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Human-centred design (HCD) is an approach to problem-solving that prioritises understanding and meeting the needs of the end-users. Researchers and designers practice empathic listening as users share their perspectives, thereby enabling a variety of stakeholders to cocreate effective solutions. While a valuable and, in theory, straightforward process, HCD in practice can be chaotic: Practitioners often struggle to navigate an excess of (often conflicting) ideas and to strike a balance between problem-understanding and problem-solving. In this practice paper, we outline our own experiences with HCD, which ultimately resulted in the development of a successful video-based intervention to bolster vaccine confidence in the Philippines. We highlight the use of 'radical circles' to overcome roadblocks and navigate tensions. Radical circles entail groups of individuals with divergent opinions and identities engaging in critical analysis of a given idea, actively challenging standard ways of thinking, and ultimately, generating solutions. Employing radical circles enabled us to innovate and adapt to new perspectives that emerged along the non-linear HCD pathway. Our incorporation of radical circles into HCD methodology demonstrates its potential as a powerful complementary step in the meaning-making process. In our view, radical circles could enrich HCD processes and provide a solution to design overcrowding, leading to meaningful, transformative and successful interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The interplay between devolution, health financing and public financial management processes in health-or the lack of coherence between them-can have profound implications for a country's progress towards universal health coverage. This paper explores this relationship in seven Asian and African countries (Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia and the Philippines), highlighting challenges and suggesting policy solutions. First, subnational governments rely heavily on transfers from central governments, and most are not required to allocate a minimum share of their budget to health. Central governments channelling more funds to subnational governments through conditional grants is a promising way to increase public financing for health. Second, devolution makes it difficult to pool funding across populations by fragmenting them geographically. Greater fiscal equalisation through improved revenue sharing arrangements and, where applicable, using budgetary funds to subsidise the poor in government-financed health insurance schemes could bridge the gap. Third, weak budget planning across levels could be improved by aligning budget structures, building subnational budgeting capacity and strengthening coordination across levels. Fourth, delays in central transfers and complicated procedures for approvals and disbursements stymie expenditure management at subnational levels. Simplifying processes and enhancing visibility over funding flows, including through digitalised information systems, promise to improve expenditure management and oversight in health. Fifth, subnational governments purchase services primarily through line-item budgets. Shifting to practices that link financial allocations with population health needs and facility performance, combined with reforms to grant commensurate autonomy to facilities, has the potential to enable more strategic purchasing., Competing Interests: Competing interests: None declared., (© World Health Organization 2024. Licensee BMJ.)

The COVID-19 pandemic has highlighted the persistent fragmentation of health systems and has amplified the necessity for integration. This issue is particularly pronounced in decentralise settings, where fragmentation is evident with poor coordination that impedes timely information sharing, efficient resource allocation and effective response to health threats. It is within this context that the Philippine Universal Health Care law introduced reforms focusing on equitable access and resilient health systems through intermunicipal cooperation, enhancing primary care networks and harnessing digital health technologies-efforts that underline the demand for a comprehensively integrated healthcare system. The WHO and the global community have long called for integration as a strategy to optimise healthcare delivery. The authors contend that at the core of health system integration lies the need to synchronise public health and primary care interventions to enhance individual and population health. Drawing lessons from the implementation of a pilot project in the Philippines which demonstrates an integrated approach to delivering COVID-19 vaccination, family planning and primary care services, this paper examines the crucial role of local health officers in the process, offering insights and practical lessons for engaging these key actors to advance health system integration. These lessons may hold relevance for other low-ncome and middle-income economies pursuing similar reforms, providing a path forward towards achieving universal health coverage., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)