“I have liked this meeting because it was safe. There was not that this one is old, and this one is young. We were all doing things as one.” (Male adolescent attendee)

Work Strand 4 (WASH team) of the NIHR Global Research Group on Improving Adolescent Health & Wellbeing in Malawi kicked off the year with co-designing workshops in Blantyre, following successful sessions in Mchinji. These workshops brought together key stakeholders, including adolescents, chiefs, parents, headteachers, School Health & Nutrition (SHN) Coordinators, NGO partners, officials from the Blantyre Urban Education Office, and the District Health Office (DHO). The goal was to collaboratively develop solutions to address ongoing WASH challenges affecting both in-school and out-of-school adolescents.

The process began with a preparatory workshop on January 16, 2025, to inform the stakeholders on the co-design process. During this workshop, formative research findings were presented to the participants. The findings highlighted issues such as inadequate water access, insufficient sanitary facilities, and a lack of handwashing stations in both schools and households. Additionally, poor hygiene practices were observed, including low handwashing rates, smearing of faeces on walls, open defecation, low use of drop hole covers, bullying related to menstruation, poor waste disposal, and latrine sharing. These results provided attendees with the opportunity to provide feedback and contribute further insights into some of the challenges identified. The main co-designing workshops took place on January 23rd and 24th, 2025, during which participants worked together to develop solutions based on the formative research findings. On the first day, participants co-created solutions to different WASH problems identified in the formative research.  Groups were formed to facilitate in-depth discussions as participants brainstormed intervention ideas. Adolescents had their own group and room, providing them with a space to freely share their thoughts and opinions.

By the end of the first day, three challenges were prioritised (smearing of faeces, open defecation and low handwashing practice) and four solutions were identified. The solutions included: increasing availability of anal cleansing materials, conducting awareness campaigns on handwashing with soap promotion, conducting awareness campaign and recruiting of cleaners to promote toilet use and ending open defecation. The second day focused on validating the proposed solutions by mapping out key players, existing community structures, potential challenges, and alternative implementation strategies.

Stakeholder Reflections on the Co-Designing Approach

At the end of the workshops, participants shared positive feedback on the inclusive and participatory nature of the process. Adolescents appreciated being actively involved in identifying their own challenges.

One in-school adolescent (female) shared their excitement about the decision-making process:

“What I liked most about this was when that woman who was telling us to vote. There were 7 challenges, and we needed to vote for three. They want to see which challenge is huge from everyone so that we identify the most challenging issue… two of the challenges I voted for were there.”

Adults also recognized the importance of adolescent participation, where young people have raised issues, the adults were not aware of. One HSA reflected:

“For example, the problem of smearing of faeces-we couldn’t have thought about it, but you can see that the adolescents have prioritized it. Had those children not been here, we could have chosen something that we know and easily see. But since the issue is close to them, they can say so.”

Health Surveillance Assistants (HSAs) also acknowledged the value of collective input:

“The way I was thinking as an individual could have not made the solutions to be as they are. But we have all helped each other to suggest what could be done by getting ideas from all sides.”

Furthermore, one NGO partner highlighted the effectiveness of the approach, saying:

“This is a good approach. Personally, as much as I have stayed for a long time in the WASH sector, I can say this approach is great… the results which you will obtain are a true reflection as they are coming from different stakeholders.”

Looking Ahead

While further development of the solutions and intervention content has been planned, some stakeholders already view the process as a “workplan development exercise” and are eager to begin implementing some of the proposed solutions independently. The success of these workshops highlights the power of co-designing with communities to create sustainable and impactful WASH interventions.