Amplifying Resilient Communities

COVID-19 exposed fault lines in global health systems, especially for marginalised communities in Low- and Middle-Income Countries (LMICs). Already strained interactions between health seekers and providers were further compounded by pandemic-related service disruptions. Frontline workers faced overwhelming demand, while patients encountered new and unfamiliar frictions in their access to care. Project ARC sought to explore these disruptions from the perspectives of both seekers and system actors, using the pandemic as a lens to diagnose longstanding issues and highlight opportunities for systemic reform.

Through deep ethnographic engagement, the project examined what happens when health systems are under stress and, more importantly, how individuals and communities navigate, adapt, or circumvent those systems in times of crisis. By listening closely to their lived experiences, ARC uncovered the often invisible work of resilience and sought to understand how future systems might be better designed around these realities. Based on the findings, a set of design principles was developed to mitigate identified barriers and meet the genuine needs of these communities. These principles underline the design of health systems and their seekers to give crucial human-centred inputs into broader health system reforms.

Research Methods

The research was conducted across three phases: Foundational Research, Ethnography, and Immersions. In Bangladesh, the study involved 156 foundational research participants and 72 deep-dive immersion participants from Bogura, Dhaka, and Narayanganj. Similarly, in South Africa, the sample included 185 foundational research participants and 40 deep-dive immersion participants from Gauteng, Mpumalanga, KwaZulu-Natal, and Western Cape. For ethnography, five participants from each of the four provinces were selected.

Design thinking and synthesis tools were adapted to fit the cultural and logistical contours of the project. This bespoke, iterative process enabled the team to translate fragmented data into actionable insights that foregrounded the lived realities of health seekers.

World building

A world-building activity led us to delve into a socially distanced profile of Bangladesh. This unique exercise wove together the expansive landscape of the country, its diverse health systems, and insightful deep dives into specific research locations. Presented in bite-sized nuggets resembling postcards, each snippet unveils a complete story, granting readers the freedom to choose their own narrative path and pace. It provided a tactile sense of place and possibility, essential for understanding health systems not as monoliths, but as lived, negotiated spaces.

Strands of Health

Building on the social determinants of health, the project proposed Strands of Health, a framework designed to understand people's perception of their own well-being. According to our findings, six strands come together to form a holistic perception of health among individuals and communities. Stress on any one strand—whether social, economic, emotional, or environmental—was seen as a disruption to overall wellness. This approach helped ground the team’s analysis in the priorities of health seekers and revealed where systemic frictions created the greatest harm.

Journey Mapping & Friction Spotting

Mapping health seeking journeys was a focal part of our data analysis and synthesis. We analysed the experiences of health seekers within the healthcare system, specifically focusing on identifying points of friction. These frictions acted as barriers, impeding seamless access to healthcare services, but also presented opportunities for potential interventions and innovations. Among the identified frictions were challenges in navigating the healthcare system, the existence of unrecognised intermediaries, and the absence of dialogue, trust, and understanding.

Project Outcomes

Design Principles

A set of design principles were formulated to address the identified sources of friction, aiming to inspire and inform early-stage health system program & policy ideation while critically assessing new global health ideas.These principles are rooted in both academic research and grassroots ingenuity—drawing inspiration from the coping mechanisms and strategies developed by communities themselves. They advocate for the integration of digital and physical healthcare services, improved access for marginalised users, and a closer alignment between user needs and system priorities.

Stories of the Future

To communicate the principles in an imaginative and accessible way, the project produced “Stories of the Future”—a set of design fiction narratives that imagine what a seeker-centric health system could look like. These stories present speculative prototypes such as the TB Early Identifier and Seeker-centric Support Structures, prompting stakeholders to envision bold, people-first models of healthcare infrastructure.

Project ARC provides a forward-looking resource for anyone involved in the design or working towards reforming public health systems. Its user insights and design principles offer tangible starting points for reimagining healthcare in a more equitable, accessible, and resilient way. Whether used by public health advocates, policymakers, funders, or civil society organisations, ARC invites system stakeholders to position health seekers as vital collaborators, in their decision-making and co-create solutions that work in the complex realities of everyday life.