Where do we reach families without adequate health coverage or access to vaccines? How do we address inequity in our health systems? Nearly 25 years in health care delivery across Africa have taught us the importance of local expertise in answering such questions. We’ve learned that connecting local expertise to learning from across the globe can generate profound change – in mindset, in ways of working and health outcomes.
Whether in Africa or North America, we’re committed to building strong relationships with communities to improve outcomes for all. Sustained collaborations enable us to understand health users’ needs and preferences, and to work together to create lasting change. We bring this unique, locally driven, globally connected approach to our work in North America, offering a range of services to local health departments to improve outcomes in health areas such as immunization, preparedness, communicable disease and infection prevention, epidemiology and community health.
In Jefferson County Public Health (JCPH) department, Washington State, we focused on co-creating new paths to health care and immunization access for food-insecure families with school-aged children. Throughout this initiative, we prioritized two key principles: building trust through participatory research and fostering collaboration to identify local solutions.
Trust Through Participation
Co-creation workshop taking place
We worked with JCPH to bring in elements of Community-Based Participatory Research (CBPR) and Human-Centered Design (HCD), putting community voices at the forefront to ensure their needs and perspectives shaped every step of the process, from co-creation to solution design. This included:
- Data collection with a human touch: We conducted in-depth interviews, windshield surveys and observed vaccine sessions. But it wasn’t just about collecting data – it was about creating a space for open dialogue.
- Community feedback nights: We hosted informative evenings with free food and childcare, ensuring everyone had a chance to provide feedback on our findings.
- Co-creation workshops: These interactive sessions made space for community members to directly participate in designing solutions to address the identified barriers.
Throughout the process, JCPH went “into the community to listen, not just to be heard,” as a member of the JCPH team put it.
What we found in South Jefferson County were close-knit and self-reliant communities who were without many of the public services available in more populous or high-income communities. Our windshield surveys were revelatory, changing the very essence of the project, from one about immunization, to one about public health care provision more broadly, as well as environmental health.
Walking the Walk: Data Collection Through Community Engagement
The data collection process wasn’t confined to sterile surveys and clinical settings. During “data walks” in Brinnon and Quilcene, two communities in South Jefferson County, seven stations showcased key findings from the initial research phase for reflection and refinement. Community members armed with sticky notes and markers were invited to share their thoughts, ask questions and provide their own insights.
The impact was clear. JCPH Director Apple Martine was impressed that the data walks “consistently conveyed we want you here and we want to know what we missed.” Not only were we building health care solutions, but we were also building trust within the community through transparency.
Director Martine continued, “This work … brings me great delight. It’s energetic; it’s about ‘yes’, not ‘no’. It’s about harmonizing interactions between us and our partners, us and our people and how we show up in the ways that communities want us to show up.”
From Findings to Action: Co-Creation Workshops
JCPH staff explain findings during a data walk
Following the windshield surveys and the data walks, we held co-creation workshops aimed at co-developing solutions with community members. Together, we developed lists of “no-brainers”, “quick wins” and “long-term solutions”, such as:
- No-Brainers: Partner with schools and health care providers to share back to school reminders about health physicals and immunizations.
- Quick Wins: Develop a “one-stop-shop” online resource with comprehensive information about health care services in South Jefferson County, including clinic hours, location maps and appointment scheduling options.
- Long-Term Solutions: Explore options for mobile vaccination clinics and pop-up health fairs in marginalized communities or underserved areas, and partner with local schools and community organizations to improve healthcare outreach and education.
Solution mapping from a co-creation workshop
Not all of our initial ideas made the cut for consideration. Challenging, low-impact projects were allocated a long stay space in the “parking lot.”
JCPH staff shared the concerns and insights from their communities and felt confident that this project put them in a good position to tackle the identified issues. One staff member noted the importance of having “the A-team in the room,” referring to the diverse group of stakeholders who participated, including representatives from the health department, social services, schools and the local hospital system.
The collaborative decision-making and energy generated in the room is a cornerstone of HCD. As another member of JCPH said, “I felt honored that community leaders were able to take that time, how much they care about their community, and that infectious energy has rubbed off on me. I feel very empowered now for whatever we can do [next] to help the community.”
Moving Forward, Together
Stronger partnerships have been forged through this community engagement process, making new ways of working together possible. A JCPH employee noted they were excited by the potential link “with schools around vaccination and primary care access.” This had been a long-held ambition but is now on the agenda.
The learnings from this project are being used to inform improvements to health care access in Jefferson County right now. Staff ask themselves, “What can we do tomorrow to make a difference in this community.” Tomorrow. This proactivity included helping a family in need to arrange health insurance within a week, “and that is changing a family’s life.”
Together, we shared the findings openly with the community, ensuring the co-developed solutions reflected the community’s needs and fostered a sense of trust and accountability. JCPH went the extra mile, recognizing that community engagement is more than “just putting out an internet flyer and hoping that people show up.”
By working with local communities, JCPH and VillageReach identified and addressed critical barriers to immunization and health care access. Now, we are supporting JCPH to implement local solutions that make quality health care more accessible, equitable and responsive to the needs of the entire community, now and for the future.
To learn more about the project’s findings and recommendations, please read the full Jefferson County Public Health report.