PT  - JOURNAL ARTICLE
AU  - Closser, Svea
AU  - Sultan, Marium
AU  - Finley, Erin
AU  - Gerber, Sue
AU  - Shafique, Muhammad
AU  - Ahmed, Saeed
AU  - Shah, Imtiaz Ali
AU  - Khurshid, Naveed
AU  - Naz, Farah
AU  - Nayyab, Sadaf
AU  - Fei, Celena
AU  - Sohail, Ali
TI  - IMPACT: A Structured Human-Centered Design Process for Integrating Community Health Worker Insights Into Program Policy in Pakistan
AID  - 10.9745/GHSP-D-24-00050
DP  - 2026 Jun 22
TA  - Global Health: Science and Practice
4099  - http://www.ghspjournal.org/content/early/2026/06/22/GHSP-D-24-00050.short
4100  - http://www.ghspjournal.org/content/early/2026/06/22/GHSP-D-24-00050.full
AB  - Key FindingsStructured human-centered design processes facilitated substantive engagement and collaboration from both male supervisors and frontline female health workers in a highly gender-stratified setting to propose policy improvements for polio vaccination.CHWs valued the process enormously; most said it was the first time their insights had been considered, and they wanted more opportunities for such input.Key ImplicationStructured processes can allow the least powerful actors in public health programs to contribute to improved program policy.Background:Community health workers (CHWs), most of whom are women, are the bedrock of primary health care provision in much of the world. CHWs are often employed at the bottom of health hierarchies where they have little voice; in state programs and vertical initiatives, accountability has generally flowed downwards. Yet many programs might function better if CHWs’ needs and ideas were considered in program design.Methods:From 2020-2022, we implemented a human-centered design process called IMPACT with CHWs working on polio vaccination in one district of Pakistan. The name IMPACT draws from the steps in the process: Identify problems and brainstorm innovations; Make and refine ideas; Present and evaluate ideas; and ACT to disseminate and implement. We held a facilitated competition for teams of CHWs, all of whom were women, to propose policy improvements to polio vaccination. In total, 417 CHWs participated in the design process facilitated by our team, and more than 500 additional CHWs participated in sessions facilitated by local supervisors. We worked with local policymakers to short-list the best ideas. Teams of CHWs presented the short-listed ideas to a panel of provincial and national-level policymakers, who selected ideas for implementation. We conducted interviews with CHWs and policymakers throughout the process to understand their experiences (n=82).Results:We received 181 idea submissions over two rounds of the process; 9 ideas were chosen for implementation. CHWs valued the process enormously; most said it was the first time their insights had been considered, and they wanted more opportunities for such input. The second round of the process was more effective than the first, with workers generating more complex ideas and program staff running workshops themselves. We heard, across management levels, that the process had positively impacted CHW motivation and confidence. Overall, the innovations selected for implementation were in the form of adjustments rather than major programmatic changes. Yet CHWs reported that the changes made were helpful and that it was very meaningful to have contributed to program policy.Conclusion:IMPACT facilitated substantive engagement and collaboration from both male supervisors and frontline female workers in a highly gender-stratified setting. Structured processes can allow the least powerful actors in global health interventions to draw on their frontline experience to suggest policy innovations.