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Co-creating a maternal health programme with local stakeholders in Congo

Gilles Virgili
Innovation Technical Analyst, UNFPA Headquarters


UNFPA is the United Nations sexual and reproductive health agency. Our mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.



With 426 maternal deaths for 100,000 stillbirths, the Republic of Congo is one of the countries with the highest rate of maternal deaths, and is also facing a severe economic crisis that leaves the country’s infrastructure in disarray. It is in this kind of context more than anywhere else that we need to find new ways to ensure the survival and development of women and children.


Why we used the tools

In order to guide the development of a maternal health programme, we organised two co-creation sessions in a rural and urban district of the country with healthcare professionals and community workers. These workshops were meant to identify the definition of key priorities to reduce maternal death.



How we used the tools
We developed a one-day process aimed at empowering local stakeholders to identify the key challenges they face, dissect their causes and imagine innovative ways of overcoming them.


The first group was composed of 22 participants and the second 25 participants. All the exercises were done in groups of five to seven people maximum.


For the co-creation workshops, we used the following tools:

  • A visioning exercise to describe how the current health system works and to build what a well-functioning system would look like in 10 years. Each group was encouraged to represent visually the two situations (current and future) and identify the key bottlenecks or barriers that prevent them from achieving the system they envision. As a way to stimulate conversations, we used the SWOT Analysis so that participants considered the various aspects of their institutions and systems.
  • In plenary, each group presented their vision and the challenges identified. Once all the challenges were mapped out, all the participants voted on the four main challenges to work on for the rest of the day.
  • Each group focused on one problem and used the Causes Diagram to analyse in depth all the causes and consequences of the issues to overcome.
  • Each group then spent the afternoon discussing potential innovative ways to overcome their challenge using the Fast Idea Generator.


Results of using the tool

The SWOT Analysis helped the teams to review and evaluate all the characteristics of their institutions and systems. It encouraged them to also consider their strengths and opportunities rather than only focus on challenges. Reflecting on opportunities also helped them in defining the key features of their envisioned system in 10 years.


The Causes Diagram was a great way to push participants to analyse their challenge beyond what common sense was telling them. By considering underlying causes, consequences and contributing factors, they were forced to think about the roots of their problems. Some groups really identified elements that were unexpected for them and helped them to come up with creative responses during the ideation session.



Unlike the two other tools which are pretty self-explanatory, the Fast Idea Generator requires spending more time introducing its objectives and use. It is worth the facilitators spending some time before the workshop preparing specific examples related to the theme of the discussion for each of the nine approaches. The tool worked well in the first workshop with teams in the urban district used to work together and debate, but not during the second session with stakeholders in a rural town. It is worth noting that, in certain cultural contexts, asking people to “bend or break rules” might not necessarily be seen in a good light. The groups that liked the tool highlighted that it really opened new perspectives and it was apparent when they presented their idea that it had emerged from the tool itself.


Other lessons learned and recommendations

The social structures and power dynamics need to be well understood: because the co-creation approach modifies the highly codified and hierarchised order that usually prevails, there is a real risk of negatively impacting the relationship between stakeholders. Understanding the ecosystem and adapting the facilitation to the people present at the workshop is essential.


Meaningful participation is a process, not an event. One day was not sufficient to truly open a safe and free space for expression and creation. We will therefore organise follow-up sessions during which more time will be spent on ideating and refining solutions.

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  1. Said Ahmed Mohamed

    Bulay Development Organization(BUDO)

    Very useful analysis data and must be in mind at any time.