Immersive research and interdisciplinary solutioning to combat high under 5 years old mortality rates in Bihar, India from a social lens.
THE CHALLENGE
• Identifying social factors that impact the health of low-income populations in India.
• To design interdisciplinary solutions to address vulnerability in areas of high infant mortality.
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THE SOLUTION
Solutions across product design, information design and low-tech interventions prototyped to address varying risk factors in the home and health facilities.
Population: 32,73,127
Under 5 Mortality Rate: 97 (per 1000 live births)
Children under 5 years who are:
Stunted: 52.1%
Underweight: 47.0%
Wasted: 20.8%
DEMOGRAPHY
Bihar is a state in Northern India, which has extremely high rates of children who are at a mortal state before reaching the age of five. Purnia is a small district in Bihar where we traced social vulnerability of children.
FOCUS OF BEYOND FIVE
FRAMEWORK
The state witnesses mortality due to unrecorded episodes of repeat illnesses. The clinical systems are underequipped to capture that data.
*Diagram designed by other members of the team
Concepts
1. DEMARCATION OF SAFE SPACES
DIY design of a culturally adequate Cradle for the first 12 months after birth.
Risk Factors
MATERIAL POVERTY
Acute lack of resources due to low annual income or prolonged sickness in the family.
DESIGN IMPLICATION
Frugal, locally sources/assembled
TIME POVERTY
Absence of >1 caregiver due to migration or long working hours with the dependency of multiple members.
DESIGN IMPLICATION
Can be manufactured quickly
ABSENCE OF ACTIONABLE CONCEPT OF HEALTH
The families believe they are under-equipped to provide for the child or don’t see the risk.
DESIGN IMPLICATION
Elevated/suspended to avoid proximity from playful siblings/vector-carrying animal
Installed away from source of smoke in the home
Prototyping
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Repurposing local material/products
Prototype &
weight test
Usability testing
Installation and Uptake
Designing a celebration around the installation of the Cradle
to engage multiple caregivers to form a 'Circle of Care'. The parents procure the materials that are assembled by the relatives and decorative elements are added to celebrate the birth.
Final concept
The suspended cradle marks a safe space for the child, protecting them from vector diseases from animals, insulating them.
Every element of the Cradle is co-assembled with the family members, each reciting the responsibilities they undertake towards the child while adding their element.
DIY blueprint
Adornments added by relatives
Decorative fabric added to make the cradle celebratory
Cradle installed in a high-visibility area away from sources of smoke
RESULTS
The celebration was replicated across villages to introduce the practice of demarcating a safe space for infants. Depending on the availability of materials, people alternated between materials while maintaining the purpose of the features.
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Mother sewing scrap fabric to a woven mat
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Mother strengthening the jute to suspend the cradle
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Version 2 of the cradle using the blueprint
2. KNOW FAMILIES,
KNOW CHILDREN
Paper-based triaging tool to visually communicate the family archetype and illness history to doctors.
Risk Factors
45 SECONDS LIMIT
There is one doctor for every 17,685 persons in Bihar. This restricts each interaction to be about 45 seconds which is not enough to go over reports and dig deeper into the symptoms.
DESIGN IMPLICATIONS
Visual and triaged depiction of symptoms and illness history.
ILLNESS HISTORY
Families do not link the different episodes of child illness and do not understand the compounding and health deteriorating effects of illness.
DESIGN IMPLICATIONS
Visual patient history for a comprehensive diagnosis.
FAMILY ARCHETYPE
Different families have different capacities to adhere to the doctor's advice. For eg, prolonged sickness can cause time poverty among the caregivers.
DESIGN IMPLICATIONS
Diagnosis is compatible with family's capacity to provide care.
Enabling health providers to better grasp the severity of illness through a pre-filled visual case sheet.
Final concept
PAGE 3: DIAGNOSIS
Two-step case sheet designed in black and white on A4 standard sheet size to ensure accessibility and cost efficiency.
PAGE 1 : FAMILY ARCHETYPE
Six questions about their family dynamics, finances and resource availability to deduce family archetype.
For eg, a family with absent father and many dependents would suffer from time poverty and hence cannot indulge in time consuming treatments.
Inquiring about illness history in the last 3 months.
Checking for current symptoms.
Checking for symptoms of the 3 most prevalent illnesses: Pneumonia, Diarrhea and Malnutrition.
PAGE 2: SYMPTOMS & ILLNESS HISTORY
RESULTS
This tool was piloted in the hospital in Rosera district of Bihar. Some doctors and paramedics said that this added a few questions that they were not previously asking. While that increased work load for the paramedic, the doctor's consultation was more efficient.
3. ACTIONABLE
CONCEPT OF HEALTH
Camera based app to visually establish missing links between environmental risks and poor health outcomes.
Risk Factors
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UNCOVERED FOOD
As obvious as it may be, uncovered food is a common sight, making it prone to contamination.
DESIGN IMPLICATIONS
Establish the ill effects of uncovered meals and what happens when you cover it.
INDOOR SMOKE
It is common practice to light fire for cooking or warmth inside the house, subjecting the child to smoke.
DESIGN IMPLICATIONS
Establish a safe distance for child.
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UNCLEAN HANDS
There isn't enough emphasis on washing hands resulting in many food-borne illnesses.
DESIGN IMPLICATIONS
Establish what dirty hands mean and how to clean them.
Final Concept
Animated and annotated GIFs superimposed on the surroundings to visually establish risk factors. Tap on it to explore redressal which shows shielding practices, and the third frame gives affirmation of positive behaviour.
Visual language is representational, to literally and clearly depict the messages.
UNCOVERED FOOD
INDOOR SMOKE
Move away from the flame till it fits completely in the green frame. This helps manually establish a safe distance from the smoke.
UNCLEAN HANDS
A Prototype Fair was conducted at the Bill & Melinda Gates Foundation in Delhi, India to present these concepts to several stakeholders like CARE India, M4ID Finland, local health workers, government health department, etc. for further development through collaboration.