April 2025 — UNICEF and its partners have been actively working to improve access to health services in Amboanio through a human-centered design (HCD) consultation with communities. This approach focuses on contextualized problem-solving and involves various stakeholders, including community health workers, local leaders, and mothers. The goal is to discuss communities' experiences, perspectives, and solutions tailored to the needs of mothers in Amboanio.

Community Engagement and Key Insights

The HCD consultation sessions provided a platform for participants to voice their concerns, share their experiences, and collaboratively identify barriers to accessing health services. Through a series of community consultations, several key barriers to health service access were identified:

1. Lack of Knowledge: Many mothers lacked basic information about the importance of routine health services such as immunizations, Vitamin A supplementation, and antenatal care. Misunderstandings about how and when to access services led to delays or complete avoidance of care.

2. Trust Issues: Mistrust in the health system was widespread. Some mothers had experienced poor treatment at clinics, such as being ignored or spoken to harshly. Others had encountered stockouts of vaccines or medicines, which made them question the reliability of services. Misinformation—such as rumors that vaccines cause infertility—further deepened fear and skepticism.

3. Accessibility: Geographic and financial barriers were significant. Many families live far from health centers, and transportation is either unavailable or unaffordable. Mothers often have to walk long distances with young children, which discourages regular visits.

4. Limited Community Involvement: Health programs were often designed and implemented without input from the people they were meant to serve. This top-down approach led to a lack of ownership and low participation in health initiatives.

5. Gender Dynamics: In some households, women lacked the autonomy to make decisions about their children’s health. Cultural norms sometimes required permission from male family members, delaying or preventing access to care.

6. Inadequate Follow-Up: Even when mothers accessed services, there was often no system in place to ensure follow-up. Missed appointments, incomplete immunization schedules, and lack of reminders contributed to poor continuity of care.

Implemented Solutions

UNICEF and its partners responded with a suite of community-driven interventions:

1. Awareness Campaigns: Educational campaigns were launched using posters, radio messages, and community meetings. Local mothers were trained to deliver health messages in their own dialects, using relatable stories and examples. These campaigns focused on the benefits of immunization, nutrition, and early childhood care.

2. Community Health Testimonies: Mothers and health workers who had positive experiences with health services shared their stories publicly. These testimonies were delivered during village meetings, market days, and through local radio. Hearing trusted neighbours speak about the benefits of care helped dispel myths and rebuild trust.

3. Improved Accessibility: Mobile health clinics were deployed to reach remote areas. Community health workers were trained to provide basic services and referrals directly in villages. In some areas, local transport cooperatives were organized to help mothers reach health centers on immunization days.

4. Inclusive Planning: The HCD process itself ensured that community members were involved in identifying problems and designing solutions. This participatory approach increased buy-in and made programs more responsive to local needs.

5. Empowerment of Mothers: Role model mothers were identified and trained to act as health advocates. These women encouraged their peers to seek care, shared their own experiences, and helped shift social norms around maternal and child health. This also helped elevate women’s voices in household and community decision-making.

6. Continuity of Care: Community health workers now conduct home visits to follow up with families, provide reminders for upcoming appointments, and ensure that children complete their immunization schedules. This has improved retention and reduced dropouts from essential services.

Impact and Outcomes

The combined efforts of HCD consultations, community health testimonies, and awareness campaigns have led to significant improvements:

• There is now greater trust in health services among community members, built through consistent and positive interactions with health workers and the visible benefits of health services.

• More mothers are taking their children to health centers for routine services, as the reduction in physical and informational barriers has made health services more accessible.

• Better health outcomes for children have been achieved due to increased uptake of essential health services, including higher rates of immunization and Vitamin A supplementation, leading to stronger immune systems and overall healthier growth.

• The initiatives have also empowered local mothers to become advocates for health within their communities, fostering a culture of proactive health-seeking behavior.

• The intervention has shown the success of peer accountability models for promoting healthy behaviors and seeking healthcare.