Danielle Agnello is a Marie Curie doctoral fellow within the Health CASCADE project. Her research focuses on investigating methods that are most appropriate for evidence-based co-creation.
Danielle has joined Health CASCADE from the World Health Organisation (WHO), where she had a chance to use co-creation in her work. In this blog, she reflects on both the successes and challenges of co-creation; presenting the areas where Health CASCADE could help.
Public health is defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.” This definition is the backbone of what the World Health Organization (WHO) does daily. Since its birth in 1948, the WHO has evolved to be a global United Nations agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable. It directs and coordinates the world’s response to health emergencies and promotes healthier lives for all.
As a young global health professional, I was very proud to begin my career at the World Health Organization. My adventure started there in 2015, and I continued to work in different teams in WHO Regional Office for Europe, and WHO Headquarters, until the end of 2021, when I leapt back into academia, by joining the Health CASCADE network as a PhD Fellow.
Source: WHO/Europe Photographer, Mission in Georgia, 2015
My Introduction to Co-creation
While my career started on the Antimicrobial Resistance team (mission pictured above), my understanding of the complexity of addressing pressing public health issues was deepened when I joined the Public Health Services team. As a team, we were tasked with supporting countries in strengthening their public health services. We answered this call by establishing and convening a community of practice, which we called the Coalition of Partners (CoP). This platform was an invitation for collaborating with decision-makers and experts from national public health services, international organizations, and academia. We aimed to convene the top expertise and resources the European Region had to offer, to share lessons learned and co-develop context-appropriate solutions for national and regional challenges.
Through establishing the CoP, we embarked on a three-year co-design process, which included countless design meetings, and numerous participatory workshops. Thankfully we were aided in our pursuits with the support of participatory facilitators. However, we very much were building our whole co-creation process from scratch – as there were no evidence-based guidelines for executing this process. Therefore, we faced many challenges and pitfalls.
For instance, we attempted to create a sense of ownership among all members of the CoP, but we were faced with balancing that desire with the limitations placed on us by donors and our organizational mandate and policies. Furthermore, we found that without concrete follow-up actions, the momentum, motivation, and trust from our co-creators was waning. Additionally, since there was no way for us to accurately predict our next steps, it was difficult to gain buy-in from key stakeholders within the public health community. Even with those challenges, we did make an impact in Ukraine, Estonia, Finland, North Macedonia, and other countries facing wicked problems, and my interest and belief in the power of co-creation was sparked!
Source: Photos taken by WHO/Europe photographer in Slovenia and Estonia, 2018
Applying my Learnings
My career in the WHO progressed, and I was given an exciting opportunity to work in the Global Coordination Mechanism on the Prevention and Control of Noncommunicable Diseases (GCM/NCDs) at WHO Headquarters. Established in 2014, this was the first and only WHO instrument aimed at facilitating multistakeholder engagement and cross-sectoral collaboration for preventing NCDs.
When I joined the team in 2020, I emphasized the value of using participatory methods to engage communities and create meaningful collaboration. Bringing my experiences and lessons learned from the CoP, I drove home the importance of unbiased data collection and analysis, and the execution of clear follow-up actions with all stakeholders. Our team recognized the need for co-creation, so I designed a new methodology we named ‘NCD Sprints.’ This methodology aims to serve as a model for identifying and addressing pressing challenges faced at the national and regional levels. I also co-led the design of their first participatory workshop to engage People Living with NCDs (PLWNCDs) (report here).
However, again I was faced with the challenge of finding an appropriate co-creation model or a body of literature where I could find supportive materials. For instance, we had to consider political factors, as well as ensure the protection of the populations we were co-creating with. Furthermore, due to time constraints, it wasn’t possible to answer the research question, ‘How can we use co-creation in public health?” Consequently, we would have benefited from access to a set of literature that represented true co-creation — where we could find similar cases or gain inspiration from other people’s experiences.
Due to its initial success, the GCM/NCDs are expanding this PLWNCDs engagement to all six WHO regions in 2022, through a series of workshops to co-design a global framework of action (See more here)! This is a great accomplishment for the team, and those participating, but they still face the challenge once again in finding the best, evidence-based way to execute this important engagement process.
Health CASCADE can help
I am sharing my story with you because I think many people who have attempted to address public health challenges using co-creation, are also faced with similar, unanswered, questions – What are the steps of the co-creation process? Who has done co-creation successfully? How do I argue that my approach is the best course of action? How do I know when my co-creation process is done? How do I evaluate my process and our product?
Public health has evolved over the past two centuries due to changing threats to human health that vary with time and geography. Therefore, it is time to evolve our research methods to appropriately engage those that are facing these threats. I imagine many will agree that co-creation is a promising way forward. Health CASCADE is up for the challenge, and I am proud to be a part of this ambitious endeavour!
Source: Participatory Grant Making