Under the Bihar Innovation Lab initiative, the Center for Knowledge Societies, together with the Gates Foundation, plans to kickstart its four principal innovation projects in rural Bihar. These are focussed on developing the healthcare delivery scenario in terms of products, services and systems. One of these four projects focuses on revisiting the use and impact of a labour progression monitoring tool known as the Partograph.The Partograph is paper-based tool that helps health workers record and monitor the progression of labour in terms of critical information such as foetal heart rate, cervical dilation, blood pressure and contraction. Currently, only ANMs (Auxiliary Nurse Midwifes) and obstetricians are equipped to use the Partograph. In an ideal scenario, the tool assists the health worker in accurately assessing the labour condition and taking timely decisions in the case of complications. However, WHO research states that, in spite of its life saving potential, this tool is not being used extensively mainly because of its cumbersome user interface. Even the simplified version introduced by the WHO has not been accepted by many health workers. Hence, there is a need for a design intervention to address this issue.
In this regard, I joined France Donnay and Debarshi Bhattacharya from the Gates Foundation, along with other experts from CARE India, to conduct a two day visit in the remote district of Khagaria in Bihar. The objective was to get a preliminary understanding of the Partograph usage and its challenges that would help us shape our further research and develop directions for innovation. During these visits, the team surveyed various Primary Health Centers (PHCs), district hospitals and private maternity clinics, where we interacted with the staff and health workers who carry out the labour management activities at these facilities.While our initial presumption was that the challenge lay in simplifying the user interface of the tool, it was also imperative to look at the overall labour management ecology in a rural setting in order to understand its users and the context in which the tool is being used. Such a systems thinking approach led us to identify the challenges of the Partograph which were beyond just the user interface and related to the entire gamut of the labour management reality in these remote areas. Through our conversations with the healthcare practitioners and observations made at these maternity facilities, it was evident that while there was a clear understanding of the value of the Partograph amongst the health workers, larger challenges with labour management were hindering the use of this tool. Some of these systemic challenges included limited human resources, under-trained paramedical staff, inefficient labour traffic management, and a lack of infrastructure such as limited ambulances and bed capacity.
Faced with such fundamental challenges and a lack of any set labour management protocol, health workers struggle to manage the heavy traffic of labour deliveries on a daily basis. In such a scenario, the Partograph, with a cumbersome and time consuming interface, is essentially coming in the way of labour management as an additional task rather than assisting it. This holistic approach to the problem allowed us to take into consideration all the factors surrounding the Partograph rather than just looking at the tool in isolation. Eventually, the goal is to re-invent the tool so that it blends in with the work process and environment, making life simpler for the healthcare providers as well as the beneficiaries. With many ideas and possibilities in mind, I am looking forward to be back on field in Bihar soon to see how this project turns out.