Co-designed interventions package for enhancing women's resilience in reproductive and child health through income-generating associations: a human-centered design study in Tanzania.

Background: Maternal and under-five mortality remain major public health concerns in many low- and middle-income countries, including Tanzania. Despite their widespread use in strengthening economic resilience, income-generating associations (IGAs) have not fully utilized their potential as platforms for addressing reproductive and child health (RCH) challenges. Objective: This study aimed to co-design an intervention package with women participating in income-generating associations to enhance their preparedness and resilience in addressing RCH challenges in Tanzania. Methods: A qualitative descriptive study guided by a Human-Centered Design (HCD) framework was conducted in the Arusha and Shinyanga regions of Tanzania. The study followed four iterative phases: (1) discovery and mapping of IGAs to understand members' experiences and RCH challenges; (2) co-design and prototyping of potential interventions with women and stakeholders; (3) validation of the prototype intervention package with additional IGA members; and (4) refinement of the package through consultations with reproductive and child health experts. Data was collected through focus group discussions, key informant interviews, and consultative workshops with individuals participating in IGAs, community development officers, IGA coordinators, and RCH stakeholders. Qualitative data were analyzed using thematic analysis, while intervention priorities were ranked based on acceptability, feasibility, and sustainability. Results: The discovery phase revealed that IGAs function as important economic resilience mechanisms for women but are rarely utilized as platforms for reproductive and child health promotion. Key barriers included limited health education within groups, financial constraints affecting access to healthcare, gender norms influencing participation, and limited engagement among men. Through the co-design process, several candidate interventions were generated and prioritized. Four core components emerged as the most feasible and acceptable: (1) delivery of maternal and child health education through regular IGA meetings; (2) facilitation of health insurance awareness and enrollment among members; (3) strengthening governance and coordination within IGA groups; and (4) increasing participation and support for vulnerable women, including adolescent girls and young women. Validation with additional participants confirmed the feasibility and relevance of these interventions within the existing IGA structure. Conclusion: The co-designed intervention package emphasizes the necessity of integrating health education, financial protection mechanisms, and governance strengthening within existing economic groups.