Our public healthcare system, all its policies, programs and designs, seem to be targeted primarily at the mother and the child- the end beneficiaries at whose welfare the system is aimed. While this way of thinking and designing may seem to be effective in tackling the challenges of mother and child healthcare, there is before us more than enough evidence to indicate that the hoped for results are not being achieved. The problem, some may say, lies in the way the system is structured. While that may be true, it is not a reason for failure. It is the context, and the solutions and interventions we create must be designed for the context, not in spite of it. If it is the latter that we are doing, we are fighting a losing battle.
Going by the principles of the user centric approach, the beneficiary must indeed be placed at the centre of our interventions and designs, as the public healthcare system seems to be doing presently. What the current system is not doing, or rather not seeing, is the context and its related conditions, in which the mother and child exist. The family, the community, the agro-economy, the emissaries of the healthcare system- private, public, formal and non-formal, all make up the system (or the context) of which the mother and the child are parts. Each of these stakeholders impacts the decisions taken by the woman for her and her childâ€™s health, influencing not only her access to nutrition- in the form of food and medicines- but also her perceptions about the foods and services provided to her. So while the ANM usually steps into the picture after the detection of a womanâ€™s pregnancy, her mother-in-law has been a dominant presence since the woman got married. Imparting information to pregnant women only through the ANM, disregarding the role of the mother in law and other senior women of the community is a mistake on the part of those designing healthcare systems.
Fortunately or otherwise, the way we are structured as a society, the woman and her child are placed at the bottom of a deeply hierarchical power structure. Her access to food is often decided by her husband who is seen as the primary breadwinner of the family, and quite literally, responsible for bringing home the bread (or the veggies, milk and meat). The decision on what the husband will bring home is taken chiefly by the matriarch of the family, the mother in law. The information and services created for the benefit of the woman by the public healthcare system are accessed by her through these two people- the mother in law taking decisions,Â and the husband planning the financial and logistical side of things.
There are two ways of addressing these problems at the core, and they must both be applied if we are seeking more efficient and effective solutions for mother and child nutrition. One is to work towards a more equal social structure, ensuring that a large group of the population is not dependent on others for the most basic and crucial decisions about their health including what food to eat during the times when their health is at its most vulnerable. Utopian as it may sound, empowering those at the bottom of the ladder is not only a preferred ideal, but also crucial to the health of the people we direct our interventions and resources at. The second method, which is to work taking into account the existing structures and design our interventions to include the stakeholders responsible for the decisions impacting the mother and childâ€™s nutrition.
It is keeping these two principles in mind that the team at Bihar Innovation Lab has designed initial concepts for mother and child nutrition services. These are designs for services that take into account societal inequalities and work through them to improve the woman and her familyâ€™s access to nutrition resources and services. These concepts also demonstrate how it is possible to design systems and services that allow for greater agency by those at the bottom of the societal power ladder.
We would like to add more ideas to this stream of thought and design, in order to design systems that are not only more efficient and effective, but also address the structural problems in our social systems.