When humanity takes centre stage
How the application of the human-centred design approach to the measles outbreak in western Nepal helped plant the seeds for enduring social and behavioural change in the community
Banke, Nepal: In January 2023, an outbreak of measles ignited concern and urgency in Nepalgunj Sub-Metropolitan City in Banke District in western Nepal. And complicating this already delicate situation was the fact that existing, conventional approaches to promoting vaccines were proving wholly ineffective in convincing an all-too hesitant community to take the necessary steps.
Among these Nepalgunj locals were Rakesh and Sabita (names changed), parents of five children – four of whom were eligible for the measles vaccine but had not yet received it. Although efforts to encourage uptake of vaccines have long been ongoing in the area, and general information on the benefits of vaccines disseminated regularly, the data so far collected had yet to provide a clear picture of why it was that families like that of Rakesh and Sabita continued to be reluctant to get their children vaccinated.
To tackle this, UNICEF had partnered with the Behavior Science Center at Kathmandu University to apply Human-Centred Design or HCD principles in response efforts. This approach wasn’t just a shift in strategy, it was a commitment to dive deeper into the beliefs, fears and hopes of the people behind the statistics.
That journey began with active listening, using ‘Kuragraphy’ – an ethnographic approach to informal, unstructured and context-driven conversation with members of a given community that creates a space for open dialogue.
Once this approach was applied, stories soon began to emerge that made evident the existence of a deep sense of mistrust around vaccines, born from communication gaps and misunderstandings, also linked to cultural and religious factors. In the case of Rakesh and Sabita, for instance, their skepticism could be traced to a fear of side-effects, as well as the limited decision-making power enjoyed by women in the community.
“Some families believe measles is a sin, and the fever and rashes that develop after infection are a curse from God. They also believe that if they use modern medicine for treatment, it will make God even angrier and worsen the child’s condition,” said one local.
It was precisely to gather these kinds of insights that, in close coordination with the district health offices, the UNICEF and BSC team had gone door-to-door, engaging community members – particularly caregivers among them – in conversation.
With a better understanding of the behavioral and social drivers behind vaccine hesitancy, interventions could then be designed to address these barriers and foster an environment of trust.
These interventions included working with key community influencers – such as ward representatives who also hailed from the target community and could therefore inspire them to action – and mobilizing volunteers for home-based counseling as well as to identify measles cases.
This process was not linear and demanded a lot of iteration and follow-up to convince caregivers to vaccinate their children against measles. Thanks to the efforts of a dedicated team, however, 65 households across three wards in Nepalgunj were reached with counselling and encouraged to bring their children to a health facility to get the measles vaccine. A total of 40 children received vaccinations at their doorsteps.
"The HCD approach identified the core causes of vaccine hesitancy, broke barriers and pinpointed possible measles cases,” says Sandeep Shahi, a health facility in-charge.
Indeed, through the lens of HCD, the measles intervention in Nepalgunj illuminated the potency of empathy, collaboration and tailored approaches. Placing community needs, beliefs and aspirations at the forefront didn't just contain the measles outbreak; it planted seeds for enduring change.
Nepalgunj's outbreak turned into a testament: a testament to the transformation possible when humanity takes center stage.
