4 Years for a Bachelor’s? Who’s Got the Time? – The Chronicle of Higher Education

The tension between service provider universities keen to keep students paying fees longer, and students keen to get out sooner has seen many changes to the old 5 year degrees. Architecture dodged the bullet and remade itself into a 3+2, but all other creative arts programs were cut to 4.

Years ago, I spent 5 years to get my bachelors in mechanical engineering. Possibly better spent doing other stuff. I then spent 2 and a half years doing a design degree. If you add to that the 5 years it took me to get my PhD – I have been a fee paying student for a glorious 12 years. If I start from school that’s a total of 23 years of academia. At a moderate contemporary fee of 30,000 AUD a year I have paid fees totalling 690,000 AUD. If I compute this in terms of a US private college like RISD or Art Center that figure will double to a hefty 1.5 million.

Does education have to cost this much? (or will Corbyn ever be able to deliver on his promise of free university education?)

I am teacher in an Industrial Design program training people to produce visualization for material artefacts. You can do a course in a ‘design school’ (Japanese terminology) and be a graduate in 2 years. That will be with a diploma. If you want a degree you will need to spend 4 years – and potentially function alongside the 2 year graduate. The 3+2 Bologna model potentially changed this first degree in the UK where the 3 year program is now the norm. With a sandwich year in Industry after year 2.

Schools generally insist that for quality graduates, or to have schools with status, you need to spend 4 years in a design program. Probing further, it is possible you will see a ‘contamination of the content’ with the introduction of more theory in these longer degrees. More engineering? More digression? More writing, more reading is always an option. The rationale to produce “more” diverse capability so as to train for resilience is another oft touted rationale. While different kinds of rationale abound, the reality is that the production of such rationale can be convenient.

The norm in post graduate qualification is 18 months in the majority of institutions around the globe. So a 3 year undergraduate tacked on behind it produces college terms of just 4 and a half years. With the advantage of having two independent programs or course areas journeyed through. That is more than the four years in one program with limited resilience.

Then of course there is the rationale of, possibility of/ opportunity to add a further one year between school and university. Variously referred to as the foiundation program, this course is to bridge the gap between capability in school leavers and that required in university. Studies on what capabilities school leavers have though are hard to come by.

So what are all these different pronouncements of the “right way”?

Or are they as Kurt Vonnegut said, “all lies”.

For now have a read, and make up your own mind. Or just fume.

Colleges are increasingly offering three-year B.A.s and other accelerated programs in response to a growing market of money-conscious go-getters and career changers.

Source: 4 Years for a Bachelor’s? Who’s Got the Time? – The Chronicle of Higher Education

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It Matters a Lot Who Teaches Introductory Courses. Here’s Why. – The Chronicle of Higher Education

I am the seniormost, oldest, academic in my area. And I am teaching 1st year – this year and for the next 3 to 5 years. I may have become a bit too excited about this experience – its a place of incredible positive energy. The fact that we manage to suck the life out of them – do we make under confident year 3 and 4 students by who we are? – is another story.

When this article popped up in Flipboard, I paused. This, that senior most academics ought to teach 1st year, is a trope. I used it in my start of your workplanning meeting. In most contexts where I use the trope – I am teaching 1st year because there is this thing, that year 1 should be taught by the most senior – I get the repeated nods, “yes yes, but”. So it is quite common to see visiting academics teaching year 1. And something is missing – and its potentially wrong.

This article however lays it out nicely. I love it.

In a self serving way – I am going top be hanging out with a really lovely bunch of young ones, and this article gives me permision to do so. So good one Beckie Supiano.

Introductory courses can open doors for students, helping them not only discover a love for a subject area that can blossom into their major but also feel more connected to their campus.

But on many campuses, teaching introductory courses typically falls to less-experienced instructors. Sometimes the task is assigned to instructors whose very connection to the college is tenuous.

A growing body of evidence suggests that this tension could have negative consequences for students.

Source: It Matters a Lot Who Teaches Introductory Courses. Here’s Why. – The Chronicle of Higher Education

Inside the big fat Indian wedding: conservatism, competition and networks

There were pastitsi’s in the over. It has been the required 10 minutes. The pastitsi’s are still wearing that white frozen pallor. I am waiting for them to get golden.

Since everyone has gathered in the dining room. Hovering around the oven. I play ‘Radha’ to dispell the heaviness – and we dance. Which then makes me curious – and I have another look at the British Royal Wedding.

In that search in youtube I notice a whole list of other wedding videos. So this is a thing then – a personal movie genre. The wedding video is a thing.

I decide to go have a look to see if someone had done some work on the Indian wedding video. I did not find a video piece – but found this, a tour-guide take on the actors in the wedding network.  So I am posting this to myself as a placeholder.

If you know of someone who has done some work on unpacking the wedding video – tell me about it in the comments.

As a prominent “fixer”, a middleman of sorts for the political and social honchos, whose job it is to introduce influential figures to one another to expand their networks, told me, “The most effective meetings are outside the meeting rooms”. At one wedding, on citing the presence of a senior politican, the fixer said to me, “This indicates that he [the politican] is willing to negotiate the business deal or else he would not have attended the wedding.”

Attendance at weddings is not only a matter of prestige and power for the host but also for the guests, and a snub of non-invitation may transform into an open feud lasting many years.In one such incident, a leading exporter “forgot” to invite a real estate baron to the marriage of his son, straining not only their social and business ties but also of their networks. It took more than a decade and multiple attempts by common friends to restore their relationship.

The politics of invitation most certainly resonates with the politics of businesses and survival.The elite Indian wedding, therefore, is not simply an ostentatious celebration involving an unabashed display of money and taste. It is about competition, conservatism, and assertion of power. It is nothing less than the coronation ceremony of an elite status.

Source: Inside the big fat Indian wedding: conservatism, competition and networks

The Body That Ages – Unruly Bodies – Medium

It is a cold and rainy day – yay. The cats have been fed. Dinner is a short while away. Eggs apparently.

I have settled down to read – essays in wordpress. Writers I follow – for I want to get going with my writing. As wordpress is a good place to procrastinate. You may tarry a while here too. Have a read.

Pretty privilege seems to act similarly to Justice Potter Stewart’s 1964 definition of obscenity: You know it when you feel it. The amorphous and ambient help an attractive person gets just as a bonus for being conventionally attractive, pretty privilege seems to be everywhere and nowhere; it’s woven into the fabric of culture, of patriarchal power structures, and of human erotic drive. It’s difficult to pin down the privilege attendant to being pretty because, in part, it’s hard to define prettiness — beauty/eye/beholder and all that — but we accept the notion that being attractive gives you a boost.“

I don’t want to lose my pretty privilege,” Cho says, “because it’s currency. It’s social currency.” The idea of equating prettiness with capital is not new — Wolf calls beauty “a currency system like the gold standard,” a statement that blends money, conventional attractiveness, patriarchal privilege, the sense of limited resources, and America’s hierarchical class structure into a gendered slurry of access and exclusion. Enid sums up the beauty advantage in a few words: “It’s more profitable to be younger,” she says.

Source: The Body That Ages – Unruly Bodies – Medium

Divi Theme

I have been a lover of wordpresssince 2005. Thats 13 years now. I have recetlty been introduced to Divi – for wordpress. Its amazing.

So now my site is on wordpress. Take a look: http://soumitri.com.au/

Plus (thanks to Sophie) – it has a favicon for when you add the site to your iPhone.

The Illicit and the Ad Hoc

(The text Describes the background to my thinking about the Project Nomadic Affordances)

The affordance is the thing that’s makes something possible. So there exist a category of affordances that makes nomadicity possible. Flipped around the affordances that we design for “improving the quality of life” or “peoples experiences” are appropriated for nomadic purposes. If this is correct then design exposes its failure to be critical and emerges as merely a program of iterative development of past materialities.

A failure that Urry sees in the social sciences as he takes the contemporary research ecology to task. He calls to account social science theory for neglecting through all this time the notion of automobilities, and the very notion of mobility. He uses the term ‘sedentarism’ as the current location of theory, the dominant paradigm, characterised by the complete neglect of the nomadic. Now what he says applies to design and to the paradigms of creative practice that create museum objects and museum inspired spaces that wait, immobile and inactive, for the human user and experiencer to arrive to be activated or animated. Or indeed to exist at all.

For a person such as I, a transnational, a migrant, a nomad inhabiting the diaspora, the absence of acknowledgement of one who is visibly here but mentally in multiple worlds is a reality. Whose days are in the here, but who strays into another location as the sun reaches the afternoon mark, for he lives in the now and in an imaginary simultaneously. The inability of taking into the narrative of a creative practice the simultaneities of ‘the other’ is the tragedy of the ‘assimilationist’ paradigm of elite creative practice. Melbourne is somehow the epicentre of the special, as a place and a paradigm of discourse. This pervasive ‘nativity’ excludes one the one hand, the diaspora, and at the same time yearns to be itself a diaspora of a distant ‘centre’.

If indeed the moments of mobility are to be retained at the periphery – so be it. This periphery is an exciting place – and place of great energy and pulsating with the illicit. In Urry words:

All the world seems to be on the move.

Asylum seekers, international students, terrorists, members of diasporas, holidaymakers, business people, sports stars, refugees, backpackers, commuters, the early retired, young mobile professionals, prostitutes, armed forces; these and many others fill the world’s airports, buses, ships, and trains. The scale of this travelling is immense.

Internationally there are over 700 million legal passenger arrivals each year (compared with 25 million in 1950) with a predicted 1 billion by 2010; there are 4 million air passengers each day; 31 million refugees are displaced from their homes; and there is one car for every 8.6 people.

These diverse yet intersecting mobilities have many consequences for different peoples and places that are located in the fast and slow lanes across the globe. There are new places and technologies that enhance the mobility of some peoples and places and heighten the immobility of others, especially as they try to cross borders (Graham and Wood, forthcoming; Verstraete 2004). [2]

Nomadic Affordances is situated here – in this place, the place of mobility. A form of contemporary nomadicity.

This nomadicity is an ecology supported by a system of affordances. Some are practices such as the ‘road trip’. Some are imperatives such as being forced to seek ‘refuge’. Twitter, facebook, mobile phones, tents, trucks, boats and water bottles are all implicated in this narrative as affordances enabling the nomadicity. Such artefacts exist and we have experience of them. What other may be seen to exist that are yet to be conceived?

Designers in this account actively imagine making the experience of nomadicity pleasurable or more conventient. The backpack – makes the office or classroom mobile. Every little thing that is carried is activated to enable tiny, small or even large nomadicity. The material possessions we carry, as we move, are fellow conspirators in the project of making a placeless or multi-place engagement, the main way of life.

Imagine sometime in the future; a gallery, an archive, a collection of nomadic paraphernalia from the present. Or a speculation upon a proscription of mobility; what will need to be proscribed? Or even How will society need to be re-schooled to stay still and in one place?

Nomadic Affordances is thus an ongoing project, an inquiry, a conversation and a conscious engagement with the tools and contexts of mobility.

When I travel I leave my fountain pen behind. Requiring liquid ink refill the fountain pen, though an improvement upon the inkwell pen, is an improvement though not nomadic enough. Stated another way the fountain pen is thus a nomadic affordance, and the biro does nomadicity really well. Redesigning writing instruments for mobility constitutes a design project. Redesigning artefacts for living – cooking, cleaning and sleeping – away from home is a robust domain of design and innovation practice, the results of which can be seen in camping stores. However the main argument in the construction of the category of nomadic affordances is that camping products constitute merely one category of nomadicity. Seen as a continuum camping is the sporadic and smaller, though more visible in some specific countries, aspect of nomadicity.

Places of rest, recreation and living – are inherently in multiple places. Being in a place but travelling in the imaginary constitutes another form of nomadicity.

In 2016 the opportunity arose to interrogate the ‘caravan’ and the practice of ‘camping’ with the Caravan as a studio project. As an initial project the options available were to frame the studio as a ‘mod’ or ‘redesign’ project. Or to imagine a wider and more conceptual project that focussed upon all manner of affordances, not just the camper-van, that are tools and affordances to a culture of mobility. The contemporary notion of the ‘grey nomad’, the recently retired travelling around Australia in a well kitted out Camper-Van, is then also an affordance. An idea that can be inhabited as a cultural practice. Similarly the camp site with power outlets for the Caravans, facilities for cooking and for body care become implicated as the ecology of affordances. Is it then possible to draw frames where things, places, cultural practices and consumption practices constitute an ecology of nomadicity?

In this way the idea of a Studio titled Nomadic-Affordances was constructed as both being about  mobility and about the anxiety surrounding ‘sedentarism’, the not being nomadic being uncool.

The studio was visualized as providing opportunities:

  • for working big ( a studio with a large number of students working in groups),
  • for an intensive ( a period in the studio of single minded focus where students work/collaborate off-campus for a week exclusively upon the studio),
  • for a transdisciplinary studio and
  • for an international academic to participate in the intensive.

The planning began in 2015 with seeking funding for travel for Ido Bruno, from Bezalel Academy of Art in Jerusalem to come to Melbourne to teach a week long intensive. In the initial conversations I was imagining many vehicles, many topics, for this intensive. At about this time I was also in conversations with Jayco about offering a studio to students of Industrial design in the general area of camping and camper vans. My conversations with Ross McLeod and Michael Trudgeon were around tent cities and history of Australia’s romance with the sea and beach. Lingering alongside this was my desire to construct a studio collaboration between Industrial Design and Interior addressing simultaneously the object scale and the interior envelope scale.

I was simultaneously reading Urry and Rheingold, watching the unfolding mass migration across the planet and connecting the affordances that were making the sociality of the ‘smart mobs’.

Combine wearable computing, wireless communications, and peer-to-peer resource sharing, and all the people in a building or a crowd walking down the street can join into ad-hoc networks. [1]

And …

There are the dangers as well as opportunities concerning smart mobs. I used the word “mob” deliberately because of its dark resonances. Humans have used our talents for cooperation to organize atrocities. Technologies that enable cooperation are not inherently pathological: unlike nuclear bombs or land mines, smart mob technologies have the potential for being used for good as well as evil.

On the other hand, when cooperation breaks out, civilizations advance and the lives of citizens improve. This is the big opportunity of smart mobs. Language, the alphabet, cities, the printing press did not eliminate poverty or injustice, but they did make it possible for groups of people to create cooperative enterprises such as science and democracy that increased the health, welfare, and liberty of many. [1]

In these words lay a description of society as lived out and as appropriated by people. The notion of the mob, and of the smart describes one end of a continuum. A polar opposite of the bricks and mortar sedentarist view of continuation of the current way of imagining people being or coming together.

In these readings I saw a place for design to grab something, the notion of displacing the centre, and to run with the notion such as that of nomadicity being the new normal.

The studio was thus ‘put together’ with a wide domain, a place for exploration. It is possible the initial explorations would read the notion of the nomad literally – such as the practices and material culture of the Bedouin – which is a good starting place. The intensive was imagined to make the wider exploration of the ‘displaced’ or the illicit or the ad hoc possible and in this the practice of Ido Bruno was central to how the exploration would proceed.

In the this is how it eventuated – with the explosion of possibilities of how materiality could be imagined, and how nomadic affordances could emerge.

In many ways the studio was merely an initial step. We are already imaging new projects and new collaborations – especially between Australia and Israel – taking forward the idea and potentially constructing the capacity of smart mobs within the global design diaspora.

References

[1] Rheingold H. (2002) Smart Mobs: The Next Social Revolution: Perseus Publishing.

[2] Sheller M and Urry J. (2006) The New Mobilities Paradigm. Environment and Planning A 38: 207-226.

 

 

 

 

 

 

Issues in Health Services Design focused upon Remote-Rural-Poor

 

Soumitri Varadarajan, RMIT University, 2010

Abstract

Maternal mortality is a significant health issue in India. Roughly 20 to 25% of Maternal Deaths on this planet occur in India. A major proportion of these deaths occur among the rural poor. To focus more sharply upon rural health indicators the Government of India has set up The National Rural Health Mission (NRHM). There have been significant improvements in maternal mortality rates (MMR) because of NRHM, though there is still a long way to go to meet the Millennium Development Goals. Currently the discourse in MMR in India is informed by two perspectives; one, the development of state medical infrastructure focused upon health service provision, and two, the public health perspective of connecting medical health practitioners with the clients. In effect the rural is viewed as a neglected condition needing more resourcing. While increasing resourcing is fine as a solution in the short term and to meet immediate goals – it is not sufficient and does not contribute towards the development of a resilient model of universal health care. I argue that the remote rural poor are a unique category of consumer for health services, who are strategically placed to privilege a mode of health service that is uniquely responsive to their particular needs. In this paper I argue a particular service design practice for rural remote poor could provide a resilient ecosystem going into the future.

Background

Late in 2009, I commenced work on a pilot project to explore maternal mortality in Assam to explore how service design could contribute solutions to the problem of maternal mortality reduction. The project was undertaken at a time of a unique rethink and reformation of rural health services in India brought on by its commitment to meet the Millennium Development Goals (Mavalankar, Vora et al. 2008). This commitment has created a condition of unprecedented openness to innovation among government agencies dealing with rural health. The research in the pilot project began with a literature review, a mapping of the stakeholder network, both in the maternal health system in rural India, and with specific focus upon the stakeholder network in the Indian state of Assam, followed by a field-study. The field study was undertaken in two stages: one, interviews with key agencies that were either doing research on maternal health or were actively involved in projects at the grass roots level, and two, interviews in the state of Assam in India with rural families and key stakeholders in the maternal health system in Assam. I was looking at maternal health as a specific category of service delivery. The key findings of the pilot project that are significant here are:

  1. Urban models of service delivery rely on good infrastructure and often do not work for rural poor.
  2. Government mandates can have adverse effects. In India mandating 100% hospital births, has de-legitimized midwifery and de-skilled the community.

The pilot project concluded that services for marginalized and remote communities are indeed a separate category of services. A methodology of service design practice in such contexts would need to be; one, inclusive and account for traditions and deep rooted community practices; and two, decentralized, to account for both the need to support and stimulate local economy and to build self reliance as a way to tackle potential marginalizations (Gupta 2007). Such a practice of service design would be situated in opposition to mainstream service design practice that privileges centralization, use of sophisticated technologies and assumes urban consumption practices.

In this paper I first describe current approaches and practices in maternal mortality reduction and point out the need for a multifacteted approach. I then introduce current services design practices and point out their inadequacies to make a case for a special category of service design for resource poor settings. I refer to this practice as “service design for the remote rural poor” to distinguish the key attributes of the community that suffers significantly due to high rates of maternal health deaths.

Current Approaches: Problem Solving Maternal deaths

Current approaches to tackle maternal mortality have three focus areas;

  1. Focus upon Direct Causes – Medical intervention
  2. Focus upon Indirect Causes – Public health theory orientated intervention
  3. Focus upon the Ecosystem – The administration of state service provision

Focus upon Direct Causes: Medical Intervention!

A significant portion (38%) of maternal deaths occur due to Post-partum Hemorrhage (PPH) (See Image 1). An injection – such as Misoprostol, Oxytocin, or Endometrine – can stop the hemorrhage. So it appears the solution could be: Drug to be available at the time of Delivery! In field work in India I was asking the question of whether access to drugs was factor in the mortality rate. I learnt that Oxytocin was easily available in rural contexts as its misuse was widespread in the dairy industry. It appeared then that improved availability of such drugs would not change the situation dramatically. In addition as deliveries in remote areas are not often attended by trained personnel the actual delivery of the injection would be an issue. Therefore though direct intervention looks like a solution the problem could be solved by a focus upon indirect causes too, such as access to institutional care, which is the option favoured by the NRHM. In effect focusing upon drug delivery may not be the appropriate or complete solution!

 

Image 1: Causes of Maternal Deaths

Image 2: Evidence based interventions

Focus upon Indirect Causes

Most maternal deaths occur among women in remote and rural communities, often among the poor. These women do not have access to complete and continual care from the public health system. While physical, socio-cultural (gender, culture, religion and resultant lifestyles) and economic barriers (poverty) affect women’s access to institutional health services, youth pregnancy, anemia and medical history further compromise their ability to have a safe pregnancy and delivery. It is therefore entirely possible tha some deaths can be prevented through proper preparation before labour and delivery. Three case studies that highlight the possibility of improved health outcomes through non medical intervention are described below:

SEWA Rural in Tribal areas of Gujarat: This is an example of an NGO realizing improved health outcomes. With 75% home delivery, SEWA Rural could reduce MMR by 40% and NMR by 45% in three years with specific interventions at community level backed up by a functional FRU. Some of the features of this project were:

  • Empowering TBA[1]s/ Local women volunteers ensuring satisfactory Birth Preparedness/ Complication readiness
  • Clean and Safe normal delivery ensuring critical new born care and post natal follow up
  • Timely identification of any complications during delivery and ensuring prompt referral to SEWA Rural’s functional FRU[2]
  • Professional provision of basic and comprehensive emergency obstetric care by SEWA Rural FRU

Department of Health Tamil Nadu: This is an example of an improvement in maternal health outcomes through a systematic improvement in the practices of a state health system. Characterized by 90% institutional delivery the Tamil Nadu health system is a case study of best practice in systemic transformation.

The Boat Clinics of Assam: The Centre for North East Studies (CNES) runs a boat clinic service in Assam. The program comprises a fleet of 15 boats and has the support of the state NRHM. This is a story of coverage and a whole population living in the riverine areas of Assam has been brought into the ambit of the NRHM in Assam. While the improvement in health outcomes is yet to be reported upon in the maternal health space, the potential for overall health improvement and education impacting upon health outcomes is a real possibility.

Focus upon the ecosystem

The Government of India recognized that the health care service delivery in urban contexts was better than that available for rural populations. Their response, The National Rural Health Mission, attempts an ‘architectural correction’ by focusing separately upon the rural with a new and different design of the service. A key feature of the project’s focus upon maternal mortality is its three-tier strategy of separating states with high rates from those with moderate and low rates (MMR). Additionally the project has instruments such as: State level program-proposal development (to enable bottom up decision making), Program evaluation reports (to enable transparency) and Public Private Partnerships (to encourage diverse service provision models).

A key strategy within the project is a scheme called the Janani Suraksha Yojana (JSY – Safe Motherhood Programme). Bearing affinity to the global Safe Motherhood Initiative the JSY programme integrates the cash assistance with antenatal care during the pregnancy period, institutional care during delivery and immediate post-partum period in a health centre by establishing a system of coordinated care by field level health worker. The goal for the NRHM-JSY is to meet the Millenium Development Goal #5 target of an MMR of 100, a reduction from the 2009 Maternal Mortality Ratio (MMR) figure of 212 per 100,000 live births.

In the current scenario the efforts by the various state governments are to address the gaps in service delivery. Specifically the gaps in the NRHM focus upon MMR are:

  • Insufficient resources in NRHM focusing upon JSY
  • Reliance on Accredited Social Health Activist (ASHA)
  • Field Data not accurate and so interventions not effective
  • Quality of service, and skills available need improvement

In 2012 it’s the end of one phase of the JSY program – and there is a lot of reporting on the way the system has been rorted. Yet there are also success stories. Overall a key to improvement in maternal health outcomes will be improvements in the state health service provision. The following two stories illustrate the complexity in the situation and the need for both strengthening the state health system and building demand for the system. I highlight two significant aspects of the remote rural health condition as being one, access to Quality of Care and two, access to EmOC (Emergency Obstetric Care) Transport.

Of the two cases one was an instance in a remote tribal community of a home birth that went wrong. As narrated by the women who worked on the delivery the placenta could not be extracted and the woman was in distress though not bleeding. She was placed on the khatiya, a wooden bed with rope webbing, and carried by the men for kilometres to the local sub-centre. On arrival she was referred to the hospital, the ambulance was called and she was taken to the hospital some 50 kms away. By this time hours had gone by. At the hospital it is unclear if the personnel in attendance were qualified as no attempt was made to extract the placenta. She did not survive till the morning. In this case the community spoke of their reluctance to call the 108 Ambulance which was located 40 kms away, beyond some pretty poor potholed roads, to come to the aid of the woman who then had to be transported just 3 kms to the sub-centre. Home births are common in this community and the women spoke of their confidence in handling deliveries. When questioned they said a specific category of Dai’s (traditional birth attendants- TBAs) did not exist as any of the older women folk could be pressed into service at delivery. The capacity for ‘normal delivery’ (a phrase they used repeatedly) was considered to be widely prevalent.

The second case was the wife of a sub-inspector in the police. This was a hospital delivery that went wrong. As told by the family and corroborated by the community the delivery was carried out in the local PHC/ subcentre by an AYUSH, Ayurvedic, doctor who normally is not trained for western medical practices and specifically not for performing deliveries and surgical procedures. In this narrative he picked up the forceps to extract the placenta, and the ANM claim they asked him not to use the forceps, and as he used the forceps he set off profuse bleeding. She was rushed to the hospital and died on the way. I was told that there had been unsuccessful campaigns by local communities and NGOs to get this particular doctor to stop performing deliveries. Apparently he is to retire in a few years and there is an absence of administrative and political will to act on this doctor.

The interventions in this instance could be enhancement of skills available at both home and hospital settings. In the remote tribal community it was the woman’s sixth delivery and this could have been flagged as a high-risk pregnancy which then makes a case for risk assessment.

To summarise:

  1. Risk Assessment possible in one case of home birth
  2. Delivery by untrained person in hospital setting – lack of capability in infrastructure. Need for zero tolerance on Quality of Care
  3. Two approaches could be – facilitate home births and improve capacity in hospitals.

SERVICE Design is not perfect

The current practice of service design fails when used to develop services for poor and marginalized communities. Service design is currently centered around urban and affluent contexts. Service design theory has evolved with a focus upon privileging expert discourses in a predominantly urban context (Shostack 1982; Normann 2000; Leadbeater and Cottam 2008) This form of practice is focused upon redesigning existing services to either reduce cost, or improve customer experience and is predominantly targeted at urban, educated and affluent consumers of services (Frug 1998; Glaeser, Kolko et al. 2001). Service design theory has two main themes:

  • Affordances and technologies of interaction.
  • Increasing ease of access to services.

Historically, a greater focus upon technology has suppressed the discourse of access (Candi 2007). In health care projects, service design has benefited the client, often a publicly owned organization (Cottam and Leadbeater 2004). Extending such a paradigm of practice, producer-side thinking, into disadvantaged communities often leads to unintended consequences such as the exploitation of rural-poor communities. (Goodman 1968; Whitehead, Dahlgren et al. 2001; Wagstaff 2002).

Current global practices in service design use a mix of methods added on to conventional system design practices (Manzini, Vezzoli et al. 2001; Morelli 2002; Stickdorn and Schneider 2011). These new tools and methods are in the main drawn from contemporary software development practices in the field of interaction design (Manzini 2009). By becoming significantly integrated into retail business practice discourses, service design has had a significant and visible impact upon society (Cottam and Leadbeater 2004). The goal of this form of design is to improve ‘ease’ of customers’ access to services, improvement of ‘customer experience’ by the innovative use of internet and telecommunications infrastructure that is common in urban contexts (Hollins and Hollins 1991; Varadarajan 2009). Service Design projects in health service delivery have validated inclusive practices such as ‘co-creation’, through examples such as the RED project of the Design Council UK (Cottam and Leadbeater 2004). Significantly RED and other milestone projects in service design have been urban projects.

To summarise:

  • Service design fails when used to develop services for the rural poor.
  • Emerging service design theory is intimately tied to improving urban ‘customer experience’.
  • A project of re-conceptualisation would extend service design theory by including service provision for the rural poor.

Services for marginalized and remote communities are indeed a separate category of services. A methodology of service design practice in such contexts would need to be; one, inclusive and account for traditions and deep rooted community practices; and two, decentralized, to account for both the need to support and stimulate local economy and to build self reliance as a way to tackle potential marginalizations (Gupta 2007). Such a practice of service design would be situated in opposition to mainstream service design practice that privileges centralization, use of sophisticated technologies and assumes urban consumption practices. Such a practice would be a separate category of Service design – Service Design for Remote-rural-poor (SDRRP).

Service provision for rural poor is a unique field characterized by neglect and poor performance of public services (Sainath 1992; Louis 2007). Approaches to the poor and marginalized in design have been characterized by a discourse of social engagement and social entrepreneurship (Jegou and Manzini 2008). While a focus upon the rural poor (Papanek 1985) has found form as the practice of social design (Margolin and Margolin 2002) with a strong focus upon artifacts (Rawsthorn 2007) the main paradigm is still one of pushing from the centre to the periphery (Er 2001). Service provision in health, universally viewed as a state subject has two key problems; one is the focus upon increasing access to and compliance with state services in remote areas (Humphery, Weeramanthri et al. 2001) and two is that “provider pluralism”, where different forms of service providers are allowed to operate, often goes unrecognized and is marginalized in state plans (Ministry of Health and Family Welfare 2005). To summarise, service provision for the rural poor is a complex context for design which demands  that service design theory needs to move beyond: one, the urban context and reliance on infrastructure to become more widely applicable, and two, privileging the needs of a client and move towards working ‘creatively with messy and sometimes contradictory realities to achieve better outcomes’ (Standing and Bloom 2002).

The rural poor have not been the subject of a case study thus the practice and theory of service design has had little impact beyond the urban (Varadarajan 2009). While service designers have worked with the public sector on health and their projects have included service delivery to the poor, these have been mainly to redesign services to achieve better customer satisfaction. The poor in rural areas are often not reached by these public services and so ‘are much more likely to be at the purchasing end of shoddy or dangerous goods and services’ (Standing and Bloom 2002). In a key work dealing with service provision for the rural poor, Standing and Bloom speak of a ‘a failure of conceptualisation’.

The recognition of the neglect of the rural poor in health service delivery is contained in the preamble to the Indian National Rural Health Mission document, which advocates an ‘architectural correction’ of the health care services in India (2005). The problem of government health service provision in India, being focussed upon urban populations, has meant that health indicators for rural populations have been consistently poor and this is manifested in the high incidence of maternal deaths (Bajpai, Sachs et al. 2009; Padmanaban, Sankara Raman et al. 2009). With three more years to the 2015 Millennium Development Goals it is expected that the project of maternal mortality reduction would continue to be a location for intense scrutiny of service delivery (Mavalankar, Vora et al. 2008).

Conclusion

Its three years to the target date of the Millennium Development Goals and the question reprised in the media in India is “will India meet the target?”. A lot of money has been poured in and a huge effort has been made to transform the ecosystem. The key question therefore is – has it worked. Yes the system has been rorted, but is that a phenomenon only at the periphery and limited to certain specific geographical areas. Could the NRHM intervention therefore be largely seen to have worked to transform health outcomes for pregnant women? If yes – then this is the first step toward an large improvement in the health service system.

The future however has to contain a strategy addressing the problem of maternal deaths in remote rural areas by addressing both direct (medical) and indirect (social and systemic) causes. Service design can make a significant contribution in both areas – however the possibility of service design thinking contributing in the social and systemic space is the subject of my current and future research explorations.

References

Bajpai, N., J. D. Sachs, et al. (2009). Improving access, service delivery and efficiency of the public health system in rural India: Mid-term evaluation of the National Rural Health Mission. Working Papers Series, Center on Globalization and Sustainable Development, The Earth Institute at Columbia University. CGSD Working Paper No. 37.

Candi, M. (2007). “The role of design in the development of technology-based services.” Design Studies 28(6): 559-583.

Cottam, H. and C. Leadbeater (2004). “HEALTH: Co-creating Services.” (RED PAPER 01 ).

Er, A. (2001). Design in NICs. 4th European Academy of Design Conference, Aveiro, Portugal, Universidade de Aveiro.

Goodman, C. S. (1968). “Do the Poor Pay More?” The Journal of Marketing 32(1): 18-24

Gupta, D. (2007). “Citizens versus People: The Politics of Majoritarianism and Marginalization in Democratic India*.” Sociology of Religion 68(1): 27-44.

Hollins, G. and B. Hollins (1991). Total Design : Managing the design process in the service sector. London, Pitman.

Humphery, K., T. Weeramanthri, et al. (2001). Forgetting compliance : Aboriginal health and medical culture. Casuarina, N.T., Northern Territory University Press in association with the Cooperative Research Centre for aboriginal and Tropical Health.

Jegou, F. and E. Manzini (2008). Collaborative services: Social innovation and design for sustainability. Milan, PoliDesign.

Leadbeater, C. and H. Cottam (2008) “The User Generated State: Public Services 2.0.”

Louis, P. (2007) “Social Exclusion: A Conceptual and Theoretical Framework.” What it takes to eradicate poverty.

Manzini, E. (2009). “New design knowledge.” Design Studies 30(1): 4-12.

Manzini, E., C. Vezzoli, et al. (2001). “Product-Service Systems. Using an Existing Concept as a New Approach to Sustainability.” Journal of Design Research 1(2).

Margolin, V. and S. Margolin (2002). “A ‘Social Model’ of Design: Issues of Practice and Research.” Design Issues 4(18).

Mavalankar, D., K. Vora, et al. (2008). Achieving Millennium Development Goal 5: is India serious? Bulletin of the World Health Organization. 86.

Ministry of Health and Family Welfare (2005). National Rural Health Mission. M. o. H. a. F. W. (MOHFW). New Delhi, Government of India.

Morelli, N. (2002). “Designing Product/Service Systems: A Methodological Exploration1.” Design Issues 18(3): 3-17.

Normann, R. (2000). Service management : strategy and leadership in service business. Chichester , New York, Wiley.

Padmanaban, P., P. Sankara Raman, et al. (2009). “Innovations and Challenges in Reducing Maternal Mortality in Tamil Nadu, India.” Journal of Health Population and Nutrition 27(2): 202-219.

Rawsthorn, A. (2007) “Alice Rawsthorn on design for the unwealthiest 90 percent.” International Herald Tribune.

Sainath, P. (1992). Everybody loves a good drought: stories from India’s poorest districts. New Delhi, Penguin Books.

Shostack, G. L. (1982). “How to Design a Service.” European Journal of Marketing 16(1): 49 – 63.

Standing, H. and G. Bloom (2002). Beyond Public and Private? Unorganised markets in health care delivery. Making Services Work for Poor People. Eynsham Hall, Oxford, World Development Report (WDR) 2003/4.

Stickdorn, M. and J. Schneider (2011). This is Service Design Thinking. Amsterdam, BIS Publishers.

Varadarajan, S. (2009) “Service design for India: The thinking behind the design of a local curriculum.” Re-Public.

Wagstaff, A. (2002). “Poverty and health sector inequalities.” Bulletin of the World Health Organization 80: 97-105.

Whitehead, M., G. Dahlgren, et al. (2001). “Equity and health sector reforms: can low-income countries escape the medical poverty trap?” The Lancet 358.

Glossary

NRHM                    National Rural Health Mission

EmOC                    Emergency Obstetric Care

ASHA                     Accredited Social Health Activist

ANM                      Auxiliary Nurse Midwife

[1] TBA – Traditional Birth Attendant

[2] FRU – First Referral Unit