The Mother Child Health Card (MCH Card)

A prototype proposal for the Records for Life contest

Team MRIDU MEHtA RAHUL ABHISEK VALttERI WIKStRm Aalto University

CONtENtS
INtRODUCtION
04 The Public Health Care System 05 Stakeholders in RI System 06 ANMs Responsibilities 07 Target Location: Bihar & Gujarat 08 Health Records Researched

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

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 P  regnant Mother: Registration in Village 35  Pregnant Mother: 1st Visit and Registration at Local Health Centre 36 P  regnant Mother: Repeat Visit for ANC 37 Child delivered: Birth Registration and 1st vaccination 38 C  hild : Repeat Visit for Vaccination

Introduction

ThE PUBlic HEalth CarE SYStEm

Public health care services in India are delivered through a well-established network of health care centres. In rural areas, Primary Health Centres (PHCs) / Community Health Centres (CHCs) are responsible for providing basic health services related to Antenatal Care and Immunization 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 (Anganwadi Worker) at the community level. These eld workers travel through the communities dispensing health care solutions and form the crucial backbone of Indias health care delivery mechanism.

StaKEhOlDErS IN RI SYSTEM
SURVEYOR /FOUNDATIONS /NGOs

ASHA

DOCTOR

RELATIVES /FAMILY

MOTHER

ANM

CHILD
FATHER

AWW

DATA OPERATOR

VILLAGE

HEALTH CENTRE
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ANMS 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.
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

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

Supervisor CO-ORDINAtES wItH Computer Operator AWW ASHA Village Mukhiya Cold Chain Courier Boy/Helper Commute source

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

PuBlic InTERfacE
MEEtINgS Mahila Divas ASHA Divas ANM Meeting Micro Plan Meeting TRAININg SESSIONS AIDS Immunization Practices Record keeping, if new register introduced

REpORT STRucTuRE
REpORtS tO LHV MOIC or Educator CDPO Cold Chain SUpERvISION By MOIC DIO ACMO

TARGET LOCATION: BIHAR & GUJARAT

The design of our prototype is targeted at these regions
Our team member Rahul Abhisek worked with Center for Knowledge Societies, New Delhi conducting ethnographic research on Routine Immunization in Bihar, India in 2009-2010.*
Bihar 53.8 %

Gujarat 73.2 %

INDIA

Building our current process with this foundation, further research was conducted in mid-2013 in district Kishanganj, Bihar and Ahmedabad, Gujarat

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 7

* Have a look at the BMGF funded report: the Vaccine Delivery Innovation Report here.

HEALTH RECORDS RESEARCHED

The information ow 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

Our proposal: MCH Card

PROPOSED SOLUTION
MCH Card + Due Date Cards

Your next checkup is on

+
Ma, please get me vaccinated on

ANC Due Date Card

Ma, please get me vaccinated on

RI Due Date Card

10

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.

11

PROTOTYPE: MCH CARD

Designed to look like a passport: Increase value and care of card by users

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.

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.

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PROTOTYPE: MCH CARD

Features
BINDING
Centre Sewing Edges rounded to reduce wear and tear and avoid dog ears

COvER
Soft hard cover, vinyl pasting + knurling Gold embossed lettering to give look and feel of importance

SIZE
CLOSED SIZE 3.5 x 4.9 in OpEN SIzE 7 x 4.9 in Transparent plastic pouch to hold and protect Due Date card

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PROTOTYPE: MCH CARD

Features
Form of booklet is compact and strong. The materials are weather proof.

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

Number of spreads: 7

SUGGESTED PAPER OPTIONS Stone Paper All Weather Paper PAPER THICKNESS 150 GSM

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PROTOTYPE LAYOUT DESIGN

Look and Feel

Minimal and clean

FAMILY IDENTIFICATION MOTHERS PREGNANCY RECORD

Soft colour and rounded edges of card suggest mother and child care Focus on easy and efficient: Information recording Accessing information

Mothers Name

Age

Mothers MCTS Number

Fathers Name

Date of last menstrual period

Home Address/Village

Date of expected delivery

Change in Address

No. of pregnancies

No. of previous live births

Phone Number

Last delivery conducted at

Institution

Home

CHILDS BIRTH RECORD

Childs Name Mothers Passport photograph Childs Passport photograph

Date of Birth

Weight at Birth

Girl

Boy

Childs MCTS Number

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PROTOTYPE LAYOUT DESIGN

Colour Palette
PRIMARY 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 GREY CMYK 0,0,0, 70 USAGE Text MCH gOld USAGE Lettering

SUPPORTING COLOURS
MCH PALE YELLOW CMYK 0,0,100, 0 / TINT 10% USAGE ACCENT COLOUR MCH cOvER SHADE Of DARK mAROON

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PROTOTYPE LAYOUT DESIGN

Typography
Didot is an elegant modern serif typeface

COVER
Didot bold Type size 18 pt

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 technology used

INSIDE PAGES
Univers 55 Roman Univers 65 Bold Univers 75 Black Type size 7 pt for all text

VACCINATION AND SUPPLEMENT SCHEDULE

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 including corporate branding, signage, maps, standardized testing and consumer electronics devices.

DUE DATE

VACCINE

DATE ADMINISTERED

BIRTH

BCG HepB OPV 0 Penta 1 OPV 2 Penta 2 OPV 3 BCG

1.5 MONTHS

2.5 MONTHS

3 MONTHS

(Repeat dose if no scar)

3.5 MONTHS

6 MONTHS

Penta 3 OPV 4 Folic Acid Iron Tablet Vit A

Notes

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FLOW OF INFORMATION IN PROTOTYPE

Designed to match the sequence of recording process as conducted on eld
cOvER
Due Date

1
Introduction and instructions for Mother

2
Notes Institutional Identication

5
After Delivery Check Up Notes

4
Ante Natal Check Up Notes

3
Family identication Mothers Pregnancy Record Childs Birth Record

The only exception is the Childs Birth Record which is placed along with Identication information on spread 3, instead of following After Delivery Check Up information. This has been done to ensure all identication related information

6&7
Vaccine and Supplements Schedule Additional Vaccines

8
Notes

BACK cOvER

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FLOW OF INFORMATION IN PROTOTYPE

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DESIGN DECISIONS
For Information/Content
PRImARy USER: ANM Responsible for maintaining the records in the MCH card. She conducts the check ups on mother and child and administers vaccines

Minimal IllusTRaTiOns
(Only used for Due Date card targeted at caregivers) The cards primary user, the ANM is literate and illustrations are unnecessary to her task of record keeping

DEsign FEATURES
Clarity in recording data Ease in accessing data by secondary users Integrating with other stakeholders Minimal critical Information elds for data recording Ease in updating Information elds not being currently recorded have been eliminated

SECONDARy USERS The data recorded is useful to: MCTS Caregiver Doctor/Health Care provider Surveyor Policy Makers NGOs & Foundations

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)

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PROTOTYPE
SPREAD 1: Introduction and instructions for Mother

Mothers! This booklet is the main record of you and your childs 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 ofcials During vaccination drives at your village

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 communicated by the ANM to illiterate mothers.

YOUR HEALTH CARD IS IMPORTANT. TAKE CARE OF IT AND KEEP IT IN A SAFE PLACE WITH YOUR VALUABLES.

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USAGE OF Mamta CarD

Informs design of spread 2 our prototype
Idea for prototype: Include Notes in the beginning for extra information and ease of access for ANM

The front page of this example contains data records of the mothers antenatal check up. This ANM seems to have abandoned the use of the inside information elds for the ease of writing and accessing all the information from the front page itself.

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PROTOTYPE
SPREAD 2: Notes and Institutional Identication

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 eld research indicates that there is a need for custom notation on the RI card. (Refer previous slide)

NOTES

INSTITUTIONAL IDENTIFICATION

AWW Name

The phone numbers of all the health workers can be easily accessed by the mother in case of need. Our eld research showed that institutional identication information is not rigorously lled by ANMs. Placing it at the beginning with a clean and clear design should increase its usage.

AWW Phone Number

Anganwadi Centre / Block

ASHA Name

ASHA Phone Number

ANM Name

ANM Phone Number

SHC / Clinic

Primary Health Centre / Town

Hospital / FRU

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PROTOTYPE
SPREAD 3: Family Identication, Mothers Pregnancy Record, Childs Birth Record

FAMILY IDENTIFICATION

MOTHERS PREGNANCY RECORD

Mothers Name

Age

Mothers MCTS Number

Fathers Name

Date of last menstrual period

Home Address/Village

Date of expected delivery

Change in Address

No. of pregnancies

No. of previous live births

Phone Number

Last delivery conducted at

Institution

Home

CHILDS BIRTH RECORD

Childs Name

Date of Birth

Weight at Birth

3.467 kgs

The Mother and Childs 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 identication of persons by health workers, hospitals and surveyors.

Girl

Boy

Childs MCTS Number

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USAGE OF Mamta CarD

Informs design of ANC in our prototype
Idea for prototype: Our design of the ANC is directly inspired by this example. This ANM has avoided the unnecessary repetition in recording dates per visit

This ANM seems to have abandoned the use of the Ante Natal Care table and designed her own table in the notes section on the right. 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
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PROTOTYPE
SPREAD 4: Ante Natal Check Up

ANTE NATAL CHECK UP

26/2 / 1 3

The included ante natal check up tests have been reduced from the current Bihar RI card based on eld research of what tests are practical for the ANM to carry out on eld/in the local health centre. The organisation of the information has been informed by the usage patterns seen on eld. (Refer previous slide)

BLOOD PRESSURE

urine ALBUMIN

WEIGHT (KG)

POG (WEEKS)

PULSE

VISIT DATE

Notes

26

JAUNDICE (Y/N)

IRON TABLETS

OEDEMA (Y/N)

HAEMOGLOBIN

PALLOR (Y/N)

urine SUGAR

T.T (Y/N)

PROTOTYPE
SPREAD 5: After Delivery Check Up and Notes

after deliVery check up

NOTES

Place of delivery Institution Type of delivery Normal Institutional C-Section Term Preterm Home

Space for notes provided for complications, doctor referrals, tracking patient medication in case of problems etc.

If at institution, period of stay post delivery

Complications, if any

Cried immediately after birth Yes No

Initiated exclusive breast feeding within 1 hour of birth Yes No

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USAGE OF Mamta CarD

Informs design of vaccination schedule in our prototype
Good example of how the current design of the card has unnecessary repetition of information elds that need to be lled by the ANM. ANM has lled 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.

Section of the Vaccination Schedule

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PROTOTYPE
SPREAD 6: Vaccination and Supplement Schedule

Repeat BCG dose highlighted as a reminder for the ANM and caregivers. There is no eld to record and track this repeat dose in current health records.

VACCINATION AND SUPPLEMENT SCHEDULE

VACCINATION AND SUPPLEMENT SCHEDULE

DUE DATE

Vaccine

Date Administered

DUE DATE

Vaccine

Date Administered

Birth

15 /1 0 / 1 3
1.5 MONTHS

BCG HepB OPV 0 Penta 1 OPV 2 Penta 2 OPV 3 BCG 

Penta 3

9-12 Months

15 /1 0 / 1 3
18 months

Measles Vit A Deworming DPT Booster OPV Booster MMR 2 Vit A Deworming Vit A Vit A Vit A

2.5 MONTHS

3 MONTHS

24 months

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 dose if no scar) 30 months

3.5 MONTHS

6 Months

OPV 4 Folic Acid Iron Tablet Vit A

36 months

Notes

29

DESIGN OF BIHAR RI CarD

Informs design of vaccination schedule in our prototype
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.

Vaccination Schedule in Hindi

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PROTOTYPE
SPREAD 7: Vaccination and Supplements Schedule + Additional Vaccination

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 Childs survival and good health are provided. (Refer previous slide)

VACCINATION AND SUPPLEMENT SCHEDULE

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 Vit A Vit A Vit A DPT Booster DPT Booster

Space has been included for out of schedule vaccinations, and to accommodate schedule changes by the state.

48 months

54 months

60 months

48-60 months

AFTER 1 Month

Notes

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PROTOTYPE
SPREAD 8: Notes

NOTES

Space for notes provided at the end of the card.

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Use Case Scenarios

Illustrating how the MCH cards 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

33

USE CASE SCENARIOS

Pregnant Mother: Registration in Village

34

USE CASE SCENARIOS

Pregnant Mother: 1st Visit and Registration at Local Health Centre

35

USE CASE SCENARIOS

Pregnant Mother: Repeat Visit for ANC

36

USE CASE SCENARIOS

Child delivered: Birth registration and 1st vaccination

37

USE CASE SCENARIOS

Childs Vaccination: Repeat Visit

38

BACKGROUND RESEARCH & ANALYSIS

39

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

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ANALYSIS: FIELD VISIT CONCLUSIONS

OUR ASSUMPTIONS BEFORE FIELD VISIT
Main user of the card: Mother/Caregiver Need to increase illiterate mothers engagement with Health Card Minimal text and more illustrations/images to communicate to mother Content of card can lay more emphasis on instructional information like Nutrition, Mother and Child Care, Childs growth and development The size, material and shape of the card needs to last a period of 5-6 years of usage

OUR PREMISE AFTER FIELD VISIT

Main user of the card: ANM Need to simplify ANMs recording process Illustration unnecessary in Health Card as main user is the Nurse who is literate 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, which includes a minimum of 20 interactions between a health care provider and the Health Card The design of the card needs to be compact. A lot of information is not being lled by ANM due to lack of time. These information elds can either be removed or redesigned. Need to reduce unnecessary repetition of information elds that ANM needs to record.

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 Need to reduce unnecessary repetition of information elds that ANM needs to record.

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aNalYSiS: INfOrmatiON SEtS

Current health record vs. proposed prototype
EXisTing HEalTH CaRd usagE
Information set type FAmILy IDENtIfICAtION
(Mothers & Fathers Name, Age, Address, Phone number)

PROpOsEd pROTOTypE
Data set included in prototype?
Yes

Data set If not, possible reasons being for not recording recorded?
Yes

If not, why has it been excluded?

PREgNANCy RECORD
(Mothers 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, Childs ID)

Yes Partially recorded Partially recorded Cumbersome design, card not maintained/lost/forgotten by mother during visits, tracking mother difficult Information to be recorded by gynaecologists who do not use the Health Card Information to be recorded by gynaecologists who do not use the Health Card

Yes

INStItUtIONAL IDENtIfICAtION
(Names & phone numbers of Health workers,

Yes

ANtE NAtAL CHECK Up

(Ante natal visits, Basic Abdominal investigation, Weight, B.P, Hb, Urine, T.T, Iron tablet)

Yes

ANtE NAtAL CARE

(Obstetric complication, Past history, Abdominal investigation) No

No

The ANM does not have the time or the equipment or training to carry out most of these functions The ANM does not have the time or the equipment or training to carry out most of these functions

POSt NAtAL CARE

(Mother and Childs check up care)

No Partially recorded No

No

VACCINAtION SCHEDULE
(Vaccine, due date, date administered)

Yes ANMs too busy, Childs development monitored unsystematically during visits to village
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GROwtH CHARt

No

Records not being maintained due to lack of time

REDUcED NUmBEr Of fiElDS fOr Data ENtrY

Current health record vs. proposed prototype
80 70
NUmBER Of INfORmAtION fIELDS fILLED ANC VISIT 1 Current record: 73 elds Prototype: 34 elds ANC VISIT 2 Current record: 25 elds Prototype: 12 elds SUBSEqUENt vISItS Current record: 24 elds prototype: 11 elds 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.

60 50 40 30 20 10 0 Current Health Record Our prototype

7 RI

De liv er y

C1

C2

C3

C4

RI

RI

RI

RI

RI

RI

AN

AN

AN

AN

VISItS

43

RI

REDUcED NUmBEr Of fiElDS fOr Data ENtrY

Current health record vs. proposed prototype
70
We have signicantly reduced the amount of numbers, dates and multiple choice elds by eliminating repeated information and information usually left unlled by the ANM. The number of check boxes is higher in our prototype, because we have replaced repeated date entry on several occasions with check boxes to make the process of lling out the data more efcient.

60
NUmBER Of INfORmAtION fIELDS fILLED

50

40 Current Health Record 30 Our prototype

20

10

Text

Number

Date

Checkbox

Mul<ple ch.

TYPE OF INFORMATION FIELD

44

INTERVIEWS
For nal prototype: Illustrations are not the most effective way of increasing caregivers engagement with mother and child health care

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

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 eld.

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INTERVIEWS
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 lled 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.

For nal prototype: Only include information elds that the ANM can currently record given her roles and responsibilities.

Most mothers wont look at the entire card. In fact the staff at the clinic also wouldnt have gone through the entire card.
- Dr. Hardik Mewada MOIC, Arjun Urban Health Centre (Slum Area), Vasna, Ahmedabad

46

FIELD OBSERVATIONS & INTERVIEWS

ASHA Worker Bharti Ben providing samples of the Mamta Card and explaining her duties

ANM Zankhani Ben demonstrates her recording responsibilities on the Mamta Card and her set of MCH registers

MCH register maintained by ANM Zankhani Ben for digitization by Data Operator

ANM Zankhani Ben describes how she uses illustrations during counselling sessions to inform young mothers about breast feeding

ANM Zankhani Ben comments on our prototype for the childs growth and development
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ANM Zankhani Ben approves of our prototype for the vaccination schedule

FIELD OBSERVATIONS & INTERVIEWS

Multi Purpose Health Worker (MPHW) Shailaja Ben at the V S Public Hospital, Ahmedabad, Gujarat preparing to vaccinate a new born child

The MPHWs assistant lls 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 explaining the sequence of information recording in the Mamta card

MPHW Shailaja Ben describing usage of the ANC table in the Mamta Card while caregivers wait for her to vaccinate their child
48

She looks at our prototype and doesnt seem to understand the logic of information distribution at rst glance

FIELD OBSERVATIONS & INTERVIEWS

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 regarding child care and do not use the Mamta card

Dr Sarkar, (Retired National Tech Advisor to WHO) offering suggestions for the redesign of the vaccination schedule

Entrance to Urban Health Centre (UHC), Vasna, Ahmedabad

Posters and information graphics on the walls inside the UHC

49

MOIC at the UHC pointed out information that is frequently recorded, and information that doesnt get recorded on Health Cards

FIELD OBSERVATIONS & INTERVIEWS

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

Weekly ANM meeting, where ANMs put forth their trouble and challenges to the Medical Officer in charge (MOIC)

ANM explaining the columns of hand made MCH register

Documentation of the register storage room at Potia block in Kishanganj district, Bihar
50

Data operator room. Prints of the seven block in the Kishanganj distract and the gures of RI coverage.

INITIAL PROTOTYPES: FOR FIELD TESTING

PROTOTYPE 1 PROTOTYPE 2 PROTOTYPE 3

PROTOTYPE 4

51

PROTOTYPE 1: RATIONALE
AIM
To improve illiterate mothers engagement with the Health Card and her childs 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.

52

PROTOTYPE 2: RATIONALE
AIM
To improve illiterate mothers engagement with the Health Card and her childs health

PROTOTYPE IDEA
Includes vaccination schedule, growth chart and nutritional and childs development information on one large chart as a timeline to be hung as a chart in the mothers house.

53

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

54

PROTOTYPE 4: RATIONALE
AIM
Increase mothers engagement in her childs vaccination process by highlighting Due Date through illustrations. Reducing repeated data entry of date administered and due date.

55

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

56

THANK YOU!
MRIDU MEHtA mridu.mehta@gmail.com RAHUL ABHISEK rahul.abhisek@gmail.com VALttERI WIKStRm vatte.wikstrom@gmail.com

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