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

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 %

http://cks.in/wp-content/uploads/2012/10/vaccinedeliveryinnovationinitiative.pdf

http://cks.in/wp-content/uploads/2012/10/vaccinedeliveryinnovationinitiative.pdf

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


☐ OPV 3

3 MONTHS ☐ BCG (Repeat dose if no scar)


☐ 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


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


BIRTH ☐ BCG

☐ HepB

☐ OPV 0


☐ OPV 2


☐ OPV 3

3 MONTHS

☐ BCG (Repeat dose if no scar)


☐ OPV 4

6 MONTHS ☐ Folic Acid

☐ Iron Tablet

☐ Vit A


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



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


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.”

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

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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


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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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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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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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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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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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

[email protected]

•

rahul abhisek

[email protected]

•

ValTTeri WiksTröM

[email protected]

Date post:	30-Nov-2014
Category:	Design
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