Innovation Working Group 4-Building Service Accountability towards Citizen Community Demand

Health! Public has taken on the mammoth task of answering important questions around maternal and child healthcare delivery in rural India. How do we create a more community driven approach to medical care? What obstacles can we foresee in centring the system around a mother’s and child’s wellbeing?

The working group was moderated by Shreya, who introduced the topic under discussion- ‘Building Service Accountability towards Citizen Communities’. The key problem identified by Bihar Innovation labs, where Shreya works as the research lead, is the absence of a feedback mechanism for patients, leaving them often uncared for, discharged before time and resulting in them being distanced from Primary Health Centres (PHCs). Another problem that has been identified is the inequity in service provided, with the local hierarchies guaranteeing services to the more influential members of society. Lastly, villagers look to PHC’s only for basic medical facilities- safe deliveries, basic medication and vaccinations.

The Bihar Innovation Lab has chalked out solutions and has put them out to the group to bring in a diverse set of perspectives in the room. Our participants included Anna Schurmann a public health consultant, Dr. Prashant Jha from the Standford India Biodesign, Ms. Priyanka Mukherjee from CEDPA, Neeti Bandodkar from Dasra, an ensemble from the medical fraternity, public healthcare, maternal wellness and the education sector.

Dr. Jha has concerns about the rewarding system that has been proposed as an intervention in the delivery system. The public dashboard, displaying village statistics, and  could result in low morale and incentivizing the role may not be the best way forward. He supports positive reinforcement likening the local champions concept to what Ponds, Lakme and other brands did in the world of beauty- using Indian models themselves.

Schurmann feels that the distribution of power could sway. Priyanka provides interesting input from the field- that women don’t go in for institutional deliveries. However, 91% of lactating mothers have access to telephones, using technology to understand women’s understanding of healthcare facilities, their preferences of the private or government hospitals is the way forward. Another attempts is around sensitizing men to women’s issues through similar calls on the dialling deck. The deck offers a gamut of information via this telephone line.

Dr. Jha on visits to Haryana doctors offices noticed a services a charter-this is a good practice in almost every PHC. But how is this data being used? Unfortunately the data isn’t being greatly used- the boards are almost redundant since most people are illiterate. Once again reiterates positive reinforcement. How to avoid being the enemy from beyond home lines and the agency stands the risk of being undermined. GOI proactively working towards quality assurance cells, look at PIPs of the state. A huge missed opportunity is the CRNs – there is an existing mechanism but isn’t used across all states- [ensuring quality of case]. Neeti, drawing a parallel from the education sector, draws on the Sarvashiksha Abhiyaan, an outcome of the Right to Education, where a body exists for review of school functioning, maintenance and is a grievance facility.

Dr. Jha narrates another BCP of Haryana that improved attendance of employees in every PHC through video cameras. Do doctors need an incentive to do their duties asserts Priyanka. Anna agrees, in TN the facility information system-an e-health case study. Dr. Jha says that doctors, often alien and on duty in PHCs in this rural set up, have to fill sheets and handle MIS systems. Innovators keep bringing in this feedback mechanism but that won’t guarantee a positive outcome always and doctors are often displeased with this.

Deepshika intervenes to bring the discussion back on track- focussing their energies back on the proposed solutions.

Local Champions

Who is going to fund them, take the pictures, manage the local champion scheme? What about invasion of privacy? These are Dr. Jha’s main concerns. Priyanka offers the idea of making celebrity mascots- known figures with mass appeal to champion the cause and localizing this could also work out great. But another social challenge arises- What about the ethical dilemma this poses where girls picture posed across the village could anger the family? Radio announcements could be a safer alternative.

A possible drawback is the need to pick from castes, class, religions to keep the community happy and not threaten the good samaritans- need to understand the sociological impact of this.

Community Health Dashboard

  • Infographics along with text
  • The idea works- but how to guarantee
  • Deepshika- rural hotspots- primary schools, tolas, temples for upper castes- not a blanket solution
  • Data collection could get messy and time-consuming- in case of quantitative feedbacks
  • Make the dashboard dynamic and disseminating information- funding and maintenance issues
  • JSSK-MoHFW- mobile van
  • Breakthrough- organization- child marriage- nukkad natak, holographic images, movie screenings
  • Dashboard could also present data collected from the feedback

Dr. Jha also pipes in with another BCP of a PHC in Haryana-declared as a model PHC, where the doctor takes residence as well. The PHC hasn’t used government funds in the last ten years, the villagers themselves have contributed and it is community owned PHC. A similar model in Chhatisgarh and in another village near Bokaro. Leadership from within the village community can spearhead this.

A challenge faced, even with the revamp of the PHCs and delivery system is that mothers also use PHCs only if they know there are no complications in the pregnancy. Deepshika brings in her perspective of working in the education sector in Read Alliance. Are we looking at the right criteria for the evaluation of the success of the system? Community can’t judge technical proficiency, only service delivery. Perceptions of facilities are also different and almost always rate high always except in the case of maternal deaths. Priyanka, referring back to Jharkand success story of calling anonymously into a helpline/info-desk.

Create a communications platform with toll-free calling via technology partners- Airtel, JMK, GSKI. Simple enough for the rural masses to understand. Another option is also to implement a centralized system for tracking mothers-MCTS system which records vitals of the mother and appears on an app on the doc phone. This could be a tool for community case management for the community.

The suggestion for an anonymous messaging system Not a public machine, but an anonymous messaging system. What do we do with the feedback? Are we increasing MO risk with angry patients- already isolated- vulnerabilities in case of safety? Or will it just remain a wall to vent

BIL Involvement

Partner with GVK, Airtel, BSNL- telecom companies with a CSR budget to implement the pre-recorded message for calling.

Unilever to disseminate information through products

Where else? BIMARU-EAG (Empowered actionable groups)

Actionable Steps for BIL

Case studies: Look at Best Case Practices of similar maternal healthcare delivery systems across the world

Evidences: Similarly look for evidences of similar technologies being implemented

Start small: Test the delivery system in a small area and scale up based on success and feedback

Identify partner organizations- banking institutions, telecom and FMCG companies

A positive outcome from the session was the promising offer by CEDPA to collaborate on raising awareness of the delivery system along with BIL.

This entry was posted in Design!publiC. Bookmark the permalink.

Leave a Reply

Your email address will not be published. Required fields are marked *