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

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’.