Grand Challenges Breakout Session: Quality Maternal and Child Healthcare

The Challenge
Statistics indicate that maternal and child health in India is amongst the poorest in the world. India has over 50 percent of the world’s undernourished children, especially under the age of five. This situation is hugely problematic but also easily preventable, by providing better services and better dissemination of knowledge and information, and by ensuring that quality healthcare and nutrition is provided throughout pregnancy. Moreover, more accessible and affordable medical services should be made available to women in rural and semi-rural areas to ensure proper care throughout pregnancy as well as during and after delivery. The Ministry of Woman and Child Development has initiated several programs over the last five years to overcome these problems, but the situation persists despite these attempts. This session is an attempt to brainstorm ways in which innovation and strategic redesign of these programs and services can help create effective solutions to this grand social challenge.

The Field Research
A team consisting of CKS design researchers and other research volunteers conducted a short field research of ante-natal healthcare services in semi-rural areas in order to gather information on the existing situation in a semi-rural area near Bangalore. This will help place this workshop in a real-world context and therefore direct and focus the brainstorming session and solutioneering attempts of this immense challenge.

The team visited a village called Chandapura, situated in the semi-industrialized taluk of Hosur, an area close to the city of Bangalore. There, they explored the various maternal and child healthcare services in different government and private clinics, with an aim to understand the existing services and the challenges therein. They also wanted to gain an understanding of both the beneficiaries’ as well as the service providers’ perspectives on quality ante-natal care, their expectations, actual experiences of the existing services, and the challenges they face in either receiving or providing these services.

They also wanted to map the existing health services available, and the various perceptions of the benefits and challenges of each. In addition, they wanted to gain a comprehensive understanding of the kinds of facilities and services offered by each, the lacks therein, and the system and network of referrals that is necessitated as a result.

The main focus in their investigation was on the gaps in the delivery of the services to beneficiaries. This is especially the case because of the lack of sufficient health services — there is a greater demand on the system than there is supply.

Interesting Insights
The team began by mapping the various health centers in the area, while seeking to understand any perceptions of quality differences amongst the different kinds of clinics. These tend to be three-fold: field healthworkers who live amongst the community and often offer at-home services, public or government clinics, and private clinics. They found that beneficiaries tended to view public clinics as more affordable but offering lesser quality services, while private clinics are seen as better equipped, offering better quality healthcare, but being less affordable. Field healthworkers, on the other hand, are seen as being sometimes less knowledgeable, but are always more trusted as they are actually a part of the community.

This means that the level of interaction and communication of the beneficiaries with the field healthworkers is often more deep and personal, as they are comfortable with these healthworkers. In public clinics, beneficiaries seemed to feel that the services were sometimes inadequate and run-of-the-mill, with insufficient personal attention. Beneficiaries who went to private health clinics tended to always be accompanied by their husbands or other members of the family. There, however, doctors and other service providers were found to be more accomodating and would provide more personal attention to the patient.

Possible Solutions
– More education to increase awareness about the facilities and services offered
– Incentives to the healthworkers
– Local government makes sure that every facility is running well, with an assurance of accountability and transparency

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