the first 1000 days: mother and child in rural bihar - findings of the bihar innovation lab
DESCRIPTION
Divya Datta's presentation on the findings of the Bihar Innovation Lab. At Health Public, CKS, New Delhi.TRANSCRIPT
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The First 1000 Days: Mother and Child in Rural Bihar
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5 Weeks
7 Innovation Specialists
3 Districts: Begusarai, Saharsa,Kishanganj
950 + hours of field interviews, observation,
photos, videos, audios
18 + hours expert and practitioner interviews
The Effort
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Human Experiences
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Cultural Values of Health and Protection
A Lighter is kept near the
child to ward of evil eye
An Iron Kajrota, a holder of kajal,
to ward of evil eye.
Making children wear Tabeejs for protection
is a common practice
Worship areas outside homes as
women are not allowed to enter it
during gestation and periods
Palnas for the infant are
gifted by the maternal
household to new parents
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New Syringes
Ferro Tablets
Zinc Tablets
Vitamin A syrup
Green Jhola
with medicines
Cotton Roll
Non-functional
hub-cutter
Bag with new syringes
Registers
& RI cards
Vaccine Vials
Pen
Registers
Purse
Seeing like a Designer
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Mapping 1000 day Health Information Needs
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Mapping ASHA’s Mobilization Interactions
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Labor Journeys over Multiple Deliveries
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Diurnal Mapping of a Pregnant Woman’s Nutrition
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Building Divergent Ideation based on Failure Cases
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A Convergent Approach to Prioritization
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Public Health Delivery Systems Analysis
Tools
Players
Rules
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Systems Challenge:
Unidirectional model of Care Provision
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The focus of the healthcare service and its (FLWs) on the health and wellbeing of the mother and child is limited to these periodic and narrow interactions
Largely influence of these interactions are limited to looking at health and wellbeing through the lenses of preventive medication and vaccines.
Limited Interactions = Limited Scope for Impact
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The Circle of Influence and Decision Making around the Mother
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‘ASHA nahi aayi bulane toh hum nahi gayi injecsion lene – uska kaam hai na’
Who is Responsible for the Health of Mothers and Children?
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Systems Challenge 4:
Cookie Cutter Care and Counselling
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Sulekha Devi | Health Vitals
HB: 5 gms | BP: 140/100
BMI:(Height: 5:2” Weight: 42 Kgs)
Severe Edema (Swollen Feet)
6th Pregnancy
2 Miscarriages in the Past
Rekha Devi | Health Vitals
HB: 9 gms | BP: 130/100
BMI:(Height: 5:4” Weight: 50 Kgs)
2nd Pregnancy
Standard Advice from Front-line Workers to Both These and all other
Pregnant Women:
‘IFA Tablet khao’ Eat Iron Tablets
‘TT Lagao’ Get TT
“Saag sabzi khao’ Eat green leafy vegetables
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Missed Opportunities to Provide Relevant Care
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Systems Challenge:
Uniform Service Delivery Across Socio- behavioral -
Geographical Contexts
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Systems planning and emergency response is linear in structure and ignores impact of temporal activities such as festivals, high volume, seasonality, etc.
The Temporality of Health
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Existing systems aren’t designed to respond to variations occurring due to:
- Seasonal factors
- Geographical challenges
- Attitudinal challenges
- Socio-Cultural resistance
- Local Healthcare Beliefs and Perceptions
- Infrastructure
- Political Events: Elections often result in total shutdown in transportation. Ambulances and other key personnel are redeployed during elections / political rallies impacting access to public facilities
Blanket Service Strategies
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Systems Challenge:
Imbalanced Hierarchies Between The Service and
Beneficiaries
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Inequity is rife in the system: Choosing whom to prioritize or whom to provide. “Hum hi bure bante hain.” – AWW worker.
Some FLWs show bias towards their own kin when itto distribution of resources and providing services.
Beneficiaries’ class & caste sometimes determines the attitude of FLWs, thereby affecting the quality of service. Socially or financially influential beneficiaries may be givenpreferential treatment at the RI site.
Service Provision Inequity
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Low Expectations
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A Non-Participatory Environment
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Systems Challenge:
Data Reporting over Care | Misplace Priorities
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Only Measurable and Incentivized Services Provided
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Who’s Interest is Priority?
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Skewed Time-Spent on Data Reporting as opposed to Care Provision
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In spite of there being no weighing machine at
the RI/VHSND a beneficiary’s MCH card had
mention of her weight recorded.
Data recording often takes precedence over
caring for the health of the mother and
reporting her actual status.
Data Reporting over Care
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Systems Challenge 6:
Lack of Critical Infrastructure Required to
Operationalize Best Health Practices
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A Woman Centric Approach:
The Layered 1000 Days
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A ‘Mother and Child’ Centric Health and Well-being Ecosystem
Automating Patient Tailored Care Provision at Scale
A Self-Aware Healthcare Delivery System
Service Accountability towards Citizen Communities
Service Delivery Infrastructure for Best Practices
New Performance Evaluation Parameters and Differential Incentive Structures
Key Innovation Directions