Co-design for equity in public health: from participation to partnership
L MustaAbstract
Issue
Co-design is increasingly recognised as essential for reducing health inequities through meaningful engagement with end users and stakeholders. Beyond promoting social justice, it contributes to creating feasible, acceptable, and sustainable solutions. However, in many initiatives, co-design remains loosely defined or applied only at isolated stages, risking fragmentation and jeopardising its benefits.
Description of the problem
Co-design is often misunderstood as a one-off activity rather than a continuous, structured process. Power imbalances, time constraints and institutional routines may lead to tokenistic participation, where lived experience is invited but has limited influence on decisions, and may be even harmful for participants. As a result, interventions may fail to reflect the priorities, capacities and realities of diverse populations, undermining acceptability, effectiveness, sustainability, and potentially reinforcing inequities.
Effects
This presentation provides practical examples of co-design, drawing on a multi-country contexts and showcasing tools for systematic stakeholder engagement across all phases of implementation. Examples include engagement of patient organisations and NGOs as partners in defining priorities, refining intervention content, and supporting outreach. Further examples demonstrate how co-design can promote equitable participation, for instance through culturally and linguistically sensitive facilitation and adapted materials. Integration of co-design into evaluation through stakeholder engagement in reflecting on outcomes, implementation barriers and lessons learnt will also be discussed.
Lessons
Meaningful co-design requires intentional structures, critical reflection on power and sustained engagement, rather than additional resources alone. When applied systematically, co-design strengthens equity by ensuring that public health actions are shaped with, rather than for, the populations they aim to serve.