Co-designing an integrated intervention package to strengthen adolescent sexual and reproductive health services in primary healthcare units in Southern Ethiopia: A human-centered design approach

Adolescent sexual and reproductive health (ASRH) remains a major public health priority in Ethiopia, where adolescents face barriers to accessing confidential, responsive, and high-quality sexual and reproductive health services. Although various ASRH interventions have been implemented in Ethiopia, limited involvement of adolescents and other stakeholders in participatory intervention development may constrain their contextual relevance, acceptability, and sustainability. This study applied Human-Centered Design (HCD) principles to co-design an integrated, adolescent-responsive intervention package for primary healthcare facilities in Southern Ethiopia. An intervention development study using an HCD approach was conducted from May to October 2025 in Arba Minch town and surrounding districts. The process followed five iterative HCD phases: empathize, define, ideate, prototype, and test/refine. A total of 61 participants, including adolescents, healthcare providers, facility managers, and community stakeholders, contributed through formative assessments, stakeholder workshops, problem identification and prioritization exercises, and co-design sessions. Qualitative data from interviews, discussions, and workshops were analyzed thematically, while participatory prioritization and iterative feedback informed intervention refinement. The process identified and prioritized 57 barriers affecting ASRH service delivery, access, and utilization. These findings informed the development of four complementary intervention components: strengthening healthcare provider and facility manager capacity through training, mentorship, and supportive supervision; establishing an adolescent peer navigator system to improve awareness, service uptake, access, and linkage to care; establishing a confidential sexual and reproductive health call center to provide counseling, appointment support, and referrals; and strengthening adolescent-responsive primary healthcare facilities through improved privacy, accessibility, service organization, and responsiveness to adolescents’ needs. Together, these components address barriers at the provider, facility, community, and service-access levels. The resulting package offers a contextually grounded, multilevel approach to integrating adolescent-responsive ASRH services into routine primary healthcare. By involving adolescents and key stakeholders throughout the design process, the study provides a foundation for developing services that better reflect adolescents’ needs and local health system realities. Further research is needed to evaluate the package’s feasibility, acceptability, implementation, and effectiveness, and to determine its potential for adaptation and scale-up in other settings.