THEORY O IMPACT:

Child' centric Health and Well-being EcosystemSelf, Home, Community and Institution Based Care across the 1000 day window

HEALTH!PUBLIC

TOKEN NO. 22

ORSORS

PRE DELIVERY DELIVERY POSTDELIVERY

SUBSIDISED FOOD

Insulated material

The beneficiaries should be called at fixed times according to the vaccine that has to be administered to them. In this way, the ANM's working is more e�cient, which in turn saves the beneficiaries' time, and time-based vials are not wasted.

A diagnostic device that auto-flags criticalities and shows health profile and vitals progression for the ANM to provide patient responsive care and advice.

to keep children entertained.

The VHSND site can have a permanent ORS dis-pensing machine, which works with MCH id. The machine dispenses ORS upon scanning the code on the MCH card. This way, the system can track the number of children who were ill because di-arrhea and the frequency of the same. Subse-quently, the ANM can counsel families based on their child's health record.

Tea and lunch for mothers and pregnant women to enhance nutrition intake at least on R.I. days

hearing device as an experi-ential tool to make the par-ents feel the connect with their child, to make the con-nect between the nutrition of the child and the mother even stronger.

to keep beneficiaries engaged, which could also edu-cate them on simple things like nutrition, sanitation, hygiene.

Seating that can be pulled down from the wall as tem-porary structures.

A mirror to encourage tracking of the growth of the stomach by pregnant women. This could be an engag-ing activity to keep mothers occupied while the ANM is busy with other women. It could also store the marking at di�erent ANCs to gauge growth and au-to-flag criticalty.

1. Token system for managing the inflow of beneficiaries.2. First come first serve, card piling system, to ensure fair service delivery.3. If families are aware of the danger signs in preg-nancy, they can be allowed to demand to be seen by the ANM first. With this incentive, beneficiaries will make an e�ort to remember the danger signs upon and know when to seek medical attention.

BATCH SYSTEM FOR MOBILIZING

VILLAGE HEALTH SANITATION & NUTRITION DAY

PRIMARY HEALTHCENTRE

FEOTAL HEART RATE

INTERACTIVE MIRROR FOR PREGNANCY TRACKING

FOLDABLE SEATING

WAITING-TIME GAMES

CROWD MANAGEMENT

DIAGNOSTIC DEVICEORS DISPENSING MACHINE

PLAYGROUND

COMMUNITY MEAL

INFORMATION POST-VACCINE

CONTEXTUAL VHSNDSTRUCTURES

Religious shrines in the PHC.

Waiting room space can be converted into an ad-hoc delivery space in case of emergencies in peak delivery seasons.

Existing waiting room Existing waiting room Existing waiting room

Collage of images of mothers who had healthy deliveries in the PHC to inspire confidence among families coming in and to motivate women to take good care of themselves.

Incubator that doubles as a weighing machine and a baby warmer and is por-table from the delivery room to the NBCU.

PROMOTING SQUATTING BIRTHING BEDSDesigning context relevant, possibly using local materials, squatting birth-ing beds / contraptions for a better posture and ease in deliveries.

Encourage use of Solar Lighting in Healthcare facilities.

Incubator that doubles as a weighing machine and a baby warmer and is portable from the delivery room to the NBCU.

COLOSTRUM FEEDINGMa ka pehela gadha dudh bacche ko jaroor pilaye, bacche ki swast aur khushaal zindegi me ek aur kadam badaye.

Communication on the PHC walls, or in the waiting room, for families to understand the criticality of spending time at the facility after delivery by telling them exactly what needs to be done for the good health of the mother and child.

The PHC should have waiting rooms for ASHAs, as they currently have for ANMs and Doctors, to make the space conducive for ASHAs to get pa-tients at late hours.

Canteen in the PHC that provides subsidized food for FLWs.

NEW BORN CARE, CLOTH DRIVE, a system of providing families with sanitized cloth to wrap the new born around immediately after the delivery. For every sterilized cloth, the family has to contribute a piece of cloth themselves, which will then be sterilized to replenish the stock at the PHC.

Beneficiaries can be given audio recordings to make them stay post-vaccine for the ANM to observe potential side e�ects. The recordings give health information relevant to beneficiary’s profile, the intent and side e�ect of the vaccine, sanitation and hygiene information and counselling on family planning.

Use of local/waste material to build interesting structures as VHSND spaces in villages. The involvement of village people in building the structure will enhance the level of connect the people have with the activity. At other times this space can be used as a community centre for fathers, MILs, FILs, etc.

Imbalanced Hierarchies between the Service and Beneficiaries

'Building Service Accountability towards Citizen Communities’Creating structured feedback loops that allow citizens to rate public health services and demand equitable, transparent and higher quality service

COMMUNITY FEEDBACKfor better decision-making to improve service quality

ASHA

1 2 3 4 5

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Anonymous grievance redressal and direct feedback from beneficiaries, by repeatedly polling through their mobile phones / public polling machines installed at village level.

KISHANGANJ

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Poor quality of services

Good quality of services

BELVA PHC#2 PHC in Kishanganj

public votes in favour of service1 2 0 5 4

PHC

Sadar

VHSND siteHome visit

Real-time community controlled audits, ratings and performance tracking of public health services, synced with Village Health Sanitation Nutrition Committees / Self Help Groups. Creating a board to showcase the same will define the quality and acceptance of the services of the PHC at public level.

PUBLIC DISPLAY OF COMMUNITY RATING OF SERVICES

Rate the quality of service and the performance of service providers:

- Freq of interaction- Politeness- Patience- Did your problem get sorted?

Prolonged and reccurring pain in abdomen and

chest

Detection of pregnancy and growth of the

child

Prolongedpassing of stool

by the child (Diarhoea)

Prolongedhigh fever

Extremenausea and weekness

Extremeswelling in the calves

VaginalBleeding

C-sectiondelivery

An Incomplete loop

SYSTEM

FLW

System diretcs newpolicies, programs,protocols to the FLWsto implement and operationalise.

There is a one way interaction which does not allow the beneficiaries to put forth their grievances nor does it allow a feedbackon/review of the services received.

COMMUNITY

Ÿ The system necessitates the need for inequity– choose people for take home rations, choose whose health to priorities over others, etc. '…Hum hi burein bantein hain bhaiya. Ek ko de todusra bura bhala bolta hain. Isse achan to na hi do.'– Anganwadi worker.

Ÿ Some ASHAs/ AWWs use public health resources and facilities in favor of their own family'skith and kin, peers and socially influential community members sidelining other beneficiaries who may actually need those services more. '…Didi (anganwadi) apne logo main sab anaj bant deti hain. Humein to khabhi nahi milta.'- Beneficiary

Ÿ Class and caste play an important role in determining the attitude of the FLWs towardsbeneficiaries, thus impacting the quality of services. ‘…Muslim logon se family planning kebarein main baat karne ka koi fayda hi nahi. To hum to kartein hi nahi hain.’

Ÿ

Service Inequity:Prasav ke liyein private gayein the. Wahan sari suvidha hoti hain. Sarkari main to chotein moteinkaam ke liyein chalein jatein hain. Wahan kuch suvidhayein nahi hoti.’

The expectations with the public facilities is low amongst the beneficiaries and they either visit oraspire to visit the private facility for anything that they consider serious. As reported following arethe services that people consider going to private or public facility for:

Low Expectations

Sulekha for her first deliverywent to Sadar and had a stillborn. She could not understandthe reason for it nor was she provided with any reason for the same. For her consecutivedeliveries she went to the private facility. She had another still birth, this time in a privatefacility, however she believedthat it was for no fault of the facility but rather blamed it on her destiny.

‘….private main saari suvidhaein thi. Khoon bhi chadaya tha. Uskebaad bhi agar nahi huan to phir to upar walein ke haath main hain.'

Mohhamad hakim is a proudfather of a 3 month old girl. He does not know what the role of ASHA or ANM is neither does he understand what RI is and whathappens on that day. Wheneverthey feel the need they insteadgo to a nearby private clinic. Atone time the baby fell ill and no home remedies were working.He then decided to go to the private clinic for which he had toborrow some money from a friend.

‘…uthar lekar private jana behtar hain. Sarkari main theek se thektein hain. Na dactor milta ha na hi koi dawai milti hain.'

Avail basic medicationslike ORS, IFAand vitamin

Normaldelivery

To get vaccines

The woman reached the RI centre at 9am and was finally looked at, at 1.30pm

The woman came to RI with her husband on a bike at 11.30am.The FLWs greeted them warmly and services were providedimmediately

FLWs transfer the numbers to the PHC around the

services given as the basis for the evaluation

of her work

A non-participatoryenvironment

FLW

COMMUNITY

SYSTEM

The systeminforms and trainsthe FLWs on newpolicies, programs,protocols to be implemented.

The system responds with more e�ective policies, programs and protocols on the basis of the feedback/suggestion / grievancesfrom both the communityand the FLWs

Active inclusion of the FLWs through regular feedback and suggestion. FLW stories, personal initiatives to be accounted for performance review

Activating community to act as both demand and pressure group

The FLWs, instead of being agents of the system, become a part of the community.

A citizen-inclusive system

Radha Devi ki doosri beti paida hone ke baad unki saas Suman Devi ne apni bahu ko operation karane ki salah de ke ek swasth zindagi ki taraf kadam badhane mein madad ki.

Sabista Khatun ne pran liya hai ki apni bahu aur potey ke swaasth ki taraf ek aur kadam badhayengi.

Public pledges and success stories of healthy families shared to inspire community behaviour.

LOCAL CHAMPIONSCOMMUNITY HEALTHDASHBOARD

TARAVARIMONTHLY STATISTICS

JULY ‘14

Healthy ChildreN - 30MalNourished ChildreN - 15Weak Mothers - 05ChildreN who died - 01Mothers who died - 02ASHA rouNds - 05VHSNDs - 03Diarrhea cases - 08ORS packets distributed - 40

Self Help Groups to maintain maternal and child health community records and hold public audits of services based on the performance.

Every month, the Self Help Group / Community representatives can have a meeting with the Service providers (Block Health Managers and Medical O�cers in Charge and present their findings to demand better care where required.

We demand re-election of the

ASHA! We demand better post-partum care for

mothers

During RIs, “Late come first serve” is not uncommon when some beneficiaries are more socially or financially influencial than others as they are provided services first.