes I have to go out in the ambulance to pick up the mothers, so they come for immunisation.

“I get so worried when parents refuse immunisation, and it makes me feel like I am not doing my job properly.”

Supported by the Government of Japan, UNICEF partnered with the Cook Islands Ministry of Health to organise and facilitate a HCD training for 23 health workers.

The HCD uses existing motivations, daily realities, habits, and limitations to generate tailored solutions for communities. This approach emphasises the designing of successful health services as a human-centric challenge. It results in programmes or services that are desired by, used by, and responsive to the communities they are meant to serve.

Unlike other approaches, HCD allows programme managers and health workers designing health services to be empathetic through understanding the lived reality and true motivations of people and co-designing solutions directly with the communities of people who will either use or implement proposed interventions.

The participants were drawn from Rarotonga, Aitutaki and Mangaia Islands. They were a multidisciplinary group from various departments in the Ministry of Health including public health, mental health, maternity, health information system, health intelligence and health promotion.

Although the participants considered HCD to be a novel experience for them, they showed up with open minds, camaraderie and a sterling display of commitment to learn as much as they could in order to use the skills gained to improve health programmes.

The reflections and the shift of perceptions on the concept as the training progressed was truly inspirational.

“The HCD tools are really useful and allow you to empathize with the communities we serve. Initially, I did not understand why I have to use it, but using the ‘Day in the Life’ tool really allows you to find opportunities to do immunization, in line with the caregiver’s daily activities,” said Rangi Tairi, manager, community nursing.

The in-charge public health nurse, Rufina Tutai appreciated the new way of thinking brought about by the HCD approach.

“The HCD training has made us see some existing gaps in our programming that we can address to make our service provision even better.”

After the initial HCD training, UNICEF will support the Cook Islands Ministry of Health in the second phase to conduct the actual HCD process in selected areas to address existing gaps.

Although the primary focus will be immunisation, the integration lens will be applied, with a view to developing sustainable solutions.

For Tohoa, the training was only the beginning, and she looks forward to sharing all the information and skills gained during the training with her colleagues back in Aitutaki.

She also plans to apply the HCD approach in her work.

“I am definitely going to use HCD in my area of work.”

Tohoa also said she was grateful for the HCD initiative as it has brought with it a world full of new possibilities.

She says it has given them a new direction in their work to improve service provision for their communities. Not only that, but the vehicle that was also provided is helping her visit her patients in the various health programmes, including for immunisation.

The HCD training is part of the social and behaviour change support currently being provided by UNICEF.

UNICEF is also providing ongoing nutrition interventions support in collaboration with the Food and Agricultural Organization and vaccine logistics support to Cook Islands.

In addition, UNICEF, together with the World Health Organization is providing support to conduct an Effective Vaccine Management Assessment, with the aim of improving the supply chain for vaccines in the country.

• Unicef Pacific