This post is long overdue. Ive been caught up with the madness that trails behind deadlines, mundane activities like getting my driving license, visas etc. In the midst of all this thankfully, I managed to have a chat with Aditya Dev Sood,  Founder and CEO of the Center for Knowledge Societies (CKS). CKS is an innovation consulting firm based in Bangalore, India.

How CKS began – Aditya Sood came to back to India from the States, after studying Architecture, Critical Theory, Sanskrit and Anthropology, amongst other things in 1999, when the Dot Com revolution in India was just about turning into a raging bull, much like the Silicon Valley in the West. As most of these things go, it got Aditya thinking about Information, Communication and Technology and most importantly how these resources can fuel the local ecology and economies. One thing lead to another, and CKS was born. Aditya, while travelling through the country, had collected photographs of village information kiosks, showing how people were clustering around computers. These pictures were noticed, and he was invited to talk about how to use technology more effectively in a non profit world, at The Doors of Perception conference in Amsterdam in 2002. The next couple of years, from 2003 to 2007, were spent in the realm of mobile services and telecommunications. A lot of time was spent researching and studying street technologies and how they were used here in India. All this, while still thinking about the deep and large question of how to design for our economy and ecology. Interrogating and understanding these principles have made up the core DNA of the company.

In 2009, CKS diversified its portfolio and made a bold foray into the world of financial, medical and health services. With a grant from the Bill & Melinda Gates Foundation (that is in the forefront of applying innovation to the social sectors) and in partnership with the Government of Bihar, CKS took on the Innovation for Improved Maternal and Child Healthcare (IIMCH) study, the outcome of which are the 34 ways to save a life that provides solutions as identified by its antecedent,the Vaccine Delivery Innovation Initiative (VDII)

From the report - (Context of the study) – The northern Indian state of Bihar is witnessing rapid change today. It is the fastest growing state in India with an astonishing 10.5% growth rate (CSO, 2010-11), in comparison to the national average of 8.6% (CSO, 2010-11). This is a major leap from 6.3% recorded in 2009 (Economic Survey 2008-09). Bihar has, thus, come a long way from the morass state it was in about a decade back, with growing promises for the future, but not without its own set of challenges.

One of the most critical challenges that the state encounters today is in its health scenario. Being the second most challenging state as far as health care service delivery is concerned, Bihar today, cannot afford to tread the traditional developmental path of continuous roll out and upgrade. Set back by at least a decade of no active development, Bihar now needs to look at innovative ways of leapfrogging a decade of little development.

Keeping with the research and innovation that CKS’s work surround, the  34 Ways to save a life special report focused on studing and developing and detailing out potential design solutions to address key challenges identified through its antecedent, the Vaccine Delivery Innovation Initiative (VDII). The main objective was to facilitate innovation in the delivery of maternal and child healthcare services in Bihar and other rural parts of India through design solutions that not only address challenges in the vaccine delivery mechanism, but also cater to related services within the broader ecology of maternal and child healthcare.

A broad array of design solutions have emerged in this report, which are presented against five metacategories:

• Managing Health Information

• Enhancing Service Delivery Infrastructure

• Improving Medical Equipment

• Strengthening the Healthcare System

• Transforming Community Perceptions

One of the solutions that has emerged from this extensive study has been the redesigning of the Vaccine Delivery Service Kit.While its currently still at its early stages of development, the kit used by the frontline health workers, to delivers vaccines to children in remote parts of the district.

The challenges address by this concept are -

• Immunization session execution and logistics
• Tracking children and work activities
• Accountability and training

Types of problems addressed-

• Unwieldy structure- Very large and heavy vaccine carrier box, making its transportation and handling difficult.
• Space and function- Carries only vaccine vials irrespective of its large size, and has no provision for incorporating other components (e.g. syringes, needles, hub cutter) that need to be transported to the immunization session site.
• Safety issues- Difficulty in cleaning and maintenance of pockets provided for ice packs lead to formation of molds. No provision to carry cotton, disposable needles and syringes, leading to unhygienic practices and disposal methods.
• Temperature control- Melting of ice packs owing to improper freezing, large distances of transportation from the cold storage and lack of provision for refilling poses potential threat of spoiling the vaccines. Handling of the vaccine vials using sweaty hands also poses a challenge.
• Potential for institutional branding to build recognition, credibility and empowerment remains unexploited.

The existing vaccine carrier box can be judiciously redesigned to incorporate multiple functions such as storage of RI paraphernalia, easy transportation and collapsible work surface.

The RI kit here is designed in the form of a briefcase, with adjustable straps to provide flexibility to the ANMs to carry it either on their shoulder or back. Alternatively, the RI kit can also be designed in the form of a roller bag, provided with wheels and telescopic handle to allow easy mobility. It also has shoulder straps for the ANMs to carry it on their backs on rough terrains.

Multifunctionality is the highlight of the concept, with storage provision for registers, disposable syringes and needles, cotton, Vitamin A bottle, and medicines, in addition to vaccine vials. The extensible tray acts as a work surface for holding vials and other paraphernalia while in use and as a writing surface support. Incorporating technological features such as an information display screen and smart card reader could help in improved session execution.

Characteristics creating potential value

• The compact form with its smooth rounded edges adhering to the shape of the body, enhances its ergonomics. It would also help in easy stacking, enabling courier men to carry more than one box at a time.
• Accommodating all required paraphernalia for vaccine administration and record keeping, as well as providing work surface in the same box would improve its functionality. Color-coded vials would allow easier identification of vaccine types. This would help in resolving the challenges around equipment management, enabling smoother work flow.
• Replacing ice packs with materials such as PCM would reduce space wastage as well as help in easy cleaning and maintenance.
• Integrating the hub cutter and compartments for safe and easier disposal of needles, syringes and vials ensure effective waste
management.
• Use of innovative materials such as Phase Change Material (PCM) provides insulation to the vials and constantly maintain them at the desired temperature range of 2 to 8 degree Celsius. Provision of an outer case to hold the vials prevents direct contact with
person holding the vials, and contributes towards maintaining the temperature intact.
• Additional features such as information screen displaying the names of due recipients and vaccines due could aid in easier tracking of children, and faster vaccine administration. Incorporating smart card reader would make data entry faster and error proof, and also provide an in-built feedback mechanism by tallying due recipients with recipients administered vaccines at the end of every session. This would generate better accountability.
• Branding the RI kit (e.g. NRHM logo) would create improved recognition of the services provided, impart a professional identity to the ANMs and make them feel more empowered.

One can read the full 34 Ways to save a life report here.

All images from the 34 ways to save a life and the Vaccine Delivery Innovation Reports by CKS.

A big percentage of indian village population is illiterate. Traditional mode  of transmitting news like newspapers are not effective for that demographic. Television as a medium to disseminate news are not effective in villages either because of unreliable electricity as well as the cost behind purchasing a TV unit. Transistor radios have been a cheap and accessible way of news dissemination for a long time now. However with mobile technology making its way into the heartlands of rural india, a project like Gaon Ki Awaaz was waiting to happen. Gaon Ki Awaaz is India’s first mobile news service. The service targets rural india.

The reports are transmitted in the local dialect which is Avhadi. The subscribers need to answer their phones in order to hear pre-recorded news messages. The news is related to local events happening around the village or villages close by, making the information relevant to the subscriber. Subject matter for the broadcasts can include other useful information like farming tips, healthcamps and government announcements etc. A news bulletin like this would hold the villagers attention and inform them about the happenings in and around their village.

The news is broadcast twice a day, at noon and 5pm. The village reporters record the bulletins which makes it way to the local editor and is then converted by the founder of the service into .wav files. These files are then sent to Netxcell, a company in Hyderabad for broadcast. The file is then sent out to the numbers of the subscribed villagers in the database.

The program is available to the villages at a nominal subscription cost of Rs 30 for three months. The other costs being MMS equipped phones for the two reporters and the local editor that cost about $100 each and the monthly broadcast fee. The number of users is over 250 subscribers and has spread over 20 villages. The project was launched by Sunil Saxena who is also the dean of International Media Institute of India and Satyendra Pratap, a journalist from Rampur.

The service is trying to bring in some revenue by using advertising which will be played in the beginning of the transmission. The plan is to start local advertising from agricultural companies and services that could actually benefit the user in the long run. According to the Gaon Ki Awaaz blog, the local village barber, tailor, internet cafe operator, coaching center owner and the village astrologer have advertised their services. In the true spirit of present day technologies the future plan is to make this service interactive by allowing the subscribers to not only receive news but also submit news updates. These updates would be then vetted by local editors and then added in to the reports. The idea is to enable the villagers to create an ecosystem of citizen reporting and generate reports relevant to them.

Recently Gaon Ki Awaaz was awarded the Manthan 2010 award in the e-news and media category. The project also won the mBillionth South Asia award in m-News and Journalism category last year. The future plans for the service include creating a self sustaining model and scaling this social venture by raising more capital to gear up for rapid growth to reach millions of villagers.

Also check out how ‘Gaon Ki Awaz’ is produced – Video

Primary health centers are the cornerstone of the rural health care system. In 1991, India had about 22,400 primary health centers, 11,200 hospitals, and 27,400 clinics. These facilities are part of a tiered health care system that funnels more difficult cases into urban hospitals while attempting to provide routine medical care to the vast majority in the countryside. Primary health centers and sub centers rely on trained paramedics to meet most of their needs. The main problems affecting the success of primary health centers are the predominance of clinical and curative concerns over the intended emphasis on preventive work and the reluctance of staff to work in rural areas. -(Source – Wikipedia)

This is where the Low cost self-diagnosis tool comes in.

Winner of the International Design Excellence Awards 08 (http://www.idsa.org/IDEA_Awards/gallery/2008/award_details.asp?ID=35918307), this is a mechanical self-diagnosis tool was created to help patients in rural India capture symptoms and provide them basic information about their disease. Made with recycled materials to maintain low costs, it aims to empower patients and aid doctors with accurate diagnosis and efficient recovery throughout the rural parts of the country.

Designed at Honeywell Technology Solutions in Bangalore by Ankur Sardana (NID) and Parag Trivedi (IDC), this tool displays relevant information. With simple rotation of rings & mapping on the chart, the tool provides -

1. Criticality of disease, basic suggestions (like – ‘how soon to meet the doctor’)

2. Kind of diagnostic tests would be done on them (this is based on the research finding that the villagers are quite suspicious of blood being used for testing & also unprepared for the expense which tests might require)

3. Cases in which they should meet a specialist directly instead of going to a general practitioner

4. Information & contact numbers of healthcare providers

The tool consists of a set of Rings (symptoms), a disease chart & other information. These rings could be made of cheap but durable cardboard. Each ring has set of symptoms. The patient rotates the rings (starting from smallest) & chooses his symptoms by bringing them in one line, below the marker. Each symptom has a number printed on it. The user maps the disease code (set of numbers, 1 from each ring) on the chart. The chart provides tentative result –disease name, severity, next steps, diagnostic tests required to confirm disease, doctor they should meet (i.e. which specialty) & contact information of doctors &hospitals. Made out recycled plastic/cardboard, it is easy to be produced locally in the villages.

The low-cost self-diagnosis tool was born out of the need to provide rural Indian patients with a method to help themselves. Healthcare has not been a priority of rural dwellers in India & they have been used to taking ‘over the counter drugs’ or getting quick relief in the form of a steroid injection from the unregistered medical practitioners- URMP’s (in villages there are usually no qualified doctors). Though an immediate solution, it is not a proper one, disease symptoms resurface & the patient is rushed to a proper registered doctor in the city, who now administers an emergency case where it could have been a case of normal diagnosis. With the tool, the rural dwellers can be empowered with basic knowledge about their disease & can avoid the mistreatment by URMP’s. This tool can also be used by NGOs (non-governmental organizations) and self-help groups (in cases of illiteracy) to increase awareness & help make disease symptoms more understandable to the patients. There is also a mutual benefit for healthcare providers and patients. The patients save the money and side effects of self-medication and time, while the doctors have increased inflow of patients and thus more usage of their services.

Currently, in its present form it has not been tested on a large-scale. Most of the feedback has been gathered from the villagers. The educated villagers usually becomes excited, as they understand that they can get empowered if they have some idea of what disease they have. What has been tested in the field (in UP) is a variant in which there are no results, just collection of symptoms. The results have been mixed. Literacy is by far the biggest problem.

While this tool doesn’t aim to act as the messiah of the rural health care problems in the country, it certainly is a step in the right direction. One hopes that it inspires other creative practitioners and problem solvers to delve deeper into this space. It certainly needs more such social innovations.

For more information about more the tool, contact: Ankur Sardana: ankur.sardana@honeywell.com

More on Honeywell at – https://www.honeywell.com/sites/htsl/

The head of IDEO, a design and strategy firm based in Palo Alto, Tim Brown talked about Aravind Eye Care Hospital in Madurai in a recent interview with socialedge. The lesson he learnt on his trip to India was – “By trying to serve those who have the most needs, you can end up being truly innovative, to a point where those innovations have relevance not only in the developing world but in the developed world also.” Aravind Eye care has an systems approach to eye care very similar to Edisons holistic concept of electric power delivery (as per an ideo document on design thinking).

A detailed look at the systems approach of Aravind Eye Care