This Innovation Working Group focused on innovating and ideating around the system challenge of cookie cutter care and counselling. ItÂ exploredÂ the creation of tools and protocols to ease and automate the provision of differential care, even at scale.Â
This could span from low cost diagnostics, patient health profiling and information recording tools, care decision frameworks, tailored health plans, progression mapping protocols etc.Â The outcome was expected to be a solution aimed at tackling the issue of ‘blanket medical care’ provided to all pregnant women or mothers uniformly without accounting for specific needs. The breakout session on cookie cutter care and counselling involved participants from varied disciplines, led by Divya Datta, Director of the Bihar Innovation Lab.
A crisp and concise introduction to the topic by Divya seamlessly transformed into a richÂ ideationÂ session with an informative debate around the challenge of patient-centric care. An interesting – and unanimous – idea that emerged out of the session pertained to standardizing care through patient-centric designs. A minimum standard or level of the quality of care provided by FLWs (Frontline Health Workers) needs to be set. Setting standards is essential because there is a high variation in the care that is provided – some ASHAs do excellent work, while others are below par. Whether the standards are being met needs to be assessed in the next phase. This could be done through capacity building of not just the FLWs but the community itself – including the beneficiaries.
A number of ideas that emanated from the discussion focused not only on capacity building but also good patient profiling. The importance of meticulous health profiling was highlighted in the development of practices to bridge the gap of variance in the skills of ASHAs. The requirement of a ‘suggestive care plan’ was also brought up to reduce the dependence on FLWs. This particular discussion culminated in the realization that beneficiaries need to ensure that they understand the criticality of their own problems. A few questions were also raised – can we switch from cookie cutter care to differentiated care in a low resource setting? Can we explicate the transformation of the incentive-based ASHA system to one that is aligned with a market system?
Another critical outcome of the session was the importance of interventions in the feedback system. It is essential for beneficiaries (consumers), as well as third-party observers, to be able to rate the performance of FLWs to counter inequity in an already impoverished environment. Wherever subjectivity fails, there is a need to introduce automated systems. ASHAs, it was suggested, have started looking at beneficiaries as mere numbers. The incentive structure is based on the number of blocks of patients covered, which completely ignores patient-centric care and promotes the cookie cutter approach. FLWs have lost the interpersonal touch because of hectic work schedules and seem to follow a pattern. When a pattern is followed, Mr. Lysander Menezes added, they (FLWs) may ignore distinct cases and that is the inherent problem with cookie cutter care.
There is a need to track each woman as an entity on her own. However, there is noÂ explicit demand from a beneficiary for tailored healthcare – primarily because of the existing power dynamics. The fact that a beneficiary looks at an FLW as a superior demotivates them to demand better care. During the discussion, however, a realization occurred that the group was looking at the problem of ‘leakage’, and not demand. The solution needs to be at the nexus of supply and demand.
The prototype of an integrated maternal health vitals diagnostics device was also showcased. The device can determine the blood pressure, pulse, temperature, BMI, and abdominal circumference of a pregnant lady. The basic maternal health vitals can be recorded through this device by an ASHA. It then connects to an app and presents the patientâ€™s details in a simple and easy-to-understand format.Â The data can be utilized to track the patient’s health and help in implementing differentiated care at the PHC-level.The app also provides information around care and nutrition plans, follow-up with FLWs, and benefits that can be availed from the system. This will help in building a birth preparedness plan for women.
The session concluded Â with the participants discussing partnerships that could be availed – from theÂ state-run NHRC Â to private players like the Grameen Foundation.