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This is for the local communities

Gaining new knowledge and exploring ideas

Country vs multilateral agency

Empower individuals to use decision support tools and take leadership of their own healthcare choices

By disempowering the local prime in having the time to upskilling and lead this work.

Increases access to information that is critical to high quality care

It will provide critical health information

I think over 80% of our offices and staff are in LMICs. However, resource-wise, I think the proportion skews much higher to being based in high income countries because many central services for the organization are US-based. We recognize this is a challenge and are looking to distribute resources globally.

As a designer working within a large funding organization, there are inherent power imbalances between me and the stakeholders I seek feedback from (even though I am not the funder directly)

It might reinforce a health only approach to Autism

The solution in the project being implemented is designed by people who are not members of the community, therefore sustainability might be an issue in the future.

This is a challenge that I am navigating

Funder and government trying to determine decision making authority, and me trying to help them come to shared governance in some critical pieces

All systems for patient health care must be evaluated in the clinical settings where they will be used. This must include all patient groups particularly those that are particularly under served

I find that most of the senior leaders at my company are non-diverse, typically white, older adult (60+), and were born and educated in the U.S.

It is very specific to the question being answer for this project.

They are the custodians for data collection, but analysis is done at global level

Using text-based follow up methods to allow patients to respond to their care privately, timely, and seek care on time while health care workers track resistance and data management thus reducing their workload and decongesting health facilities

Collaborating with telecommunication companies to support with availability of network services and subsidized cost to text messaging

Through developing a system to track challenges, resource mobilization, and empower communities to engage seek health in their settings without spending for travels

It is important for designers to understand who are users of the services and tools we are designing. In the social sector, there are many stakeholders along a value chain that are essential for success. In the private sector it is often just a customer and a seller. I've seen many design projects that have floundered when intermediary users were not sufficiently involved in the design -- for example when a health service works perfectly for a client but seems unworkable for a nurse or administrator. In this project we were an in-house design team. This somewhat constrained our perspectives, but it meant that we were aware of each and every stakeholder who needed to be involved for the project to work. We used personas for each individual and used a variety of methods to explore their needs and desires. All of them informed the final design. When there was a conflict between the needs of an intermediary user and an end user, we prioritized the needs of the end user. This was in the context of mobile money payments for community health workers. While most reports of mobile money payments are glowing, they often reflect the perspectives of administrators rather than CHWs. Some research shows that mobile payments benefits organizations more than payment recipients, and can exclude those who do not have the resources to access them.

There are other colleagues working on this project, an analysis plan was written, the data are shared across the team. The other colleagues might have less time for this particular project than I do, given their other work, so maybe the progress will be slower. Project leaders will find a new person to keep up the work.

Untold stories of the impact of lack of power for communities to negotiate for what works for them. Donors assuming the invented ideas works best for communities

Availability of funding motivated the project. Lack of political and technical support derails implementation due to lack of prioritization

Due to the increased in the follow up rate and test of cure results reeported

Acknowledging that one size doesn’t fit all, adapting tools based on the country context and their capacity and ability to sustain the use of tools

Great questions. Progress is for the community, public health programs and implementers.

The difference in power and positionality, reflecting on what positions are important in a specific society to lead health agendas, specifically community gate keepers and their leadership roles can block or support the implementations

You have to deliver per your contract, which means this is your primary obligation. However, it is unethical if fulfilling that obligation will not lead to the ultimate intended benefit or will cause harm. I find that establishing an honest relationship early on with all project stakeholders enables transparency -- and you should invite them to say 'no' to your work. It is important to have sufficient contextual knowledge to understand whether a local stakeholder is looking out for their own interests vs a broader community interest. Having an insider/ outsider perspective can be helpful, as well as consulting with varied stakeholders. This project had several stakeholders who were well aligned and a long history of working together. They understood each others roles and constraints, and the project was well scoped.

In my role at an international organization, I was part of a project providing technical assistance to local partners, including non-governmental organizations, health management teams, and healthcare workers. We focused on enhancing data accessibility, analysis, and its use in decision-making. This fast-paced, donor- and target-driven project required us to support our partners in reporting and analyzing data and pinpointing areas for improvement within the HIV care continuum. However, there was a significant oversight in our approach: the patients receiving HIV services were not involved in the process. The project’s dialogue often centered on 'targets,' inadvertently overlooking that these 'targets' were real people with real lives. This disconnect became evident during numerous meetings where we strategized on meeting donor targets, rapidly deploying these strategies for the next reporting cycle without considering the patients' perspectives. This approach was akin to developing solutions without understanding the needs of the end-users. Consequently, many of these strategies, although well-intentioned, lacked sustainability. They turned out to be resource-intensive - financially, in human resources, and in time - yet built on unstable foundations, like 'castles built on sand.' This experience highlighted the importance of involving those directly impacted by our strategies, ensuring that our efforts are target-driven but also patient-centered and sustainable.

By understanding the different organizational politics and dynamics as well and how individuals perceive their professionalism

My limitations are that I do not have any evidence that the intervention works as i have never read anything in literature that show that this intended intervention works.Unintended harm may be that the intervention may misallocate resources and label my target community wrongly and stigmatize them

1. Recognize funding sources 2. Seek explicit permissions / authorizations 3. Express gratitude to participants 4. Always credit collaborators 5. De-identify / anonymize all data 6. Offer alternative/ substitute forms of recognition 7. Focus on the impact 8. Maintain confidentiality 9. Ethical research practices + informed consent

These decisions are usually made by out of country experts and rubber stamped locally by relatively optionless leaders as it all deals with funding sources

When we define needs assessments or baseline indicators, we rarely think of the contextual and patient factors which drive success. In this case we oversimplify health challenges by ignoring patients/clients as recipients of services and not contributors to success

1. Sub-optimal effectiveness of the intervention 2. Overlooked / neglected stakeholder needs 3. Researcher burnout Who is left behind? 1. At-risk / vulnerable populations who need further support 2. Stakeholders with the potential to offer valuable insights

No European or North Americans at direct project implementation except positions defined at the University for Award Management

No European or North Americans at direct project implementation except positions defined at the University for Award Management

sense of urgency means that communities and the target populations are not consulted leaving decision and ownership entirely to technocrats, therefore interventions are not well accepted and are usually incorrect and may even be harmful to target groups

Lack of a balanced approach may while prioritizing speed over quality may bypass crucial community involvement.

This will enable them live in a disease free society where they are able to implement development projects and live happy lives

Knowledge gaps Resource constraints Sustainability

Because it was a secondary data analysis project, the research team did not directly interact with most of the community partners. However, we did spend a lot of time discussing how the results of the project would need to be applied within the local context where community partners remain the primary decision makers and involved the operations team who does interact directly with community partners in these discussions. We proposed that the results would serve as another type of information for community partners, but not that they would be positioned as better or more correct than other types of knowledge used in decision making.

I sometimes miss the context in witch we implement our programs. By context I mean, cultural, economic, geographic,etc. So our project might change a system that is already existing. We also bring a lot of money on a small place and just that have a big impact on the community.

This is a challenge for this particular project because some aspects of it require technical skills that may not be available within the implementing organization. However, we try to address this in several ways. First, local partners are involved at all steps of the project, from design to implementation to evaluation. Second, we are designing the intervention so that it fits within the existing resources used by the Ministry of Health and can be scaled up or applied elsewhere if needed. Third, we have planned for trainings for training of trainers so that experts on the tool will be embedded in teams at multiple levels of the health system. Fourth, we are trying to create a community of practice surrounding the tool use, which will help enable adoption and sustainability of the project by creating a community where people can help each other with its use.

Making sure that our project is serving the beneficieris

(not sure who the intended "we" is) As a team, we implicitly acknowledge that building trust and maintaining relationships with stakeholder is essential and costly - in time and money. But we're also often frustrated that this our research budgets and timelines don't really allow for the time and money this takes.

I think I am pretty good at including stakeholders who would be seen as contributors to the data collection, analysis, and reporting. For example, I have a very inclusive approach towards co-authorship on journal articles. I think this works well for including people who collect data or contribute ideas but who are not academics (e.g., research nurses, ministry officials). I don't think it adequately captures the contributions of individuals who provide their data or who are otherwise critical to execution of the project but who don't meet ICMJE criteria for authorship. I am not sure how to capture these 'voices' in the writeup of the research except through quotes (really only works for qualitative papers) or acknowledgements at the end of the papers.

This project was developed with guidance and consultation from our local research collaborators and policymakers. But the specific visions was not articulated or led by these experts.

I define progress in this project in 3 dimensions. First, there is the public health dimension -- is the project doing anything to improve the healthcare system and patient outcomes? Second, is the project strengthening local research capacity by giving equitable ownership of the execution and dissemination to the local team? Third, is there project adding value to the portfolio of my research team, especially by providing junior researchers (PhD students, etc) opportunities for learning and co-leadership?

The study is executed by a large team with a lot of skill. I'm able to delegate to individuals and teams with specific focus areas but am very reliant on one key person, an outstanding study coordinator. Without this person there would be a lot of issues. When I have unexpectedly been absent, this person was able to maintain most core functions, but I realized that there wasn't full redundancy and things fell by the way-side. The main challenge is having multiple people who can hold the big picture of the project and step in and out of high level vs detailed thinking. It's probably a weakness in our team structure and my management, but I've continued to struggle with building in redundancy in that combination of high-level vision and detailed execution. I don't know if other teams are better able to do this.

Projects and grants have hard deadlines. I am fortunate to work with a team that is very capable and can usually meet those deadlines. However in some cases the team on the ground is stretched thin between projects and needs some extra support to get aspects of the work done. In those cases it can be tempting just to send in someone external (eg, UW student, research scientist) to help and/or drive the project. This sort of action can reinforce dependency if we are not careful. There is a tension between doing fewer projects with higher quality and more sole local ownership, and doing more projects (which provide more funding and visibility for the local team) but fostering a structure where they rely more on HIC partners to get the work done.

The most impacted communities. Secondarily, indigenous health system leaders.

Funders! Grant budgets and timelines constantly create a sense of artificially rushed timeline and urgency.

I am part of a large academic organization that has a governance structure that includes an advisory board with lots of LIC and MIC representation. However, I do not have a leadership role in the organization and am not really able to influence how the organization engages these representatives

I am typically brought in as a technical expert in a specific role to train local scientists in that method, and support efforts led by local scientists to develop research and evaluation programs. There is little additional European or North American involvement beyond this

Donors are largely based in HIC. Wealthy people exist in LMICs and HICs. More wealthy people/institutions from LMICs should start their own donor/funding programs to compete with HIC, and target LMIC scientists for awards

Education is the best way to ensure people agency in deciding health programs that enable “live and thrive”. But this needs to be accompanied by infrastructure for wealth creation through investment

All major scientific, funding and operational decisions are made together with LMIC partner