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

Abstract Background Adolescent sexual and reproductive health (ASRH) remains a critical public health priority in Ethiopia, where adolescents face persistent barriers to accessing responsive and high-quality sexual and reproductive health (SRH) services. Conventional top-down interventions often fail to address adolescents’ lived experiences and local contexts. Human-centered design (HCD) offers a participatory and context-sensitive approach for developing adolescent-responsive interventions. As part of the SAFE study ( S trengthening Prim A ry Healthcare F aciliti e s), this study reports on the application of HCD to co-design an integrated ASRH intervention package for primary healthcare facilities in Southern Ethiopia. Methods The study was conducted from 25 th May to 5 th October 2025 in Arba Minch town and surrounding districts, encompassing urban and rural communities served by primary healthcare facilities. We employed a participatory co-design approach grounded in HCD and participatory action research to develop integrated intervention packages. This approach was selected to ensure contextual relevance, cultural sensitivity, and feasibility within existing health system structures. Adolescents, healthcare providers, youth leaders, facility managers, and researchers were engaged through iterative needs assessments, co-design workshops, and prototype refinement. Qualitative data were analyzed thematically and iteratively to inform Intervention package development. Results The co-design process generated four integrated intervention packages: (1) capacity building for healthcare providers and facility managers to enhance technical competence and adolescent-responsive service delivery; (2) peer navigator programs to enhance demand, service utilization, adherence, and linkage to ASRH service; (3) an SRH call center to Confidential information counseling, appointment, and bridge secondary barriers (barriers from treatment seeking to reach health service); and (4) strengthening adolescent-friendly health facilities to improve accessibility, privacy, and quality of care. Conclusion Human-centered co-design enabled the development of a comprehensive and integrated ASRH intervention package that addresses multilevel barriers Service provision, accessibility, utilization, and integration. Institutionalizing human-centered approaches within existing health systems may enhance equity, effectiveness, and sustainability of ASRH services. Future research should evaluate the implementation, scalability, and impact of these interventions.