By using the Design Thinking approach, we established a user-centred view amongst all process, combining the public and public servants to find solutions for common problems. This was possible by developing a deep understanding of the user experience and needs, creating a complex set of different points of view and enlarging the challenge first issued. The major stakeholders were involved and every step was approved by the stakeholders, leading to better supported solutions at the end.

Although recognized as important, community participation and empowerment at public policies is not a common practice for governments in Brazil. There are several issues blocking this kind of procedure, including a lack of knowledge and/or skills on how to involve people to discuss public policies. This project aims at this challenge, bringing people closer to the policy core and attaining their point of view to policy elaboration. This resulted in a much more clear approach to the real citizens' problems and needs, developing an innovative Public Health policy, even awarded by the Brazilian Central Government.

We conducted in-depth interviews with stakeholders, including experts, and made several visits to the public health units to understand everyone’s experiences within the “Health Journey". Among the insights into how people see and think “Public Health,” we understood more about the poor quality of public health service delivered, with high complaints rates related to the length of waiting lines and poor reception from health workers.

This feedback built our core concept for the project: Continuous Care. Then, we hosted a solutions workshop, which were open to the public. We invited experts and public servants, providing technical insights and widening the common point of view. From our findings, we used a systems thinking approach, and implemented the first project. It went through a complete repair of its new services, freshly created in the last phase of the Project. There, we implemented most of our solutions and framed them within the Primary Services scope.

The approach we used relies on collaboration through all the process, regarding to people's distinct needs and points of view every outcome designed. So, by bringing their own experience to the discussion, we were able to create a deep understanding of the context, resulting in more long-term solutions.

We used several tools, such as workshops of many kinds (ideation, exploration, co-creation, prototyping), interviews, surveys. We also visited citizens’ houses and accompanied them through their days, understanding how that Health service impact their lives. Basic research on data and historic models of service deliverance in Pelotas were also used, especially when talking to experts on that field.

The project delivered outcomes, ranging from the building of new health facilities to the development of a public manager training focused on health management. Here are some of the deliverables:

- At first, people had to arrive at 5:00AM to receive treatment. Now, since the change in the reception procedure, people come by anytime and can be treated, even if they do not have a scheduled appointment.

- The reception architecture has significantly changed, with new seats, bathrooms, televisions showing Health tips, and all reception procedures being electronically made.

- The first attendance time has reduced, from two months to 2-3 weeks

- Every unit has its own pharmacy, delivering medicines to nearby neighbourhoods.

- With the SuperAgentes program, the quality of household medical care has significantly improved. The public servers use tablets to quickly search for families’ information and to update information directly to physicians and nurses, making diagnosis easier to define.

Developing such project is not easy and many challenges must be overcome in order to keep functioning. Projects that deal with public policy are slower and harder to implement. However, the complexity of projects greatly improves the range and scale of solutions, and if we think that, despite of all problems, their results are looking for a “greater good”, that is what keeps us going.

The major issues we faced were:

- Adopting innovation in a highly conservative environment

- Finding the correct stakeholders to develop a focus group towards maintaining the project going

- Little time to fulfil research on a complex system such as Public Health

- Public budget and the purchase of legal equipment

- Articulation between different stakeholders and Departments

- Poor internet infrastructure in the city

No matter how good the project is, if there is no formal leadership inside the government, nor resources available for maintaining the project after unfolding the pilot, it won't work. So it is of primary importance to create the political conditions for the project to establish within the government.

We already have replicated it within the same city (Pelotas has, today, 4 Well-Caring Network units, and 3 more are soon to come). since the project has been awarded by the central government, many other politicians from around Brazil are visiting Pelotas. These politicians are looking forward to understanding the units creation, using the network's ideas to implement inside their own units.