The provision of health services for mothers, children and other vulnerable populations in rural areas represents an extraordinarily multimodal challenge, who is responsible for the ‘intentional design of these public health services’ and how they must accomplish it is a question that is not often delved into.
The Bihar Innovation Lab, a first-of-its-kind user-centered and systems design thinking led program run by Center for Knowledge Societies in collaboration with the Ananya Partnership (Bihar), has been formed with a vision to address the need to ‘design’ health services and specific key components of their delivery, to transform the current public health system into a more well being oriented system. These components range from new products, tools and technologies, protocols, communications strategies, new services and service delivery mechanisms, and new systems for reaching out to patients, with a laser intention and purpose towards improving the health of mothers and their children.
Among the Lab’s seminal pieces of work is a wide-ranging ethnographic study focused on identifying the critical junctures in the 1000-day window from the conception of a woman’s pregnancy to her child turning two years of age, that have the maximum and most direct impact on the health and well-being of the mother and the child and within those junctures, prioritize those that are critical to the challenge of saving more lives, and where design intervention can lead to radical improvement in health outcomes.
The Lab has identified key opportunity areas for maximum impact in maternal and child health/ vaccine and integrated delivery. They are as follows:
Tools and Protocols to Ease and Automate the Provision of Differential Care Even at Scale
Tools to generate an accurate health profiling and progression mapping of the pregnant woman and children to and enable the healthcare providers to provide appropriate, timely and tailored care
Low-cost diagnostics tools to track, record, and co-relate maternal health vitals: HB, BMI, nutritional status, BP and child health vitals: BMI, Head Circumference, Nutritional Status etc.
Action Tools, Checklists, Care Plans and Frameworks to aid evidence based medical decision making amongst Frontline Health Providers
Moving from a Public Health System to a ‘Mother and Child’ centric Health and Well-being Ecosystem: Self, Home, Community and Institution Based Care across the 1000 day Window
A suite of maternity artefacts that inspire adoption and continuation of best health practices at the home i.e. nutrition plates that inspire healthy behaviour, breast feeding ‘reminder’ bottles, nutrition diurnal plans, recipe cards, diet diaries and kitchen budgeting tools for mothers, low cost infant warming ‘swaddles’ for hypothermic babies, etc.
Holistic birth preparedness Tool for families and ASHAs that enables timely and effective labor mobilization including aspects of transportation and ready finances
A band of Barefoot Caregivers, Nutritionists and Behaviour change agents, comprising of Key Community Influencers, by leveraging upon their Social agency, Proximity to mothers and Capacity
Home based Patient health ‘1000 day information records’ responding to information needs of the family in a colloquial and culturally resonant format
Nutrition Security – New local agriculture supply chain and community ‘nutrition’ kitchen entrepreneurial models for to supply and ensure routine availability of high nutrition foods for mothers for anemia, malnutrition, inadequate lactation etc.
1000 day care scheme: health financing programs, emergency mobilization and local transportation passes, and ancillary public utilities benefits
Neo-natal Care and Child Growth Tracking Aids and Protocol for ASHAs Routine Home Visits.
Collaboration models between PHCs, District Hospitals and Private Hospitals for patient information systems, smooth patient referral systems and advance preparedness, subsidized resource sharing and complimentary service strengthening.
Labor Mobilization Protocols for (rural care givers) ASHAs and Labor Management Tool for ANMs for High Birthing Volume Environments
Building A Self Aware System: Evidence based Decision Making and Creative Problem Solving Capacity
Dynamically updated best MCH practices ‘dashboard’ for Block Health Managers and Frontline workers: that collates Local and Global Learnings for Quick Access to Solution Options and Rapid Piloting #ways to tackle anemia #ways to prevent eclampsia #ways to tackle malnutrition
Village / Block Qualitative Profiling Dashboards (that map Cultural or Attitudinal Resistance, Local health Vulnerabilities, Coverage, Health Outcomes, Emerging Phenomena etc.) and Data ‘Sense-Making’ Models for Stakeholders to create Context Responsive Service Strategy and Delivery
Seasonal System Strengthening Strategies to address Demand in Floods, Mobilize in Harvest Seasons, Reconfigure Resources in High Volume Birthing seasons, Align Specific Health Services around Migration and other Socio-Temporal Phenomena
Reflective and Free-Associative’ Block and District Meetings and Micro-Innovations Bank
Community Health Needs – HR Skills Alignment framework for Human Resource Rationalization and Upskilling
Experiential Learning and Role-Play based Modules and Simulation Aids for Effective Front-line Health worker Trainings.
Data Reporting, Performance Evaluation, Accountability, Incentive Structures and Trust
A differential incentive system based on mobilization of and care for remote and vulnerable beneficiaries; individual beneficiary centric incentive structures for FLWs spread more consistently across the 1000 days based on qualitative parameters; community tracking linked to incentives
New ‘Field Data Recording – Integrated, Accurate, Easy to Fill’ Design (Datapoints and Formats) that lead to better Medical Decision Making for a variety of Different Kind of Patients as Opposed to just Reporting Compliance
Automated ‘Service Transaction’ based Reporting rather than Post Transaction Manual Reporting
Building Citizen Demand for Quality Services: Creating Pressure Points for the System to Perform
Community Maternal Health Dashboards linked to real-time Community Controlled Audits, Ratings and Performance Tracking of Public Health Services, synced with VHSNCs
Text / Audio-blog feedback service for beneficiaries’ sms based for anonymous grievance redressal and service direct feedback from workers, by repeatedly polling workers through their mobile phones.
Specific Service Components: Spaces, Amenities, Experiences
Support Aids: Seating that enables postures for faster dilatation or reduced bleeding, ergonomic pillows to ease breathing in asphyxiated babies, home based kangaroo care cum breast feeding thermal wraps, infant body temperature management
Aids for best practices: aided external cephalic version, better oxygen support devices, medical equipment that self-flags dysfunction, birthing beds or contraptions that enable squatting births or support contraptions that allow for delayed cord cutting etc.
Health ‘Ambience’ and Patient Experience Design at Labor Waiting Rooms, Village Health, Sanitation and Nutrition Days and other service sites
Health Public is an annual platform where we organize and present field data and myriad health innovation solution concepts that spark dialogue, innovation thinking, collaborative solutioneering, and live partnership building among key discussants for intense, fecund, and outcome-based health innovation dialogue.
To explore participation and collaboration opportunities , please write to Atishay Mathur, Innovation Officer, (firstname.lastname@example.org).