Till the last Man
of the largest Democracy
How Election Commission of India is enabling Youth vote to mobilise its Information System
If you don't have interest in
politics that doesn't mean politics
doesn't have interest in you
Module: System Design
Area of study: Election Commission of India
Parameters of study: ECI Information system with respect to Youth participation, Engagement and Accessibility into the free fair elections in India
we began with the System Design lens to understanding the complex Information System in our electoral voting process
.01
DEMOCRACY AND INSTITUTIONAL BODY
The research started with studying the information already available in secondary sources like newspaper articles, ground reports, official documents, etc. to understand the current scenario of rural healthcare.
.02
MAPPING THE INFORMATION SYSTEM OF ECI.
A few assumptions and hypotheses were drawn according to this secondary research. A pilot study was then conducted in a nearby village to check if these assumptions were right or wrong and to further understand the ground reality in rural areas. Tools used for the study were the sub-center observation Method and Semi-Structured Interviews.
.03
SYSTEMIC APPROACH
To gather more reliable insights by capturing instances/ data on what participants do as opposed to what they say they do.
.04
STATS AND FIGURES NARRATIVE
This method opted to draw out more specific inferences by asking repeated follow-up questions. Leading with open-ended questions which are questions that can't be answered with a simple "yes" or "no."
.05
A DIALOGUEE ON POLITICS AND "CHAI"
It is a systematic exchange of information, views, and opinions about a topic, problem, issue, or situation among the members of a group who share some common objectives and social setting.
.06
VISUALISATION OF INTERVENTION AREAS
The Observe-Think-Wonder strategy is an artful thinking routine from Harvard's Project Zero. The purpose of this routine is to allow students time to thoughtfully consider not only what they’re observing, but also what those observations mean.
.07
SOLUTION FRAMEWORK
A process to better understand how prescribed medicine is being used by its users and the culture in which it typically exists. It also serves as an opportunity for us to systematically generate insights and inspiration for future product/service designs.
RESEARCH FLOW
Secondary Research
Mapping Problem
Areas
Pilot Study
Analysis
Primary Research
Analysis
Insights
Design Direction
Understanding the rural healthcare function, structure etc. with understanding the demographic of particular village.
Finding the directions for research to make appropriate assumptions and hypothesis.
Studying similar village as pilot study via on ground visit.
Analyzing Pilot Observations to create directions for Primary Research.
Visiting Bihura village to study and gather information for making meaningful research.
Aggregating and analyzing data obtained from primary research.
Integrating and disintegrating inferences to form insights.
Leveraging the insights to create meaningful product and services.
Did you know
In India, on an average, a government doctor attends to 11,082 people, more than 10 times than what the WHO recommends (1:1000)
PHCs in India have only one doctor while about 5% have none
UP
emerged the worst performers, with less than five per cent PHCs following the norms
Distribution of services as per population density
Up to 1000
Population
5 to 6 villages
30 to 40 villages
Caters up to 100
villages
Village Level
Sub-centers (SC) delivery/ Antenatal
Primary
Health System (PHC)
Community
Health
System (CHC)
Comprehensive emergency obstetric and newborn care (CEmONC)
Basic emergency obstetric and newborn care (BEmONC)
1-2 Auxillary Nurse Wife (ANW),
1 Male Multi Purpose Worker (MPW)
ASWA/ AWW/ Community Based Organization/ Women's Group
ANM: Auxiliary Nurse Midwife ASHA: Accredited Social Health Activist CHC: Community Health Center PHC: Primary Health Center SC: Sub Center
Distribution of Health Centers
Community
Health
Center (CHC)
Each district have 01 CHC with 30 bedded facility
It serves as a referral center for 4 PHCs and also provides facilities for obstetric care and specialist consultations
Primary
Health
Center (PHC)
Referral Unit for 6 sub-centers, 4-6 Bedded, Manned with 1 Medical Officer and 14 Subordinate Paramedical Staf
Sub
Center (SC)
Each PHC have 06 SC
The primary point of contact, easy to access, Manned with 1 Auxiliary Nurse Midwifery and 1 Multi-Purpose Health Worker (M/ F)
Role of
ASHA & ANM
ASHA
Register and cares for pre/ post-natal mothers at home
Maintain records of all the services like birth and death
Register and follow all eligible couples, carryout family planning services and distribute preventives like condoms and contraceptive
Provide immunization and nutritional advice to mother and children
Provide treatment of minor ailments
Spread awareness about communicable diseases
ASHA
Mobilize community and facilitate in accessing health and health related services
Counselling of birth preparedness, escort for institutional delivery, antenatal care, immunization, family planning
Organization of VHND promotion of household toilets
Detection referral confirmation, registration of cases like malaria, TB, leprosy, RTI/STI
Depot holder of drugs such as ORS, IFA, Chloroquine disposable delivery kit, oral pills and condams
Survey of health and related events
Some of the key findings of secondary research helped us to make assumptions and hypothesis for pilot study further
COVID AND
VACCINATION
Covid-19 Vaccine Hesitancy: Believing vaccination leads to death.
Rural people trust alternative unauthorized healthcare providers and feel they are immune to diseases.
People deny, stigmatize Covid-19 Positivity and are ignorant towards prevention & medication.
See tangible as treatment for diseases.
HEALTHCARE
Lack of commitment to the healthcare process awareness towards health investment.
Males make quick decision on health compared to women.
Vaccine Preventable Diseases is placed in less priority zone until it's too late.
Unavailability of functioning healthcare centers near by, travel long distances to get a proper healthcare treatment.
DOCTORS AND WORKERS
Low Doctors to Patient Ratio. (India is 1:1456 against the WHO recommendation of 1:1000) 1:19962 in UP.
Shortage of Human resources.
Health workers lack rural/cultural sensitivity.
Healthcare providers are hesitant to work in rural areas.
MEDIA
Information flows through unorganized channels in Rural areas.
Lack of information and awareness about Covid-19.
Word of mouth, Key tool for Misinformation spreading.
System and Technology are not designed keeping the Rural people in mind.
BALANCE DIET AND HEALTH
Lack of a balanced diet: Low availability and Management of nutritious food.
Labor intensive work in harsh conditions.
To familiarize ourselves with rural context we did
pilot study
Unnao District
Samadha Village,
Unnao District, Uttar Pradesh
Population Size: 1500 +
Total No. of Houses: 317
Total Literacy Rate: 56.8% Approx.
We used Observational and Semi-structured Interviews with People, Officials, Locals and other staffs to underline key observations
AWARENESS
Villagers consider posters and banners as an ineffective and an age old way of awareness and communication, instead TV, social media, newspaper are considered to be a better source of information
People believe there is a difference between Urban area Covid vaccines and Rural area Covid vaccines.
Villagers were reluctant to take medicines which were given during health campaigns.
HEALTHCARE
SERVICES
For past 10 years, Sub-Center was opened only for Vaccination of Kids by ANM.
Both Sub Center and CHC was not maintained well. Damages on wall, algae, dampness and discarded equipment was clearly visible. Very few patients were seen at CHC.
Government medical staff expressed their reluctance towards working in a Rural setup.
ASHA workers were considered for maternity and child care only.
ECONOMY
Villagers gave first preference to over the counter medicines for any health related problem rather consulting a doctor.
CHC was 1.8Km away from the village, still people rushed to private facilities during night time emergency which were more than 5Km away from the village.
ENVIORNMENT
Drainage channels were present at some parts of the village and grey water was being directed towards ponds.
Accumulation of garbage all around the village. No government cleaning/ cleanup facility found in near vicinity.
Most of the toilets were built in front of their homes and were left abandoned or used them as storage rooms.
To analyze the context of the Prabuddh Gram village: Bhiura, an on-ground Primary Research was conducted
Two students from NID stayed near the village for 3 Days to conduct an Observational Study of the Village, Community Health Center, and nearby market areas where chemists/ pharmacists were located. Personal Interviews and Group Discussions with Kids, Young Adults, and Elders were conducted to get deeper insights regarding their general awareness, health belief, approach towards illnesses and diseases, preventive measures, and general outlook towards the village environment
Key Actions:
Medical workers and Doctors at CHC were also interviewed and observed in uncontrolled natural working conditions to get more insights into their behavior towards patients, fellow medical staff, other staff members, equipment, and infrastructure
CHC infrastructure was closely observed in terms of facilities provided to both patients and medical staff members, spatial arrangements, maintenance, the flow of services, and ambiance.
One of the students also acted as a self-participatory patient to generate more insights into the Rural Healthcare system.
Management of patients and processes during Covid-19 vaccination day was also observed to identify gaps in the service and get a better understanding of the patient’s journey
Observational Study started with first
Community Health Center (CHC) at Atraulia Block
Key Findings:
Doctors, nurses and other medical staffs were not in their uniforms.
Doctors were diagnosing patients casually. Patients felt they're not diagnosed properly
The layout was confusing and visible modifications were seen based on requirements which were creating further problems and confusion
It was observed that some doctors saw multiple patients during consultation
Medicine dispensary at
the CHC Atrauliya
.jpg)
Pharmacist checks Patient's slip
Pharmacist gives medicines
Pharmacist orally gives instructions
Patient asks for another medicine
Some medicines fell from patient's grip and he tries to pick them up
Patient patiently waits
Patient takes them
Patient checks the medicines
Pharmacist gives him
Pharmacist didn't reach out to help the patient
Key Findings:
Medicines were given loosely in hand and instruction of doses were given orally
Lack of proper medicine storage facility and dispensing window
Lack of empathy towards rural patients considering their anxiety and unawareness towards Rural Healthcare
Vaccine registration & vaccination process
at the CHC Atrauliya
.jpg)
Key Findings:
There was no temperature screening or mask vigilance at CHC. Some patients were not using mask/ not wearing them properly
Registration process differ from first time of dose vaccination and second dose, this enough created confusion over the what step should be followed
Long waiting ques for an our at registration desk made misinformed and lost
No special category lines were introduced for any of the old age, women's etc.
We conducted a drawing/ art exercise
at bihura village with kids (06- 16 Yrs.)
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Key Findings:
Observe
School infrastructure with toilet, banyan tree and school building is made where a man can be seen taking oxygen from the tree
Emphasis is given to cleanliness and dustbin in the drawings
Kids were fully aware of toilets and it's significance, relationship with cleanliness and hygiene
Kids drew villagers in cleaning effort signifying its cohesive importance towards hygiene
Think
Kids are aware of the fact that tree are the major source of oxygen and its very important for a clean environment
Kids understand the importance of how small step towards cleanliness can make country great
Kids understand importance of cleanliness and placement of dustbin in their house
Kids understand importance of using toilets and associate it with clean village
Wonder
Though kids believe in cleanliness still nobody takes initiative to keep village clean
Kids are aware of Dustbins and waste production, yet non of them use/ have a dustbin at home
Many households lack proper toilet and kids also defecate in open. Why kids don't ask/ demand a toilet or discuss it's importance with their parents?
Photography & Selfie experiment
with youth (17- 22 Yrs.)
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Key Findings:
Straw is generally considered as waste so in any case of damage/ deformity, it might get disowned very easily
No waste segregation & collection system or waste management system
Seeing cow dung kept openly is an unsightly experience for the respondent
The respondents were aware of water pits as disease breeding grounds but collective responsibility was missing
Artifact analysis of
prescriptions & medicines
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Key Findings:
Poor maintenance of storing medicines and slips, generally locals doesn't have government hospitals provided medical prescriptions safe with them
Locals belief since government facilities are free and usually in deteriorating conditions, the medical facility are not trustworthy
People prefer to consume medicines from private health institutions because of shortage and delay in government hospitals
One resident kept safe a prescription without any name and contact of doctor
Night hall in the village
with focused group discussions
Group discussion
-
18 Males and 15 Females
-
Age group between 30 to 60
-
Time 2 Hours
-
Moderators : Amit, Shubham
Key area discussed
-
Medicine & Vaccine
-
Infrastructure
-
Staff Behavior
-
Connectivity
-
Quality of care.
Key Findings:
People were feel lost while wearing a mask and perceive them as an obstacle between freedom and social image inside the village
People do not use proper First Aid due to a lack of resources and awareness. They tend to leave cuts/ wounds and animal bites in the open as they believe it will heal faster if it’s dry. Tetanus injections are a far cry as there’s no sub-center in the village
The masks they get/ purchase in the hospitals/ market have a hard time blending with their attire and becomes highlighted. Many women tend to cover their face with a saree as it blends in the social context of the village and somehow acts as a preventive measure
Preventive measures are positioned with a factor of fear to gain more impact but people in the village tend to reject them as having fear in a social scene is a display of cowardice for the villagers
Analysis: Tree mapping with respect to Health Belief Model
The Health Belief Model is a social- psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services.
Insights: for design direction
towards health belief and
services
01.
People in village tend to leave small cuts/ wounds/ animal bites without any treatment since they lack First Aid materials and awareness. This can lead to severe complications.
Opportunity Area
There is need to establish the value of First Aid treatment and make people aware about susceptible illnesses caused by small injuries, animal bites etc.
Design Direction
- Medical pouch cum first aid kit for the rural people, where patients can put his/her medicines inside. Also, it is easy to carry, hold and highly durable "Khadi Pouch".
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02.
People place higher subjective value and associate a sense of ownership with medicines & prescriptions received from private healthcare since they had paid a premium for the treatment resulting devaluing of prescription and medicines received from government healthcare facility as they cost only 1 rupee.
Opportunity Area
There is need to instigate a sense of ownership and value addition towards government provided prescription and medicines.
Design Direction
- Prescription Re-design
- Govt. Healthcare Booklet
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03.
Awareness programs fail to produce the desired optimal behavior because they are not propagated through proper channels and target specific age, gender and community.
Opportunity Area
There is an opportunity to design communication strategies defined by it's target audience and propagates through proper channels leaving no person/ kid behind.
Design Direction
- Nutrition awareness cum Recipe book
- Making kids aware with simple grounded stories/ comics
- Health Care Cadets Batches
- Teenagers as a Healthcare Cadets
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04.
Due to no tangible Healthcare service touch points in the village tend to avoid consulting with ASHA/ ANM at their residence for Health related consultations because social stigma and shyness. This results in infrequent visit to Healthcare facilities and people become more susceptible to illnesses.
Opportunity Area
There is an opportunity to build an infrastructure which caters as a Sub Center-cum-Multi Utility Space, in order to externally trigger villagers to visit this place frequently. Gradually anchoring the need to seek Healthcare services via designed awareness programs.
Design Direction
- Extending reach of Healthcare facilities touch points: Conceptualizing Sub Center + as a Primary Healthcare center and also positioning is as a recreational activity to promote frequency of visits.
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05.
First-time mothers when compared to experienced mothers tend to visit CHC more often for health checkups (Antenatal Checkups) as they perceive it as an explorative and recreational activity.
Opportunity Area
There is a potential to tap into the Health Seeking Behavior of the mothers to spread more awareness and foster their trust and ownership towards state medical Healthcare facilities for
Design Direction
- Wellbeing sessions at CHC for new mothers: First time mothers and their family members take childbirth as an important event in life, leveraging the curiosity and make them aware about other health related topics masked as recreational activities.
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Office of the Principal Scientific Adviser
to the Government of India
