1
The Mother Child Health Card
(MCH Card)
A prototype proposal for the Records for Life contest
Team
Mridu Mehta • Rahul A...
2
Introduction
04 • The Public Health Care System
05 • Stakeholders in RI System
06 • ANM’s Responsibilities
07 • Target L...
3
Introduction
4
Public health care services in
India are delivered through a
well-established network of
health care centres.
In rural a...
5
Stakeholders IN RI SYSTEM
Mother
FATHER
VILLAGE HEALTH CENTRE
RELATIVES
/FAMILY
ANM
CHILD
AWW
DOCTOR
SURVEYOR
/FOUNDATIO...
6
Functional Areas
•	Vaccines Administering
•	Ante Natal , Post Natal care and
registering
•	Family Planning Awareness
•	C...
7
Our team member Rahul Abhisek
worked with Center for Knowledge
Societies, New Delhi conducting ethno-
graphic research o...
8
HEALTH RECORDS RESEARCHED
The information flow and
design of our prototype has
been informed by the existing
health reco...
9
Our proposal:
MCH Card
10
PROPOSED SOLUTION
MCH Card + Due Date Cards
+
Ma, please get
me vaccinated on
Ma, please get
me vaccinated on
Your next...
11
DUE DATE CARDS
LEFT
ANC Due Date
RIGHT
RI Due Date
Card sheets for ANM to write
due date, tear off and insert in
pocket...
12
VALUE OF MCH CARD
We think that the card designed
like a passport will be treated
more as an official document,
and the...
13
PROTOTYPE: MCH CARD
Features
BINDING
Centre Sewing
Cover
Soft hard cover,
vinyl pasting +
knurling
SIZE
CLOSED SIZE
3.5...
14
PROTOTYPE: MCH CARD
Features
Form of booklet is
compact and strong.
The materials are
weather proof.
SUGGESTED PAPER
OP...
15
PROTOTYPE LAYOUT DESIGN
Look and Feel
Minimal and clean
Soft colour and rounded edges of
card suggest mother and child ...
16
PROTOTYPE LAYOUT DESIGN
Colour Palette
PRIMARY COLOURS SUPPORTING COLOURS
MCH DARK PINK
CMYK 0,60,0, 25
USAGE
Body Text...
17
PROTOTYPE LAYOUT DESIGN
Typography
DUE DATE VACCINE
DATE
ADMINISTERED
BIRTH
☐ BCG
☐ HepB
☐ OPV 0
1.5 MONTHS
☐ Penta 1
☐...
18
FLOW OF INFORMATION IN PROTOTYPE
Designed to match the sequence of recording process as conducted on field
cover
Due Da...
19
FLOW OF INFORMATION IN PROTOTYPE
20
DESIGN DECISIONS
For Information/Content
Minimal Illustrations
(Only used for Due Date card targeted at
caregivers)
The...
21
Mothers!
This booklet is the main record of you and
your child’s health starting from pregnancy
to age 5 of the child.
...
22
USAGE OF Mamta Card
Informs design of spread 2 our prototype
The front page of this
example contains data
records of th...
23
AWW Name
ASHA Name
Anganwadi Centre / Block
ANM Name
AWW Phone Number
ASHA Phone Number
ANM Phone Number
INSTITUTIONAL ...
24
PROTOTYPE
SPREAD 3: Family Identification, Mother’s Pregnancy Record, Child’s Birth Record
The Mother and
Child’s MCTS ...
25
Left Page: Ante Natal Care records of a mother who has
delivered the night before this photograph was taken
Right Page,...
26
PROTOTYPE
SPREAD 4: Ante Natal Check Up
The included ante
natal check up tests
have been reduced
from the current
Bihar...
27
PROTOTYPE
SPREAD 5: After Delivery Check Up and Notes
Space for notes
provided for
complications,
doctor referrals,
tra...
28
Section of the Vaccination Schedule
Good example of how the current design of the
card has unnecessary repetition of in...
29
PROTOTYPE
SPREAD 6: Vaccination and Supplement Schedule
The vaccination
schedule is based
on the pentavalent
vaccine sc...
30
Vaccination Schedule in Hindi
Supplements like Folic Acid and Iron tablets
along with medicines for deworming have been...
31
PROTOTYPE
SPREAD 7: Vaccination and Supplements Schedule + Additional Vaccination
Space has been
included for
out of sc...
32
NOTES
PROTOTYPE
SPREAD 8: Notes
Space for notes
provided at the end
of the card.
33
Use Case Scenarios
Illustrating how the MCH card’s usage
will function within the current system
Pregnant Mother
•	 Reg...
34
USE CASE SCENARIOS
Pregnant Mother: Registration in Village
35
USE CASE SCENARIOS
Pregnant Mother: 1st Visit and Registration at Local Health Centre
36
USE CASE SCENARIOS
Pregnant Mother: Repeat Visit for ANC
37
USE CASE SCENARIOS
Child delivered: Birth registration and 1st vaccination
38
USE CASE SCENARIOS
Child’s Vaccination: Repeat Visit
39
BACKGROUND RESEARCH
 ANALYSIS
40
BASIS FOR FINDINGS ANALYSIS
	
•	 Ethnographic research in
Kishanganj district, Bihar and
Ahmedabad city, Gujarat
•	 Des...
41
ANALYSIS: FIELD VISIT CONCLUSIONS
OUR ASSUMPTIONS BEFORE FIELD VISIT OUR PREMISE AFTER FIELD VISIT
Main user of the car...
42
Existing Health Card
usage
Proposed prototype
Information set type
Data set
being
recorded?
If not, possible reasons
fo...
43
0	
  
10	
  
20	
  
30	
  
40	
  
50	
  
60	
  
70	
  
80	
  
ANC1	
  
ANC2	
  
ANC3	
  
ANC4	
  
Delivery	
  
RI1	
  
...
44
0	
  
10	
  
20	
  
30	
  
40	
  
50	
  
60	
  
70	
  
Text	
   Number	
   Date	
   Checkbox	
   Mulple	
  ch.	
  
Curr...
45
INTERVIEWS
	
“We rely on the women in our family and
community for information on how to take
care of pregnant mothers ...
46
INTERVIEWS
	
“Most mothers wont look at the entire card. In
fact the staff at the clinic also wouldn’t have
gone throug...
47
FIELD OBSERVATIONS  INTERVIEWS
ASHA Worker Bharti Ben providing samples of the
Mamta Card and explaining her duties
MCH...
48
Multi Purpose Health Worker (MPHW) Shailaja Ben
at the V S Public Hospital, Ahmedabad, Gujarat
preparing to vaccinate a...
49
FIELD OBSERVATIONS  INTERVIEWS
Dr Sarkar, (Retired National Tech Advisor to WHO)
offering suggestions for the redesign ...
50
FIELD OBSERVATIONS  INTERVIEWS
Weekly ANM meeting, where ANM’s put forth their
trouble and challenges to the Medical Of...
51
INITIAL PROTOTYPES: FOR FIELD TESTING
PROTOTYPE 1 PROTOTYPE 2 PROTOTYPE 3
PROTOTYPE 4
52
PROTOTYPE 1: RATIONALE
AIM
To improve illiterate mother’s
engagement with the Health Card
and her child’s health
•	 Div...
53
PROTOTYPE 2: RATIONALE
AIM
To improve illiterate mother’s engagement with the Health
Card and her child’s health
PROTOT...
54
PROTOTYPE 3: RATIONALE
AIM
Incorporate all possible information relevant to the
vaccination schedule within one table
•...
55
PROTOTYPE 4: RATIONALE
AIM
Increase mother’s engagement in her
child’s vaccination process by high-
lighting Due Date t...
56
ABBREVIATIONS
anc: Ante Natal Care
anm: Auxiliary Nurse Midwife
asha: Accredited Social Health Activist
aww: Anganwadi ...
57
THANK YOU!
Mridu Mehta
mridu.mehta@gmail.com
•
Rahul Abhisek
rahul.abhisek@gmail.com
•
Valtteri Wikström
vatte.wikstrom...
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Records for Life: Redesigning Health Cards to Improve Maternal and Child Healthcare

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Proposed solution for the Records for Life contest 2013 by the Bill and Melinda Gates Foundation. Focus is on improving the experience of the primary user of the health card: the Health Worker.

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Records for Life: Redesigning Health Cards to Improve Maternal and Child Healthcare

  1. 1. 1 The Mother Child Health Card (MCH Card) A prototype proposal for the Records for Life contest Team Mridu Mehta • Rahul Abhisek • Valtteri Wikström Aalto University
  2. 2. 2 Introduction 04 • The Public Health Care System 05 • Stakeholders in RI System 06 • ANM’s Responsibilities 07 • Target Location: Bihar & Gujarat 08 • Health Records Researched OUR PROPOSAL: MCH Card 11 • MCH and Due Date card 13 • Prototype Features 16 • Prototype Layout Design 19 • Flow of information 21 • Design Decisions 22 • Prototype use case scenarios 34 • Pregnant Mother: Registration in Village 35 • Pregnant Mother: 1st Visit and Registration at Local Health Centre 36 • Pregnant Mother: Repeat Visit for ANC 37 • Child delivered: Birth Registration and 1st vaccination 38 • Child : Repeat Visit for Vaccination BACKGROUND RESEARCH ANALYSIS 40 • Basis for Findings Analysis 41 • Field Visits Conclusions 42 • Analysis: Information Sets 43 • Reduced Number of Fields for Data Entry 45 • Interviews 47 • Field Observations Interviews 51 • Initial Prototypes: For Field Testing 56 • Abbreviations Contents
  3. 3. 3 Introduction
  4. 4. 4 Public health care services in India are delivered through a well-established network of health care centres. In rural areas, Primary Health Centres (PHCs) / Commu- nity Health Centres (CHCs) are responsible for providing basic health services related to Antenatal Care and Immu- nization to citizens who may not have regular access to medical facilities. In urban areas, Urban Health Centres / Community Health Centres (CHCs) provide the same services. These health care activities are carried out by frontline health workers namely ANM (Auxiliary Nurse Midwife), ASHA (Accredited Social Health Activist) AWW (An- ganwadi Worker) at the com- munity level. These field workers travel through the communities dis- pensing health care solutions and form the crucial back- bone of India’s health care delivery mechanism. The Public Health Care System
  5. 5. 5 Stakeholders IN RI SYSTEM Mother FATHER VILLAGE HEALTH CENTRE RELATIVES /FAMILY ANM CHILD AWW DOCTOR SURVEYOR /FOUNDATIONS /NGOs ASHA DATA OPERATOR
  6. 6. 6 Functional Areas • Vaccines Administering • Ante Natal , Post Natal care and registering • Family Planning Awareness • Categorization of Couple about to be married • AIDS awareness • Mobilize Recipients • Refer difficult labor case to District hospital • Rendering advise regarding health and food habits • Distribution • Folic Acid to pregnant women • Vit A tablets for babies • Vit B12 syrups • Iron and ORS tablets • Contraceptives • Bleaching Powder • Prescribing • Paracetamol • Glycodine • Momentazol • Antibiotics ANM’s RESPONSIBILITIES ANM is the primary provider of the RI and ANC services but she is overloaded with work. Therefore the design of the health record needs to be as simple as possible. Detailed Activities while in Course • Scheduled vaccines to be administered • Basic medicine course (fever, cough cold, swelling) • Body positions • Syringe disposal • bed making • First Aid • Hygiene • Emergency Accidental Cases • Assisting Deliveries • AIDS Awareness Report Structure Reports to • LHV • MOIC or Educator • CDPO • Cold Chain Supervision by • MOIC • DIO • ACMO • Supervisor Co-Ordinates with • Computer Operator • AWW • ASHA • Village Mukhiya • Cold Chain • Courier Boy/Helper • Commute source Public Interface Meetings • Mahila Divas • ASHA Divas • ANM Meeting • Micro Plan Meeting Training sessions • AIDS • Immunization Practices • Record keeping, if new register introduced Administration Data Keeping • Immunization tally sheet • MCH Register • Ante-Natal Register • Out Door Register • Mala D and Copper T register • Stock Register • Cold Chain register* • Courier register • Survey Register • Advance Program register Reports • Monthly/Weekly report - AEFI register • Daily/Yearly vaccine consumptions • MCH (Mother Child Health) report Supervision and Approval • Tuberculosis Report • Leprosy report Create Microplan
  7. 7. 7 Our team member Rahul Abhisek worked with Center for Knowledge Societies, New Delhi conducting ethno- graphic research on Routine Immuniza- tion in Bihar, India in 2009-2010.* Building our current process with this foundation, further research was conducted in mid-2013 in district Kis- hanganj, Bihar and Ahmedabad, Gujarat * Have a look at the BMGF funded report: the Vaccine Delivery Innovation Report here. . Immunization coverage of Bihar and Gujarat in India http://planning.bih.nic.in/Ppts/PR-05-02-12-2009.pdf www.gujhealth.gov.in/images/pdf/routine_immunization_in_gujarat.pdf TARGET LOCATION: BIHAR GUJARAT The design of our prototype is targeted at these regions INDIA Bihar 53.8 % Gujarat 73.2 %
  8. 8. 8 HEALTH RECORDS RESEARCHED The information flow and design of our prototype has been informed by the existing health records maintained in Bihar and Gujarat. Desk research on records in other countries (as provided by the contest guide) was also conducted. LEFT: Mother and Child Health Record from Bihar ABOVE: Mamta Card from Gujarat
  9. 9. 9 Our proposal: MCH Card
  10. 10. 10 PROPOSED SOLUTION MCH Card + Due Date Cards + Ma, please get me vaccinated on Ma, please get me vaccinated on Your next checkup is on ANC Due Date Card RI Due Date Card
  11. 11. 11 DUE DATE CARDS LEFT ANC Due Date RIGHT RI Due Date Card sheets for ANM to write due date, tear off and insert in pocket of MCH card cover. The ANM will be required to carry these during her visits.
  12. 12. 12 VALUE OF MCH CARD We think that the card designed like a passport will be treated more as an official document, and the caregivers will therefore keep it in better shape. COMPACT Easy to carry around Easy to maintain The hard plastic cover and weather proof papers are unaffected by water and other environmental factors. Long lasting The design will also prolong the life of the card to the required 5-6 years of active usage. PROTOTYPE: MCH CARD Designed to look like a passport: Increase value and care of card by users RESISTANT TO WEAR AND TEAR It is also better protected from careless usage by caregivers/their families as they cannot roll it or fold it. The design is resistant to tearing.
  13. 13. 13 PROTOTYPE: MCH CARD Features BINDING Centre Sewing Cover Soft hard cover, vinyl pasting + knurling SIZE CLOSED SIZE 3.5 x 4.9 in Open Size 7 x 4.9 in Edges rounded to reduce wear and tear and avoid dog ears Transparent plastic pouch to hold and protect Due Date card Gold embossed lettering to give look and feel of importance
  14. 14. 14 PROTOTYPE: MCH CARD Features Form of booklet is compact and strong. The materials are weather proof. SUGGESTED PAPER OPTIONS • Stone Paper • All Weather Paper PAPER THICKNESS 150 GSM Number of spreads: 7 WEATHER PROOF PAPERS STONE PAPER • Anti-moth • Tear-resistant • Safe soft • Water grease resistant • Annotate with ink, felt tip, ball pens • Recyclable • Professional Print Quality • Printer friendly • Used in stationery, bags, packaging, adhesives, containers etc. All Weather Paper • Tear and Puncture resistant • Waterproof • Professional Print Quality • Printer friendly • Annotate with ink, felt tip pens • Used for maps, signs, notepads for travellers and mariners, banners, product labels and barcode labels
  15. 15. 15 PROTOTYPE LAYOUT DESIGN Look and Feel Minimal and clean Soft colour and rounded edges of card suggest mother and child care Focus on easy and efficient: • Information recording • Accessing information Child’s Passport photograph Mother’s Passport photograph Father’s Name Mother’s Name Age Home Address/Village Change in Address Phone Number FAMILY IDENTIFICATION CHILD’S BIRTH RECORD MOTHER’S PREGNANCY RECORD Last delivery conducted at Mother’s MCTS Number No. of pregnancies No. of previous live births Date of last menstrual period Date of expected delivery Date of Birth Child’s Name Weight at Birth Child’s MCTS Number Girl Boy Institution Home
  16. 16. 16 PROTOTYPE LAYOUT DESIGN Colour Palette PRIMARY COLOURS SUPPORTING COLOURS MCH DARK PINK CMYK 0,60,0, 25 USAGE Body Text Display Text (Headings) MCH LIGHT PINK CMYK 0,60,0, 25 / TINT 20% USAGE AS BACKGROUND COLOUR Tables Check boxes MCH PALE YELLOW CMYK 0,0,100, 0 / TINT 10% USAGE ACCENT COLOUR MCH cover shade of dark maroon MCH gold USAGE Lettering MCH GREY CMYK 0,0,0, 70 USAGE Text
  17. 17. 17 PROTOTYPE LAYOUT DESIGN Typography DUE DATE VACCINE DATE ADMINISTERED BIRTH ☐ BCG ☐ HepB ☐ OPV 0 1.5 MONTHS ☐ Penta 1 ☐ OPV 2 2.5 MONTHS ☐ Penta 2 ☐ OPV 3 3 MONTHS ☐ BCG (Repeat dose if no scar) 3.5 MONTHS ☐ Penta 3 ☐ OPV 4 6 MONTHS ☐ Folic Acid ☐ Iron Tablet ☐ Vit A VACCINATION AND SUPPLEMENT SCHEDULE Notes Univers Font Designer: Adrian Frutiger The font Univers is one of the greatest typographic achievements of the second half of the 20th century. The clear, objective forms of Univers make this a legible font suitable for almost any typographic need. Univers has been employed in numerous applications in- cluding corporate branding, signage, maps, standardized testing and consumer elec- tronics devices. The Univers font family suits the needs of the MCH card because: • It is highly legible at small sizes • Functions well across all paper types • Versatile font that is legible irrespective of printing technol- ogy used Didot is an elegant modern serif typeface COVER Didot bold Type size 18 pt INSIDE PAGES Univers 55 Roman Univers 65 Bold Univers 75 Black Type size 7 pt for all text
  18. 18. 18 FLOW OF INFORMATION IN PROTOTYPE Designed to match the sequence of recording process as conducted on field cover Due Date BACK cover 1 Introduction and instructions for Mother 2 Notes • Institutional Identification 8 Notes 5 After Delivery Check Up • Notes 4 Ante Natal Check Up • Notes 67 Vaccine and Supplements Schedule • Additional Vaccines 3 Family identification • Mother’s Pregnancy Record • Child’s Birth Record The only exception is the Child’s Birth Record which is placed along with Identification infor- mation on spread 3, instead of following After Delivery Check Up information. This has been done to ensure all identifica- tion related infor- mation
  19. 19. 19 FLOW OF INFORMATION IN PROTOTYPE
  20. 20. 20 DESIGN DECISIONS For Information/Content Minimal Illustrations (Only used for Due Date card targeted at caregivers) The card’s primary user, the ANM is literate and illustrations are unnecessary to her task of record keeping VALUE FOR Caregivers MCH card designed for minimal engagement with caregivers. Caregivers prefer other mediums of communication like TV, radio, verbal training sessions to learn about and act on health care information. (Please refer to slide for research that validates this) Design FEATURES • Clarity in recording data • Ease in accessing data by secondary users • Integrating with other stakeholders • Minimal critical Information fields for data recording • Ease in updating • Information fields not being currently recorded have been eliminated Primary User: ANM • Responsible for main- taining the records in the MCH card. • She conducts the check ups on mother and child and admin- isters vaccines Secondary Users The data recorded is useful to: • MCTS • Caregiver • Doctor/Health Care provider • Surveyor • Policy Makers • NGOs Foundations
  21. 21. 21 Mothers! This booklet is the main record of you and your child’s health starting from pregnancy to age 5 of the child. Carry it whenever you visit • A local health centre • A Doctor • A Hospital • Any other health care provider You may be asked to furnish this booklet • By your local health worker during visits to you or your village • By Surveyors and government officials • During vaccination drives at your village YOUR HEALTH CARD IS IMPORTANT. TAKE CARE OF IT AND KEEP IT IN A SAFE PLACE WITH YOUR VALUABLES. PROTOTYPE SPREAD 1: Introduction and instructions for Mother The information on this page establishes the value of the card for caregivers and instructs them on how to use it. It will need to be verbally communi- cated by the ANM to illiterate mothers.
  22. 22. 22 USAGE OF Mamta Card Informs design of spread 2 our prototype The front page of this example contains data records of the moth- er’s antenatal check up. This ANM seems to have abandoned the use of the inside information fields for the ease of writing and accessing all the information from the front page itself. Idea for prototype: Include Notes in the beginning for extra information and ease of access for ANM
  23. 23. 23 AWW Name ASHA Name Anganwadi Centre / Block ANM Name AWW Phone Number ASHA Phone Number ANM Phone Number INSTITUTIONAL IDENTIFICATION SHC / Clinic Hospital / FRU Primary Health Centre / Town NOTES PROTOTYPE SPREAD 2: Notes and Institutional Identification The phone numbers of all the health workers can be easily accessed by the mother in case of need. Our field research showed that institutional identification information is not rigorously filled by ANMs. Placing it at the beginning with a clean and clear design should increase its usage. Space for notes have been included in the beginning of the card, as well as in other places. Studying the usage patterns of health workers during field research indicates that there is a need for custom notation on the RI card. (Refer previous slide)
  24. 24. 24 PROTOTYPE SPREAD 3: Family Identification, Mother’s Pregnancy Record, Child’s Birth Record The Mother and Child’s MCTS number The MCTS ID numbers, as well as demographic information are used to identify the mother and child. Including different kinds of identifying information, such as the MCTS id number, name, address and phone number supports the identification of persons by health workers, hospitals and surveyors. Father’s Name Mother’s Name Age Home Address/Village Change in Address Phone Number FAMILY IDENTIFICATION CHILD’S BIRTH RECORD MOTHER’S PREGNANCY RECORD Last delivery conducted at Mother’s MCTS Number No. of pregnancies No. of previous live births Date of last menstrual period Date of expected delivery Date of Birth Child’s Name Weight at Birth Child’s MCTS Number Girl Boy Institution Home 3.467 kgs
  25. 25. 25 Left Page: Ante Natal Care records of a mother who has delivered the night before this photograph was taken Right Page, Above: Space for notes. Below: Care during pregnancy This ANM seems to have abandoned the use of the Ante Natal Care table and de- signed her own table in the notes section on the right. Idea for prototype: Our design of the ANC is directly inspired by this example. This ANM has avoided the unnecessary repetition in re- cording dates per visit USAGE OF Mamta Card Informs design of ANC in our prototype
  26. 26. 26 PROTOTYPE SPREAD 4: Ante Natal Check Up The included ante natal check up tests have been reduced from the current Bihar RI card based on field research of what tests are practical for the ANM to carry out on field/in the local health centre. The organisation of the information has been informed by the usage patterns seen on field. (Refer previous slide) VISIT DATE POG (WEEKS) WEIGHT (KG) PULSE BLOOD PRESSURE urine ALBUMIN ANTE NATAL CHECK UP 26/2/13 Notes urine SUGAR HAEMO- GLOBIN IRON TABLETS T.T (Y/N) PALLOR (Y/N) OEDEMA (Y/N) JAUNDICE (Y/N)
  27. 27. 27 PROTOTYPE SPREAD 5: After Delivery Check Up and Notes Space for notes provided for complications, doctor referrals, tracking patient medication in case of problems etc. If at institution, period of stay post delivery Cried immediately after birth Initiated exclusive breast feeding within 1 hour of birth Type of delivery after delivery check up Term Preterm C-Section Normal Institutional No No Yes Yes Complications, if any Place of delivery Institution Home NOTES
  28. 28. 28 Section of the Vaccination Schedule Good example of how the current design of the card has unnecessary repetition of information fields that need to be filled by the ANM. ANM has filled in date of administration only once for the 3 doses given to the child at birth. The due date, (in this case date of birth) has also not been recorded. This is probably because it is already recorded on the front page. This schedule is an older design which does not include the newly introduced Pentavalent vaccines. The ANM has crossed out the older vaccines and handwritten pentavalent in the margins. There appears to be an error here in recording of the due date for the Pentavalent vaccine at 1.5 months. USAGE OF Mamta Card Informs design of vaccination schedule in our prototype
  29. 29. 29 PROTOTYPE SPREAD 6: Vaccination and Supplement Schedule The vaccination schedule is based on the pentavalent vaccine schedule introduced in Gujarat and is recommended for national scale up by the National Technical Advisory Group on Immunisation (NTGAI) India, in 2008. The vaccination record has been structured to eliminate repeated date entry and to keep the chronological organisation of information consistent. (Refer previous slide) Repeat BCG dose highlighted as a reminder for the ANM and caregivers. There is no field to record and track this repeat dose in current health records. VACCINATION AND SUPPLEMENT SCHEDULE DUE DATE Vaccine Date Administered 9-12 Months ☐  Measles ☐  Vit A ☐  Deworming 18 months ☐  DPT Booster ☐  OPV Booster ☐  MMR 2 ☐  Vit A ☐  Deworming 24 months ☐  Vit A 30 months ☐  Vit A 36 months ☐  Vit A DUE DATE Vaccine Date Administered Birth ☐  BCG ☐ HepB ☐  OPV 0 1.5 MONTHS ☐  Penta 1 ☐  OPV 2 2.5 MONTHS ☐  Penta 2 ☐  OPV 3 3 MONTHS ☐ BCG (Repeat dose if no scar) 3.5 MONTHS ☐  Penta 3 ☐  OPV 4 6 Months ☐  Folic Acid ☐  Iron Tablet ☐  Vit A VACCINATION AND SUPPLEMENT SCHEDULE 15/10/13 15/10/13 Notes
  30. 30. 30 Vaccination Schedule in Hindi Supplements like Folic Acid and Iron tablets along with medicines for deworming have been added as side notes. There is no place to record their administration to the child. DESIGN OF BIHAR RI Card Informs design of vaccination schedule in our prototype
  31. 31. 31 PROTOTYPE SPREAD 7: Vaccination and Supplements Schedule + Additional Vaccination Space has been included for out of schedule vaccinations, and to accommodate schedule changes by the state. Supplements like Vitamin A, Folic Acid and Iron Tablet have been given the same importance as the vaccines by placing them sequentially in the vaccine schedule. This has been done to ensure all doses necessary for the Child’s survival and good health are provided. (Refer previous slide) ADDITIONAL VACCINATION Record new vaccine/out of schedule vaccines session here DUE DATE Vaccine Date Administered DUE DATE Vaccine Date Administered 42 months ☐  Vit A 48 months ☐  Vit A 54 months ☐  Vit A 60 months ☐  Vit A 48-60 months ☐  DPT Booster AFTER 1 Month ☐  DPT Booster VACCINATION AND SUPPLEMENT SCHEDULE Notes
  32. 32. 32 NOTES PROTOTYPE SPREAD 8: Notes Space for notes provided at the end of the card.
  33. 33. 33 Use Case Scenarios Illustrating how the MCH card’s usage will function within the current system Pregnant Mother • Registration in Village • 1st Visit and Registration at Local Health Centre • Repeat Visit for ANC Child • Child delivered: Birth registration and 1st vaccination • Repeat Visit for vaccination
  34. 34. 34 USE CASE SCENARIOS Pregnant Mother: Registration in Village
  35. 35. 35 USE CASE SCENARIOS Pregnant Mother: 1st Visit and Registration at Local Health Centre
  36. 36. 36 USE CASE SCENARIOS Pregnant Mother: Repeat Visit for ANC
  37. 37. 37 USE CASE SCENARIOS Child delivered: Birth registration and 1st vaccination
  38. 38. 38 USE CASE SCENARIOS Child’s Vaccination: Repeat Visit
  39. 39. 39 BACKGROUND RESEARCH ANALYSIS
  40. 40. 40 BASIS FOR FINDINGS ANALYSIS • Ethnographic research in Kishanganj district, Bihar and Ahmedabad city, Gujarat • Desk Research of existing child records from Bihar, Gujarat and other countries as provided by the contest • Usage patterns of 8 used Mamta Cards and 2 used cards from Bihar
  41. 41. 41 ANALYSIS: FIELD VISIT CONCLUSIONS OUR ASSUMPTIONS BEFORE FIELD VISIT OUR PREMISE AFTER FIELD VISIT Main user of the card: Mother/Caregiver Main user of the card: ANM Need to increase illiterate mothers engagement with Health Card Need to simplify ANM’s recording process Minimal text and more illustrations/images to communicate to mother Illustration unnecessary in Health Card as main user is the Nurse who is literate Content of card can lay more emphasis on instructional information like Nutrition, Mother and Child Care, Childs growth and development Content of card needs to be minimal and focus on recording information most necessary for service delivery of ante natal care for mother and vaccinations for child The size, material and shape of the card needs to last a period of 5-6 years of usage The size, material and shape of the card needs to last a period of 5-6 years of usage, which includes a minimum of 20 interactions between a health care provider and the Health Card The design of the card needs to cater to the record keeping requirements and also inform caregivers about nutritional and health requirements of mother and child The design of the card needs to be compact. A lot of information is not being filled by ANM due to lack of time. These information fields can either be removed or redesigned. Need to reduce unnecessary repetition of information fields that ANM needs to record. Need to reduce unnecessary repetition of information fields that ANM needs to record.
  42. 42. 42 Existing Health Card usage Proposed prototype Information set type Data set being recorded? If not, possible reasons for not recording Data set included in prototype? If not, why has it been excluded? Family Identification (Mother’s Father’s Name, Age, Address, Phone number) Yes Yes Pregnancy Record (Mother’s ID number, Date of last menstrual period, expected date of delivery, previous pregnancies, place of delivery) Yes Yes Birth Record (Childs name, date of birth, weight at birth, gender, Child’s ID) Yes Yes Institutional Identification (Names phone numbers of Health workers, Partially recorded Yes Ante Natal Check Up (Ante natal visits, Basic Abdominal investigation, Weight, B.P, Hb, Urine, T.T, Iron tablet) Partially recorded Cumbersome design, card not maintained/lost/forgotten by mother during visits, tracking mother difficult Yes Ante Natal Care (Obstetric complication, Past history, Abdominal investigation) No Information to be recorded by gynaecologists who do not use the Health Card No The ANM does not have the time or the equipment or training to carry out most of these functions Post Natal Care (Mother and Child’s check up care) No Information to be recorded by gynaecologists who do not use the Health Card No The ANM does not have the time or the equipment or training to carry out most of these functions Vaccination Schedule (Vaccine, due date, date administered) Partially recorded Yes Growth Chart No ANMs too busy, Child’s develop- ment monitored unsystemati- cally during visits to village No Records not being maintained due to lack of time analysis: Information sets Current health record vs. proposed prototype
  43. 43. 43 0   10   20   30   40   50   60   70   80   ANC1   ANC2   ANC3   ANC4   Delivery   RI1   RI2   RI3   RI4   RI5   RI6   RI7   RI8   Current  Health  Record   Our  prototype   Reduced number of fields for data entry Current health record vs. proposed prototype Visits Numberofinformationfieldsfilled ANC VISIT 1 Current record: 73 fields Prototype: 34 fields ANC VISIT 2 Current record: 25 fields Prototype: 12 fields subsequent visits Current record: 24 fields prototype: 11 fields RI visits With only the next due date and the current date being recorded in our prototype, there is an increase of one check box vs the current health record, but this is kept to keep the design of the record consistent over each visit.
  44. 44. 44 0   10   20   30   40   50   60   70   Text   Number   Date   Checkbox   Mulple  ch.   Current  Health  Record   Our  prototype   Reduced number of fields for data entry Current health record vs. proposed prototype TYPE OF INFORMATION FIELD Numberofinformationfieldsfilled We have significantly reduced the amount of numbers, dates and multiple choice fields by eliminating repeat- ed information and in- formation usually left unfilled by the ANM. The number of check boxes is higher in our prototype, because we have replaced re- peated date entry on several occasions with check boxes to make the process of filling out the data more ef- ficient.
  45. 45. 45 INTERVIEWS “We rely on the women in our family and community for information on how to take care of pregnant mothers and children. Television and radio are also good” - Mumtaz, Mother (Age 21) with Grandmother, Saira Bano For final prototype: Illustrations are not the most effective way of increasing caregivers engagement with mother and child health care OBSERVATION This mother and grandmother are illiterate and could not comprehend any of the existing health records or the 1st set of prototypes shown to them. They were uncomfortable even when verbal instructions complemented the information on the cards. They understood some of the illustrations but were reluctant to engage with the card. Similar observations were made with other illiterate mothers/caregivers on the field.
  46. 46. 46 INTERVIEWS “Most mothers wont look at the entire card. In fact the staff at the clinic also wouldn’t have gone through the entire card. ” - Dr. Hardik Mewada MOIC, Arjun Urban Health Centre (Slum Area), Vasna, Ahmedabad For final prototype: Only include information fields that the ANM can currently record given her roles and responsibilities. Dr Hardik said: Only the following basic info is generally entered on the card: • Date of meeting mother • Height • Weight • Blood Pressure • Date on which tablets (iron, calcium) and vitamins are administered to mother • T.T. administration • Maybe HIV, thalassaemia • Vaccination schedule of child “Information on the ANC and PNC can be filled largely by the Gynaecologist, not at Health centres. Foetal length, heart rate etc can be ascertained only through Sonography. The equipment to do this is only in hospitals, not in PHC/UHCs. Hospitals have their own records and do not document this in the mamta card.”
  47. 47. 47 FIELD OBSERVATIONS INTERVIEWS ASHA Worker Bharti Ben providing samples of the Mamta Card and explaining her duties MCH register maintained by ANM Zankhani Ben for digitization by Data Operator ANM Zankhani Ben comments on our prototype for the child’s growth and development ANM Zankhani Ben demonstrates her recording responsibilities on the Mamta Card and her set of MCH registers ANM Zankhani Ben describes how she uses illustra- tions during counselling sessions to inform young mothers about breast feeding ANM Zankhani Ben approves of our prototype for the vaccination schedule
  48. 48. 48 Multi Purpose Health Worker (MPHW) Shailaja Ben at the V S Public Hospital, Ahmedabad, Gujarat preparing to vaccinate a new born child FIELD OBSERVATIONS INTERVIEWS The MPHWs assistant fills out the date for the 1st set of vaccines being administered to a new born child onto the Mamta Card She then replicates this onto MCH register MPHW Shailaja Ben describing usage of the ANC table in the Mamta Card while caregivers wait for her to vaccinate their child MPHW Shailaja Ben explaining the sequence of information recording in the Mamta card She looks at our prototype and doesn’t seem to understand the logic of information distribution at first glance
  49. 49. 49 FIELD OBSERVATIONS INTERVIEWS Dr Sarkar, (Retired National Tech Advisor to WHO) offering suggestions for the redesign of the vaccination schedule Caregivers queuing up for vaccinating their child. One grandmother had forgotten the Mamta card and had been asked to go home and get it Expectant mother and grandmother at V S Public Hospital. They rely on family for information re- garding child care and do not use the Mamta card Posters and information graphics on the walls inside the UHC Entrance to Urban Health Centre (UHC), Vasna, Ahmedabad MOIC at the UHC pointed out information that is frequently recorded, and information that doesn’t get recorded on Health Cards
  50. 50. 50 FIELD OBSERVATIONS INTERVIEWS Weekly ANM meeting, where ANM’s put forth their trouble and challenges to the Medical Officer in charge (MOIC) Conducting a mini-group discussion with ANMs in Kishanganj. ANM Savitri devi explaining the Bihar RI card and information getting translated from RI card to the MCH register Documentation of the register storage room at Potia block in Kishanganj district, Bihar ANM explaining the columns of hand made MCH register Data operator room. Prints of the seven block in the Kishanganj distract and the figures of RI coverage.
  51. 51. 51 INITIAL PROTOTYPES: FOR FIELD TESTING PROTOTYPE 1 PROTOTYPE 2 PROTOTYPE 3 PROTOTYPE 4
  52. 52. 52 PROTOTYPE 1: RATIONALE AIM To improve illiterate mother’s engagement with the Health Card and her child’s health • Divided input information and illustration/instructional information to target different ANM and Mother respectively. • Protective folder to improve durability • Sequencing of information designed to increase engagement from mother, by making illustrated and instructional material highly visible.
  53. 53. 53 PROTOTYPE 2: RATIONALE AIM To improve illiterate mother’s engagement with the Health Card and her child’s health PROTOTYPE IDEA Includes vaccination schedule, growth chart and nutritional and child’s development information on one large chart as a timeline to be hung as a chart in the mothers house.
  54. 54. 54 PROTOTYPE 3: RATIONALE AIM Incorporate all possible information relevant to the vaccination schedule within one table • Due date and date vaccine administered designed for clarity • Disease information incorporated to inform the mother • Visual communication about vaccine administration position
  55. 55. 55 PROTOTYPE 4: RATIONALE AIM Increase mother’s engagement in her child’s vaccination process by high- lighting Due Date through illustrations. Reducing repeated data entry of date administered and due date.
  56. 56. 56 ABBREVIATIONS anc: Ante Natal Care anm: Auxiliary Nurse Midwife asha: Accredited Social Health Activist aww: Anganwadi Worker phc: Primary Health Centre mch Card: Mother and Child Card / Our prototype MCH register: Mother and Child Register mcts: Mother and Child Tracking System MOIC: Medical Officer in Charge mphw: Multi Purpose Health Worker RI: Routine Immunization UHC: Urban Health Centre
  57. 57. 57 THANK YOU! Mridu Mehta mridu.mehta@gmail.com • Rahul Abhisek rahul.abhisek@gmail.com • Valtteri Wikström vatte.wikstrom@gmail.com
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