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

UNICEF India – Health

Purulia, West Bengal: A visit to Badakhula village in Purulia district can be an eye-opener. Badakhula has no electricity, no land or cellphones – one among the several ‘no connectivity villages’ in a country emerging as a global hub of information technology.

To get to Badakhula in Bandwan block in south-east Purulia, you have to drive through dense teak forests, down mud tracks. Most people in this impoverished pocket live off forest produce or are marginal farmers. Women in labour have to trudge a mile to get to the nearest health sub-centre. From there, they can hire a jeep to take them to the block primary health centre. Those who are not physically in a condition to walk that distance are carried in a ‘duliya’ (a string cot) by able-bodied men in the village.

But this April, there was a buzz in Badakhula with the arrival of a “van rickshaw”, a locally manufactured innovation to make it easier for expecting mothers to reach a hospital.

via UNICEF India – Health.

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.

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?

Sweden to help AP in curbing infant mortality

HYDERABAD: The Swedish International Development Corporation Agency (SIDA) has agreed to continue its assistance to the State Government for Advanced Midwifery Training (CAMT) in the State. The CAMT offers skillbased midwifery training to provide high quality services to mothers and newborns for reducing maternal and infant mortality and morbidity.

A Swedish delegation led by Sweden State Secretary to Minister for Health and Social Affairs Karin Johansson called on Chief Minister K Rosaiah here today and assured all support to the State Government in providing total healthcare to the citizens, particularly the poor and low income groups in the rural areas.

The Swedish delegation appreciated various healthcare initiatives of the State Government including Rajiv Aarogyasri, 108, 104 ambulance and mobile healthcare services.

They termed Andhra Pradesh as a role model for other countries in providing free quality healthcare to the poor and low income families.

Established in 2007 at Niloufer Health School, the CAMT offered midwifery training with the support of SIDA. When an agreement signed between both the institutions ended in November 2009, SIDA officials withdrew their services.

Later, the State Government took over and started training programmes from January this year with funds from National Rural Health Mission (NRHM).

Health Minister D Nagender and officials of the Health department were also present.

via Sweden to help AP in curbing infant mortality.

India: Reviving public health services | Economists’ Forum |

What about replicability? Can other states reorganise their health systems along the lines of Tamil Nadu and reap the major health benefits that seem to accrue? Yes, they can. The administrative foundations are similar across the country. The key difference is that Tamil Nadu “(a) separates the medical officers into the public health and medical tracks, (b) requires those in the public health track to obtain a public health qualification in addition to their medical degree, and (c) orients their work towards managing population-wide health services and primary heath care…”. The additional investment required to train a cadre of public health managers is modest: in Tamil Nadu this cadre amounted to hardly 1 per cent of more than 10,000 government doctors. Of course, reverting to a separate directorate of public health and having a good public health act may also be necessary and quite feasible. And the data suggest that the costs are affordable. The central issue is not resources, but how they are organised, mandated and managed.

via India: Reviving public health services | Economists’ Forum |

Where there is no midwife: birth and loss in rural India By Sarah Pinto

The MEDP Project

The overall objective of MEDP is to help in building the capacity of midwifery and maternal health in India. It is closely linked with the material health policy under the National Rural Health Mission (NRHM) and the Reproductive and Child Health (RCH) programme of the Goverment of India which aim at the development of SBA (midwifery) and EmOC as key strategies for decreasing maternal mortality rate.

This Project is coordinated by IIM, Ahmedabad, and is being implemented through the core group of institutions including ANS, Hydrabad; TNAI, SOMI and WRAI/CEDPA in India. The coordination institution in Sweden is Karolinska Institute, Division of Reproductive and Perinatal Health. The Sweden Association of Midwives is provoding technical assistance.

via Welcome to MEDP.

Continuity, change and collaboration in midwifery: from Japan, memories of a midwife at 95 years of age; and from India, news of a new project to improve midwifery education and care for safe motherhood | International Midwifery | Find Articles at BNET

RELATED ARTICLE: Indian midwifery delegation to the Netherlands and Sweden.

ICM member association, the Society of Midwives of India, is carrying out a project called ‘Developing inter-institutional collaboration for improving midwifery and EMOC services in India’.

The partner organisations in Europe are the Karolinska Institute, Sweden, and the Swedish Association of Midwives; and in India, the Academy for Nursing Studies, the Trained Nurses’ Association of India (TNAI), White Ribbon Alliance of India and the Indian Institute of Management (IIM).

The project’s main components are the strengthening of midwifery and emergency obstetric services for Sate Motherhood. It involves the establishment of three centres of advanced midwifery training in different parts of India.

via Continuity, change and collaboration in midwifery: from Japan, memories of a midwife at 95 years of age; and from India, news of a new project to improve midwifery education and care for safe motherhood | International Midwifery | Find Articles at BNET.

SASNET: Reproductive Health Karolinska

The Division for Reproductive and Perinatal Health is responsible for the training of midwifes. It is involved in several International collaboration projects, funded by Sida, WHO and the World Bank.

In South Asia collaboration has been established with Trivandrum Medical University, College of Nursing, in Thiruvananthapuram, Kerala (India), Punjab Agricultural University in Ludhiana (India) and Fatima Jinnah Medical College in Lahore (Pakistan).

The Division is also engaged in an inter-institutional collaboration for improving midwifery and emergency obstetric care in India. The partnership project titled ”Developing inter-institutional collaboration between institutions in India and Sweden for improving midwifery and emergency obstetric care services in India” was agreed upon in 2005 between Karolinska Institutet, the Swedish Midwifery Association and a core group of organisations from India (Academy of Nursing Services, Trained Nurses Association of India, Society of Midwives in India, the White Ribbon Alliance India), with funding from the Swedish International Development Cooperation Agency, Sida. The Indian Institute of Management in Ahmedabad, through their Centre for Management of Health Services, coordinates the collaboration. The project was funded by Sida with SEK 20 million for the period December 2005 – June 2009.

via SASNET: Reproductive Health Karolinska.

Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840-1875 — Lang 18 (3): 357 — Social History of Medicine

Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840–1875

Seán Lang

Anglia Polytechnic University, East Road, Cambridge CB1 1PT, UK. E-mail:

Writing on midwifery and women’s health in nineteenth-century India has concentrated on the role of medical missionaries and on voluntary organizations, such as the Countess of Dufferin’s Fund; the role of the state has been generally discounted. However, a close study of government records from Madras Presidency suggests that there was considerable state interest in the issue from the 1840s onwards. This took the form of running and supporting a major lying-in hospital in Madras and smaller lying-in wards at provincial dispensaries, in order to train midwives to work throughout the Presidency. State action was heavily influenced by revulsion at the methods of the dai, the traditional Indian birth attendant. The strategy both at Madras and elsewhere was to replace her with a class of Indian trained midwives who would operate within the community. Various explanations for state interest in the issue are suggested, including political rivalry between the different British Presidencies.

via Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840-1875 — Lang 18 (3): 357 — Social History of Medicine.

604 Dileep Mavalankar at al, Strengthening midwifery services

Strengthening midwifery services


Over the last few years some states and NGOs in India have developed interesting models of midwife-nurse based maternal health care services supported by needed emergency obstetric care services. For example, in Tamil Nadu, the government has developed a model of primary health care centres staffed by three nurses to provide a 24-hour service for childbirth. Tamil Nadu has also established a good system of recording all maternal deaths and conducting a maternal death inquiry to find preventable factors. It has also developed centres for emergency obstetric care throughout the state.

Similarly, the Academy of Nursing Studies, Hyderabad has developed a nurse-based model of maternal care in the Medak district through the government health system. Arth, an NGO has developed a nurse-based model in rural and tribal areas of Udaipur district by appointing its own nurses for a cluster of villages. The Swedish Sida-assisted midwifery and maternal healthcare development project coordinated by IIM Ahmedabad, is also trying to help develop midwifery training, practice and research in five states in India through teacher training, skill training of ANM and networking with Swedish partners. The Indian Nursing Council has also developed a one-year curriculum for training nurses to become practitioners of midwifery. CEDPA with help from Jhpeigo has developed a model of skill-based training of midwives in rural Jharkhand.

via 604 Dileep Mavalankar at al, Strengthening midwifery services.

WHO | Achieving Millennium Development Goal 5: is India serious?

Achieving Millennium Development Goal 5: is India serious?

Dileep Mavalankar a, Kranti Vora a, M Prakasamma b

Absence of comprehensive maternal care services

With the change in the role of ANMs and programme priorities, comprehensive services have been neglected. Not only delivery care but antenatal and postnatal care are also neglected. The National Family Health Survey (2006) shows that only 52% of women receive three antenatal contacts and 42% receive any postnatal care.9 Abortion and birth-spacing services are receiving less attention lately. All of this has a major impact on maternal health indicators.In spite of rhetoric from the National Rural Health Mission, changes on the ground to improve maternal health care are slow and lack focus. We feel strongly that without a clear strategic focus on skilled birth attendance, EmOC and referral services, India will not be able to reduce maternal mortality rapidly. There is a need to provide comprehensive maternal health services, including antenatal care, delivery care, EmOC and postnatal care, within an efficient health system. The extent of the increase in political priority, managerial capacity and resource allocation will determine, if and when, India will be able to meet MDG 5.

via WHO | Achieving Millennium Development Goal 5: is India serious?.

Govt nod for setting up 132 nursing and midwifery schools – India – The Times of India

NEW DELHI: The Government gave its go ahead for setting up 132 nursing and midwifery schools across the country at a cost of Rs 660 crore.

The proposal for setting up the schools during the XIth plan was cleared by the Cabinet Committee on Economic Affairs.

The schools will be set up in high-focus states like Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Madhya Pradesh, North Eastern States, Orissa, Rajasthan, Uttarakhand, Uttar Pradesh, West Bengal and other districts in the country, preferably which do not have auxiliary nursing and midwifery schools.

via Govt nod for setting up 132 nursing and midwifery schools – India – The Times of India.