Potentials and challenges of using co-design in health services research in low-and middle-income countries

Co-design with people having poor access to health services and fragile health systems in low-and middle-income countries can be momentous in bringing service users and other stakeholders together to improve the delivery and utilisation of health services.There is ample of evidence from high-income countries regarding how co-design can translate available evidence into developing acceptable,feasible,and adaptable health solutions in different settings.However,there is limited literature on co-design in health research in the context of low-and middle-income countries.Therefore,it is crucial to understand how knowledge about collaborative working can be translated into policy and practice in the context of low-and middle-income countries.Thus,this paper discusses the concept of co-design,co-production,and co-creation in health and the potentiality and challenges of using co-design in health services research in low-and middle-income countries.Despite the challenges,the co-design research has considerable potential to encourage the meaningful engagement of service users and other stakeholders in developing,implementing,and evaluating real-world solutions in low-and middle-income countries.It is essential to balance power dynamics in a co-design process through mutual recognition and respect,participant diversity,and reciprocity and flexibility in sharing.The inclusive and collaborative approach to working is complex due to existing rigid hierarchical structures,socio-cultural beliefs,political interference and working practices.However,this could be minimised by developing transparent terms of reference that reflect the value and benefits of equal partnership in particular co-design work.