Records for Life: Redesigning Health Cards to Improve Maternal and Child Healthcare
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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
inTroducTion04 • 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 card11 • Mch and due date card
13 • Prototype Features
16 • Prototype layout design
19 • Flow of information
21 • design decisions
22 • Prototype
use case scenarios34 • 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 & analYsis40 • 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
Introduction
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
sTAkeHoLdeRs In RI sysTeM
Mother
FAther
VILLAGe heALth CeNtre
reLAtIVeS /FAMILY
ANM
ChILDAWW
DoCtor
SUrVeYor /FoUNDAtIoNS
/NGoS
AShA
DAtA oPerAtor
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 ResPonsIbILITIesANM 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 StrUCtUrerePorTs 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 INterFACeMeeTinGs
•Mahila divas
•asha divas
•anM Meeting
•Micro Plan Meeting
TraininG sessions
•aids
• immunization Practices
•record keeping, if new register
introduced
ADMINIStrAtIoNdaTa 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
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 & GuJARATthe design of our prototype is targeted at these regions
india
bihar53.8 %
Gujarat73.2 %
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 biharaboVe: Mamta card from Gujarat
9
our proposal:MCH Card
10
PRoPosed soLuTIonMCh 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
due dATe CARds
leFTanc due date
riGhTri 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
VALUe oF MCh CArDWe 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 CARdDesigned 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
PRoToTyPe: MCH CARd Features
bINDINGcentre sewing
CoVer
soft hard cover,
vinyl pasting +
knurling
SIZeclosed 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
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
PRoToTyPe LAyouT desIGnLook 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
PRoToTyPe LAyouT desIGnColour Palette
PrIMArY CoLoUrS SUPPortING CoLoUrS
MCh DArK PINKcMYk 0,60,0, 25
USAGebody Textdisplay Text (headings)
MCh LIGht PINKcMYk 0,60,0, 25 / TinT 20%
USAGe AS bACKGroUND CoLoUrTables check boxes
MCh PALe YeLLoWcMYk 0,0,100, 0 / TinT 10%
USAGe ACCeNt CoLoUr
MCh CoVershade oF dark Maroon
MCh GoLD
usaGelettering
MCh GreYcMYk 0,0,0, 70
USAGe Text
17
PRoToTyPe LAyouT desIGntypography
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 typefaceCoVerdidot bold
Type size
18 pt
INSIDe PAGeSunivers 55 roman
univers 65 bold
univers 75 black
Type size 7 pt for all text
18
FLoW oF InFoRMATIon In PRoToTyPeDesigned 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
6&7
Vaccine and supplements schedule
•additional Vaccines
3Family 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
FLoW oF InFoRMATIon In PRoToTyPe
20
desIGn deCIsIonsFor 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 usersThe data recorded is useful to:• McTs• caregiver• doctor/health care
provider• surveyor• Policy Makers• nGos & Foundations
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.
PRoToTyPeSPreAD 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
usAGe oF MAMTA CARdInforms 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
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
PRoToTyPeSPreAD 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
PRoToTyPeSPreAD 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
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 CARdInforms design of ANC in our prototype
26
PRoToTyPeSPreAD 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)
VIS
IT
DA
TE
PO
G(W
EE
KS
)
WE
IGH
T(K
G)
PU
LSE
BLO
OD
P
RE
SS
UR
E
UR
INE
A
LBU
MIN
ANTE NATAL CHECK UP
26/2/ 1 3
NotesU
RIN
E
SU
GA
R
HA
EM
O-
GLO
BIN
IRO
N
TAB
LET
S
T.T
(Y/N
)
PALL
OR
(Y/N
)
OE
DE
MA
(Y/N
)
JAU
ND
ICE
(Y
/N)
27
PRoToTyPeSPreAD 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
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 CARdInforms design of vaccination schedule in our prototype
29
PRoToTyPeSPreAD 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 /1 0/ 1 3 15 /1 0/ 1 3
Notes
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 CARdInforms design of vaccination schedule in our prototype
31
PRoToTyPeSPreAD 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
NOTES
PRoToTyPeSPreAD 8: Notes
space for notes provided at the end of the card.
33
use Case scenariosIllustrating 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
use CAse sCenARIosPregnant Mother: registration in Village
35
use CAse sCenARIosPregnant Mother: 1st Visit and registration at Local health Centre
36
use CAse sCenARIosPregnant Mother: repeat Visit for ANC
37
use CAse sCenARIosChild delivered: birth registration and 1st vaccination
38
use CAse sCenARIosChild’s Vaccination: repeat Visit
39
bACkGRound ReseARCH & AnALysIs
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
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 cardneed 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
exIStING heALth CArD USAGe
ProPoSeD PrototYPe
Information set typeData 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
noThe 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)
noinformation to be recorded by gynaecologists who do not use the health card
noThe 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 noanMs too busy, child’s develop-ment monitored unsystemati-cally during visits to village
norecords not being maintained due to lack of time
AnALysIs: InFoRMATIon seTs Current health record vs. proposed prototype
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 enTRyCurrent health record vs. proposed prototype
VisiTs
nu
Mb
er
oF
inFo
rM
aT
ion
Fie
lds
Fill
ed
anc VisiT 1 current record: 73 fields Prototype: 34 fields
anc VisiT 2 current record: 25 fields Prototype: 12 fields subseQuenT VisiTscurrent 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
0
10
20
30
40
50
60
70
Text Number Date Checkbox Mul<ple ch.
Current Health Record
Our prototype
ReduCed nuMbeR oF FIeLds FoR dATA enTRyCurrent health record vs. proposed prototype
TYPe oF inForMaTion Field
nu
Mb
er
oF
inFo
rM
aT
ion
Fie
lds
Fill
ed
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
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
obserVaTionThis 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
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 MewadaMoic, 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.”
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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
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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
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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
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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.
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InITIAL PRoToTyPes: FoR FIeLd TesTInG
PrototYPe 1 PrototYPe 2 PrototYPe 3
PrototYPe 4
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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.
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PRoToTyPe 2: RATIonALe
aiMTo improve illiterate mother’s engagement with the health card and her child’s health
ProToTYPe ideaincludes 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.
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PRoToTyPe 3: RATIonALe
aiMincorporate 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
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PRoToTyPe 4: RATIonALe
aiMincrease 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.
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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
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THAnk you!
Mridu MehTa
mridu.mehta@gmail.com
•
rahul abhisek
rahul.abhisek@gmail.com
•
ValTTeri WiksTröM
vatte.wikstrom@gmail.com
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