Participatory Design for AI-Embedded Artifacts: The Case of ECEB App Design to Fostering Ownership

AI-embedded artifacts in healthcare settings often perpetuate neocolonialism when designed and implemented without meaningful local participation, particularly in low- and middle-income countries. This paper examines how participatory design (PD) methods can transform the development of AI-driven clinical decision support tools from potentially neocolonial impositions into locally owned solutions. Through the case study of designing Essential Care for Every Baby (ECEB) app in Kenya, we demonstrate how innovative PD techniques, such as the jigsaw method, enabled healthcare workers to become active co-designers rather than passive recipients of technology. Our findings show that treating AI models as participants in the design process, along with human stakeholders, helps bridge the gap between sophisticated technology and local contexts. The paper shows that this approach improved the tool's feasibility and fostered genuine ownership among local implementers. We argue that such PD methods are crucial for developing AI-embedded artifacts that respect local agencies while leveraging advanced technology for healthcare improvement in resource-constrained settings.