Service Design Methods?

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, 2004 #845}. Significantly RED and other milestone projects in service design have been urban projects.

When this practice moves to work in the context of rural poor – there is a  potential for new theoretical frameworks!!

Service Design for Rural Poor

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). Interestingly if we were to pick up the counter current of documenting practices of the poor or old and traditional (Gennep, Vizedom et al. 1960; Varadarajan 2009) and amplify the essential paradigm that characterizes them we see similarities with social design projects in their approach of focussing upon self reliance. 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 (2005). Provider pluralism (Chernichovsky 2002; Sheehan 2009), actively encouraged in urban areas is mirrored by self reliance in remote areas. With more regulation in rural contexts such pluralism often gets ‘written out’ and even competent local health practitioners could have their work rendered illegal (Jeffery, Jeffery et al. 1984; Ram 2001).


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 client’s needs and ‘work creatively with messy and sometimes contradictory realities to achieve better outcomes’ (Standing and Bloom 2002).

Consuming health 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).

Models: push model, pull model

Oppositions: Centralized funding versus User Pays model, entitlement versus consumption

Amnesty International Calls on President Obama to Establish Office of Maternal Health to Lead Government Effort to Reduce Appalling U.S. Death Rate for Women Having Babies | Earth Times News

“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful,” said Larry Cox, executive director of Amnesty International USA. “Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies.”Cox said: “Mothers die not because the United States can’t provide good care, but because it lacks the political will to make sure good care is available to all women.”Amnesty International’s new 101-page, national report, Deadly Delivery: The Maternal Health Care Crisis in the USA, reveals the following disturbing findings:+ severe pregnancy-related complications that nearly cause death — known as “near misses” — are rising at an alarming rate, increasing by 25 percent since 1998; currently nearly 34,000 women annually experience a “near miss” during delivery;+ discrimination is costing lives. Opportunities to save women’s lives and reduce complications are being missed, in large part because women face barriers to care, especially women of color, those living in poverty, Native American and immigrant women and those who speak little or no English.

via Amnesty International Calls on President Obama to Establish Office of Maternal Health to Lead Government Effort to Reduce Appalling U.S. Death Rate for Women Having Babies | Earth Times News.

Azad, Bill Gates discuss ways to strengthen health scenario in India

New Delhi, July 24 (ANI): Union Health and Family Welfare Minister Ghulam Nabi Azad today met Bill Gates, co-chair of the Bill & Melinda Gates Foundation, to discuss their shared commitment to promote various health activities in India.

Azad appreciated the work being done by Bill & Melinda Gates Foundation for its continued support to the National Aids Control Programme through AVAHAN and to support for the National Polio Programme.

Azad reiterated the Government commitment to meet the MDG goals particularly relating to reduction in IMR & MMR as well as reduction in Morbidity and Mortality Rate and also other diseases like HIV AIDS, TB, Malaria etc.

Commenting on the Universal Immunisation Programme, Azad informed the visiting dignitaries about the road map for introduction of new vaccines to cover more vaccine preventable diseases.

In this context, he appreciated the efforts being made by Bill & Melinda Gates Foundation to discover and develop new vaccines and requested Mr. Gates for its continued support to the health Programme in India.

via Azad, Bill Gates discuss ways to strengthen health scenario in India.

ASHA scheme makes ”health for all” possible in Punjab village

Sitto Village (Punjab), Mar 20 (ANI): In an effort to make ”health for all” possible in Sitto village in Punjab, the Government is implementing the Accredited Social Health Activist (ASHA) scheme under the National Rural Health Mission (NRHM).

Under the scheme, ASHA workers are not only trying to create increased health awareness among women, but are also trying to increase the manpower of the health department in the state.

“The main aim of implementing ASHA scheme is to decrease the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR) which was very high here. An effort was made to lower the infant deaths during the delivery,” said Jaspal Singh, sub-divisional medical officer.

The results of the scheme are visible and the mortality among the women and children has fallen.

Nirmala, an ASHA worker, said: “We are employed under the ASHA workers scheme. The government has helped us a lot. We go from house-to-house and urge the pregnant women to deliver only in the hospitals. If there is a need for immunization, we tell them to get it done in the hospitals as the government is doing it for free.”

via ASHA scheme makes ”health for all” possible in Punjab village.

77,000 Indian women die every year at childbirth

New Delhi, March 10 (IANS) At least 77,000 mothers in India die every year during child birth, Minister of State for Women and Child Development Renuka Chowdhury said Monday. Chowdhury told the Rajya Sabha that the latest survey report of the Registrar General of India published in 2006, the maternal mortality ratio (MMR) for India is 301 per 100,000 live births.

It “translates into about 77,000 maternal deaths per year or in other words 211 maternal deaths per day”.

She said in order to bring a reduction in MMR, the central government has initiated certain programmes like Janani Suraksha Yojana (JSY), for institutional delivery and appointment of Accredited Social Health Activist (ASHA) for every village.

She said the government is also working to prevention and treat anemia. Nearly 60 percent of Indian women are anaemic. Supplementary nutrition to pregnant and lactating women under the integrated child development scheme are also been given, the minister explained.

via 77,000 Indian women die every year at childbirth.

Rural health schemes benefits tribals in Tripura

Agartala, Mar 7 (ANI): The implementation of various schemes in Tripura under the National Rural Health Scheme has given a reason to smile to the locals. Various health schemes under the National Rural Health Mission (NRHM) are being implemented with an aim to bring down the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR).

“NRHM can play a very important role in tribal areas where it is still difficult to reach medical services due to inaccessibility,” said L Darlong, Mission Director of NRHM, Tripura.

The schemes are not only trying to create an increased health awareness among the poor, but also to increase the manpower of the health department in the state.

New well equipped hospitals and health centers are also being constructed in the remote of the regions to provide instant aid to the people. Further, to spread awareness, tribals are being educated through puppet shows, road shows and folk songs.

via Rural health schemes benefits tribals in Tripura.

A ray of hope for expectant mothers in Maoists affected Chhattisgarh

Bilha (Chhattisgarh), Aug.18 (ANI): An ambulance service has come as a boon for expectant mothers, especially for those in their advanced stage of pregnancy, in Chhattisgarh’s Bilaspur district.

Till recently, the expectant mothers and other family members remained a worried lot since commuting to the nearest primary health centre (PHC) or the district hospital involved a big risk of life and safety in this Maoist-affected region.

Thanks to the initiative of the State government, now such fears are allayed with the introduction of an ambulance service exclusively for expectant mothers and it is named ‘Matahari Express’.

via A ray of hope for expectant mothers in Maoists affected Chhattisgarh.

Survey to check villagers’ health, flagship scheme’s impact

New Delhi, Sep 10 (IANS) A survey will be taken up in nine states to assess the health of rural population since the launch of the National Rural Health Mission (NRHM).

The annual health survey will be carried out in Bihar, Jharkhand, Madhya Pradesh, Chhattishgarh, Uttarakhand, Uttar Pradesh, Orissa, Rajasthan and Assam by the health ministry, the home ministry and the Registrar General of India (RGI).

The decision was taken Thursday at a cabinet meeting chaired by Prime Minister Manmohan Singh and was announced by Information and Broadcasting Minister Ambika Soni.

The survey aims to provide feedback on the impact of the schemes under NRHM, launched in 2005, in reduction of the Total Fertility Rate (TFR), Infant Mortality Rate (IMR) at the district level and the Maternal Mortality Ratio (MMR) at the regional level by estimating these rates on an annual basis for 284 districts in these states.

via Survey to check villagers’ health, flagship scheme’s impact.

Improvement of maternal health a far cry in Orissa

New Delhi, June 30 (IANS) In spite of the government’s claims that rural health is undergoing a massive change under its flagship programme, a survey by a federation of advocacy agencies Tuesday said quality of healthcare is too bad in Orissa and women are dying in hospitals during child-births.

“Earlier many women were dying at home during baby-birth and now they are facing the same situation at health centres,” said Nabin Kumar Pati, co-chairman of the White Ribbon Alliance, India.

A survey by the alliance that is a conglomerate of 1,500 organisations in 12 districts of Orissa found that implementation of safe motherhood policies and programmes have implementation problems.

The findings revealed that 52 percent of the Auxillary Nurse Midwife (ANM) have no weighing machines and 55 percent don’t have blood pressure measuring instruments. ANMs play a key role in imparting health care to women and children in rural India.

via Improvement of maternal health a far cry in Orissa.

J-K to make rural service must for medicos

Jammu, Mar 5 (ANI): The Jammu and Kashmir Government is contemplating to make rural services mandatory for all doctors to improve health facilities in rural areas of the state.

Addressing the National Rural Health Mission (NRHM) meeting State Chief Minister Omar Abdullah announced that those medicos who serve in rural areas under the NRHM scheme would get additional points in the Public Service Commission (PSC) selection process.

He stressed on achieving maximum physical and financial targets under NRHM and asked the authorities to conduct a survey for grading districts on basis of achievements.

In his address Abdullah also asked to conduct weekly review of all works under the NRHM and to conduct a survey on Maternal Mortality Rate (MMR) and he added that himself will conduct a quarterly review.

via J-K to make rural service must for medicos.

Uttar Pradesh tops in pregnancy related deaths

Lucknow, Oct 7 (IANS) Uttar Pradesh tops the list in pregnancy related deaths in the country, a study by a human rights watchdog said.

A US-based international organisation, Human Rights Watch (HRW) arrived at the conclusion after carrying out a case study across certain districts, culminating in a report that was released here Wednesday.

Releasing the report, former Lucknow University vice-chancellor Roop Rekha Verma expressed deep concern over the prevailing situation and called upon the state government to take note of the recommendations made by HRW to arrest the trend.

According to the report prepared by HRW’s Asia researcher Aruna Kashyap, “India alone contributes to a little under a fourth of the world’s maternal mortality, with a maternal mortality ratio (MMR) of 450 maternal deaths per 100,000 live births.”

via Uttar Pradesh tops in pregnancy related deaths.

Government system failure killing mothers in Madhya Pradesh

Bhopal, Oct 28 (IANS) A complaint by a patient that a doctor in a government-run hospital left her unattended in the operation theatre has turned the spotlight on the role played — or not played — by these hospitals in reducing deaths at childbirth in Madhya Pradesh, a state with one of the highest maternal mortality rates (MMR) in India.

via Government system failure killing mothers in Madhya Pradesh.

Maternal mortality rate declines by 15 percent in Bihar

Patna, June 17 (IANS) The maternal mortality rate (MMR) in Bihar has fallen by about 15 percent, as more and more women are opting for institutional deliveries. Women have also been demanding improvement in health services and infrastructure, according to official figures released here Wednesday.

The MMR, maternal death per lakh live births in Bihar decreased from 371 in 2001-03 to 312 in 2004-06.

via Maternal mortality rate declines by 15 percent in Bihar.

‘Insurgency main reason for Assam’s high maternal mortality’

New Delhi, March 5 (IANS) Assam in India’s northeast has the country’s highest rate of maternal mortality, as per the latest official data. According to experts, insurgency which affects access to healthcare services, is one of the main reasons for this.

Speaking at a press meet in the capital Friday, Bulbul Sood, co-chair of the White Ribbon Alliance, an NGO that campaigns for safe motherhood, said: “There may be a lot of reasons for Assam having the highest maternal mortality. Insurgency in the state is one of the main reasons because it affects access to basic healthcare services”.

“Also there is a general lack of involvement by stakeholders in uplifting the healthcare services in the region,” she added.

According to the Sample Registration Services (SRS) 2004-2006, the maternal mortality ratio (MMR) for Assam was 480 per 100,000 live births – the highest in the country. India’s MMR was 254.

via ‘Insurgency main reason for Assam’s high maternal mortality’.

US launches Rs.580 mn health initiative in India

New Delhi, June 12 (IANS) The US Thursday launched a Rs.580 million initiative to improve maternal and child health in India, with a focus on Uttar Pradseh and Jharkhand. The Maternal and Child Health Sustainable Technical Assistance and Research Initiative (MCH STAR) will work to accelerate the resource mobilization of India’s major programmes like the Notational Rural Health Mission and Integrated Child Development Services.

“Our aim is to bring real improvements in the lives of women and children. Led by USAID, our Indian partner organisations will help the initiative to achieve success,” USAID mission director George Deikun said.

“We are investing Rs.581 million and our Indian partners will also mobilise some funds. The funds will be utilised over a period of five years across India with a focus on Uttar Pradseh and Jharkhand,” Deikun told IANS.

via US launches Rs.580 mn health initiative in India.

India to conduct ‘verbal autopsy’ of maternal deaths

New Delhi, June 12 (IANS) All pregnancy-related deaths in the country will be investigated and a structured report will be prepared to fix accountability in order to reduce fatalities, a health ministry official said Thursday. “We are soon going to have a verbal autopsy of all women dying during child birth. It’s a practice followed in Tamil Nadu and it will be emulated across the country soon,” Health Secretary Naresh Dayal said.

“Each death will be interrogated (by health officials) and a proper record will be maintained. We want to know the reason behind such a huge maternal mortality rate in the country and fix accountability,” Dayal said here.

via India to conduct ‘verbal autopsy’ of maternal deaths.


The Maternal and Child Health Sustainable Technical Assistance and Research (MCH-STAR) is a five-year $13.8 Million initiative supported by United States Agency for International Development (USAID) to improve policies, program approaches and resources in the areas of maternal, neonatal, child health and nutrition (MNCHN) in India.

The MCH-STAR Initiative aims to strengthen the capacity of Indian institutions in the areas of research and evaluation, policy analysis and advocacy, and in responsive technical assistance for MNCHN, so as to provide sustainable technical leadership of global standards.


Maternal and Perinatal Conditions — Disease Control Priorities in Developing Countries — NCBI Bookshelf

In 2001, maternal and perinatal conditions represented the single largest contributor to the global burden of disease, at nearly 6 percent of total DALYs (Mathers and others 2004). Reducing that burden is widely stated as a priority at both national and international levels, but the track record of translating the rhetoric into action on a sufficiently large and equitable scale to make a difference at the population level remains disappointing. The literature abounds with examples of this disappointment (see, for example, Maine and Rosenfield 1999; Weil and Fernandez 1999). Many reasons account for the limited progress, especially in the poorest regions of the world, and researchers offer many interpretations of the bottlenecks. Lack of evidence on the size of the burden and on the effectiveness of alternative intervention strategies figures prominently in these interpretations.

via Maternal and Perinatal Conditions — Disease Control Priorities in Developing Countries — NCBI Bookshelf.

There is a really extensive bibliography listed in this site.

Human Rights Facts (37): Maternal Mortality « P.A.P. Blog – Human Rights Etc.

Maternal death, or maternal mortality, is the death of a woman during or shortly after a pregnancy. More than half a million women die during pregnancy or childbirth every year, and many millions suffer from inadequately treated complications. About half of these deaths occur in sub-Saharan Africa and about one third occur in South Asia – the two regions together account for about 85 per cent of all maternal deaths. In sub-Saharan Africa, a woman’s risk of maternal death is 1 in 22, compared with 1 in 8.000 in developed countries.

via Human Rights Facts (37): Maternal Mortality « P.A.P. Blog – Human Rights Etc..

DevInfo – di Facts

The vast majority of maternal deaths – more than 99 per cent, according to the 2005 UN inter-agency estimates – occurred in developing countries. Half of these (265,000) took place in sub-Saharan Africa and another third (187,000) in South Asia. Between them, these two regions accounted for 85 per cent of the world’s pregnancy-related deaths in 2005. India alone had 22 per cent of the global total.

via DevInfo – di Facts.


Research_Projects_for_PhDs, originally uploaded by soumitriv.

A sketch of research projects at the meta level – potential PhD questions or areas of work. The idea of capacity development includes the development of research capacity-expertise in India. So these could be international research students.

What other projects could there be?


MH_Expertise_network, originally uploaded by soumitriv.

I was looking to create a network of experts – a network that will mirror what will be available in India. This will make for easy collaboration and for discipline or expertise orientated capacity development projects to be visualized.

Have I missed out a discipline?

Thinking through how the project will work

bub_MHP1, originally uploaded by soumitriv.

There are a whole series of ways we currently work in Industrial Design – on design orientated projects and capacity development project. There are therefore a raft of agencies supporting the students, scholars and staff in their research. I have captured some of the dimensions in this mind map.

Are there other ways to enable the action research project?