Although pneumonia can be prevented and treated, every year, it claims the lives of nearly 1 million children under 5 years old.

Not all children receive appropriate care, often because they are misdiagnosed. This is especially so in the poorest regions of Africa and South Asia – a case of inequity at its most pernicious.

When UNICEF, WHO and others began researching ways to improve the reliability of pneumonia diagnosis, the possibilities offered by new technologies as well as the experiences of community health workers (CHWs) from Ghana, South Sudan and Uganda, became essential to the project.

In communities where well-equipped hospital labs and qualified doctors are far from reach, families depend on health workers to diagnose and treat diseases. Health workers use an Acute Respiratory Infection (ARI) timer as a diagnostic tool, and a small stock of medicines to carry out their work.

The ARI timer is a handheld device that helps CHWs detect rapid breathing in a sick child. User research conducted with CHWs gave insights that would otherwise have remained hidden in standard product surveys: Problems in the ARI timer design that added to difficulties in making accurate breath counts, for example, and difficulties in convincing worried parents who insisted on antibiotic treatment, even if the diagnosis using the ARI timer ruled out pneumonia. In villages where there is no electricity, the lack of sufficient light made it impossible to use the device at night time.

These examples underscore the critical role of users in providing needs-based information – a good starting point for product engineers and designers to identify solutions. Researchers went on to ask the users: ‘How can we solve the problem?’

In the context of product development, asking such a question of users might seem controversial. Research suggests that knowledge about an existing technology – and the exciting and complex advancements that could be just around the corner – is beyond the scope of the user’s normal experience. However, empirical data from industrial and consumer product research suggest that users are often the initial developers of ideas that have turned into commercially successful products and up to 30 per cent of users had already developed something new or had modified the original product themselves.

In response to the researchers’ question, and unrestrained by technical questions of feasibility, CHWs produced dozens of visualizations expressing what an innovative product should do for them as health service providers, for children whose lives were at stake and for parents who need reassurance. Understanding why CHWs struggle with the ARI timer embeds users’ working conditions into product development.

UNICEF’s project to innovate pneumonia diagnostics recognizes the complementarity of contributions from both end-users and product experts. One informs the other and each is an essential component in ensuring that innovations are not only technically feasible, but also feasible in the context where they will be used.