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!!

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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.