Records for Life: Re-evaluation and Re-design of a Healthcard Framework

A father and son on their way to getting immunization, Bihar Sharif, Patna, Bihar

RECORDS FOR LIFE

Re-evaluating and Re-designing a Health record

Children playing outside the Phulwari Sharif PHC after getting immunized, Patna, Bihar

CONTENTS: VOL. I

1. INTRODUCTION

1.1 Records for Life: The crowd sourcing competition

1.1.1. The healthcard challenge

1.1.2. How will an improvised Health card help?

1.1.3. Records for Life: A design contest that can save lives

1.2. Why the crowd sourcing approach?

1.2.1. Crowdsourcing generates big numbers; ensures crowd attention

1.2.2. Crowdsourcing links Design and Health information

1.2.3. Crowdsourcing is a platform for knowledge creation and sharing

1.3. Problem statements that the project aimed to understand

2. UNDERSTANDING THE CONTEXT

2.1. Health ecology of Kenya, India and Indonesia

2.2. Geographical, demographics, economic and growth

projections, livelihoods for each country and Rationale behind

choosing the cities under research in India, Indonesia, Kenya

3. APPROACH AND METHODS

3.1. Process map

3.3. Field and Discussion Guides

3.2. Field Partnerships and User profiling 3.4. Expert evaluation framework: Form structure and Parameters 3.5. Scenario and Persona building

3.6. Evaluation Level two: Parameters and Structure for the CKS team

3.6.1. Creation of a four layered process of down selection

3.6.2. Incorporating technical reviewers feedback

3.6.3. Diversity basis critical parameter

3.7. Disaggregating the card and Top 30

3.9. Building the script and Timeline for the focus group discussions

3.8. Cue card stimulus for focus group discussions 3.10. Process constraints

CONTENTS: VOL. I

4. FIELD WORK

4.1. Moderation and Note taking: Process and Challenges 4.2. Picture diary and Visual mapping from field work

5. FIELD INSIGHTS

100

5.1. Relationship with the card

5.2. Cue card based field Insights cross locationally

5.2.1. Unique Identification

5.2.2. Immunization Schedule

5.2.3. Growth charts and Healthcare information

5.2.4. New information fields

5.2.5. Material, Form and Colour

6. REFLECTIONS AND THE WAY AHEAD

123

6.1. Making connections from data 6.2. Looking at the larger picture

7. RECOMMENDATIONS FOR DESIGN

7.1. Concerns for validation

7.2. Systems integration

7.3. Final design recommendations

140

7.1.1. The record as a system and in a system 7.2.1. Insights from the London workshop

7.4. Design criteria

8. CONCLUSION FOR VOLUME ONE AND INTRODUCTION TO VOLUME TWO

155

CONTENTS: VOL. II

8. INTRODUCTION TO VOLUME TWO

9. CONCEPTUALISATION

9.1. Different concepts and Aproaches

9.1.1. Visual metaphors and Illustrations based on visual mapping 9.1.2. Physical format and Size 9.1.3. Paper and Printing

9.1.4. Type and Color

10. CONTENT STRUCTURE

10.1. Content Categories

10.2. Content Architecture

11. FINAL PROPOSED HEALTHCARD FRAMEWORK

12. CONCLUSION

13. REFERENCES

14. ANNEXURE

14.1. Field work guidelines

14.3. London workshop agenda and Final evaluation form

14.2. Questionnaires for all users and Locations 14.4. The Records for Life winnersâ&#x20AC;&#x2122; certificate 14.5. Stakeholders and Key players

15. CREDITS

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

8. INTRODUCTION TO

VOLUME TWO

As mentioned in the previous version, the second volume deals with the design phase of the project. This phase looks into not just the aesthetic aspects of the design but the entire system, resolving design problems with respect to the card and subtle interventions like information flow, hierarchy, context, content, language, comprehensibility, production, feasibility and the way ahead for the health card. Linking design criteria with the challenges in the current card: As mentioned in the previous volume, page 153, the design criteria had been developed from the field insights and design recommendations to give a design direction. This is how the criteria are connected with the breakdowns in the current card.

~ Preservation of card for

~ Easy identification of the

certain sections of the card and

getting spoilt hence often did not

repeatedly asked health workers

take the card along with them

current card was identification.

for that information. Certain

during visits. So, a manageable,

Due to its fragility, the names and

information was absent in the card

portable and handy card was a key

adding value to the card so that

information regarding the identity

regarding health information about

design criteria.

the users retained the card after

were erased making it difficult for

allergies, notes, milestones on the

the health worker to identify the

progress of the child etc. The users

child and the family when they

often forgot to check the due date

came for a Routine Immunization

of the next vaccination which led to

visit. Also, when parents forgot to

missed vaccinations. So appropriate

carry their cards, or carried the

content and its structuring in the

wrong card or misplaced the card

card seemed a necessary criteria.

~ Digital transfer made easy:

~ Manageable, Portable & Handy

technology. Almost all homes

card to be too difficult to handle.

laptops, tablets have become a

child: One of the challenges of the

or when relatives or friends brought children for immunizations at

~ Economical: Design solutions

proposed needed to be cost effective so that they could be feasible and adopted by the government easily.

The world is moving towards

format: The users found the current

have cell phones. Computers,

cumbersome and difficult.

This was specifically for users in

need of the day. So it is not a false

~ Content structuring - Easy

accordian fold hence in due course

the PHC instead of the parents, the identification process became

Navigation, Reminder/Recall system, Milestones: Another

Bihar as the card was a 10-12 page of time the creases of the card would tear. The size of the card was

challenge of the card was the

also disproportionate so it made

inability of users to cohesively go

reading the information difficult.

through and understand the card.

Women found it difficult to keep

Due to illiteracy or semi literacy

the card in their bags, purses or

they were unable to understand

even in house to prevent it from

ssumption that a system which would incorporate technology from a paper based to a technology based data information system is important. Thus the card needed a mechanism for the existing data to be converted to a digital format.

Preservation of data: A major challenge of the card was also

their child was 2-3 years. Therefore preservation of card for memory and sentimental purposes was necessary. Thus the criteria for preservation was stated.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Service delivery mechanism in

available at the taluka hospital.

preventive and promotive aspects

The ADHO is assisted by Medical

of healthcare, a post of Community

The design propositions and the

Officers of Health, Lady Medical

Health Officer (CHO) was proposed

framework of the card created is

Officers and Medical Officers of

to be provided at each new PHC,

to work within the current health

General Hospital. These hospitals

structure as explained below.

are being gradually converted into

Bihar:

~ The district level: In the recent

past, states have reorganized their health services structures in order to bring all healthcare programs in a district under unified control. The district level structure of health services is a middle level management organisation and acts as a link between the state and regional structure on one side and the peripheral level structures such as Primary Health Centres (PHCs) and sub-centres (SCs) on the other side. It receives information from the state level which is then transmitted to the periphery with required modifications to meet the local needs.

Community Health Centres.

peripheral health institutional

~ Community level: For a

one male and one female multi-

successful primary healthcare to be provided. For this purpose one Community Health Centre (CHC) has been established for every 80,000 to 1, 20,000 population,

Source: World Health Organisation Report; Published - 2007

Medicine, Paediatrics, Surgery,

District or

Director, Civil Surgeon, MOI/C, Physicians, Paediatricians

Referral Hospital Civil Surgeon, MOI/C, A-Grade Nurse, Sub District Hospital

Sadar Hospital

Obstetrics & Gynaecology. The CHCs are established by upgrading the sub-district/taluka hospitals

Community Health

or some of the block level PHCs or

Centre

by creating a new centre wherever absolutely needed. ~ PHC level: Many rural

has one medical officer, two

(ADHO). Some provisions are made

purpose health worker.

Government Officials

Nurse, Obstetricians, Gynaecologists,

specialty services in General

services are rendered through Health and Family Welfare Officer

Primary/ Main Hospital

Director, Civil Surgeon, Doctors,

Obstetricians & Gynaecologists, Physicians, Paediatricians

and this centre provides the basic

dispensaries have been upgraded

the office of Assistant District

Bihar

facility is the sub-centre manned by

program effective referral support is

~ Sub-divisional/Taluka level: At the taluka level, healthcare

~ Sub-centre level: The most

State health society,

one female, health workers and supporting staff. To improve

Obstetricians & Gynaecologists, Physicians, Paediatricians MOI/C, Obstetricians &

Gynaecologists, Physicians,

Paediatricians, A-Grade Nurse,

ANM, ASHA, LHV, Mamta, Dai Primary Health Centre

to create the PHCs. Each PHC health assistants â&#x20AC;&#x201C; one male and

Civil Surgeon, MOI/C, A-Grade Nurse,

An organogram of how the service delivery sector works in the health structure

Additional Primary Health Centre

Health Sub-centre

MOI/C, A-Grade Nurse, ANM, ASHA, LHV, Mamta, Dai

ANM, ASHA, LHV, Mamta, Dai

9.1.1. Visual metaphors and Illustrations based on visual mapping: Field insights had shown, that users across all locations had felt the need for simple yet realistic illustrations without any icons or abstract visual imagery. They has also advocated for a step by step iteration of dayto-day activities of motherhood like breast feeding, nutrition and taking care of the child. The need was for simple illustrations which could be comprehended by everyone. Keeping these major factors in mind, visual style sheets were created with varying illustration styles. In the following pages, these styles based on the visual mapping conducted in all three locations

9. CONCEPTUALISATION 9.1. Different concepts and Approaches

(as shown in Volume I) have been explored. They have been treated as different concepts or approaches to create the visual language of the health card.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Illustration explorations

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Final visual style

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

The final visual style chosen was a simple line art style. The images thus illustrated, attempt to fit in all cultural contexts, hence they have a universal appeal. Other than step by step iterations, icons depicting every section of the health card too have been created using the same visual style.

Final visual style

9.1.2. Physical Format and Size The field work insights showed that the users preferred simple, handy, manageable card formats which could be stored and maintained easily. These prototypes have been created using an A3 size sheet. A3 size: 11.7 x 16.5 inches

2. Envelope style single fold and double fold

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

2. A map-fold style

The tri-fold style

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

1. The final chosen format was this one because it is simple to use and

2. A5 format

handle. The centre-stapled booklet

Width ~ 5.9 inches

format keeps the card compact.

Height ~ 8.3 inches

The foldable centre spread flap ensures that more data can be accommodated in the card without the size being compromised. The prototypeâ&#x20AC;&#x2122;s format has been designed keeping in mind usersâ&#x20AC;&#x2122; preferences during field work. The format also saves paper wastage, printing costs and does not require any cumbersome folding, sticking or cutting.

Final Size:

9.1.3. Paper and Printing: The paper recommended for this physical format is of two types. For front and back cover pages ~ 200 gsm, coated/laminated paper. This paper is heavy, sturdy and smooth so stains and water can be wiped off. Being laminated, it would ease the maintenance of the card.

For pages inside ~ 120 gsm,

uncoated paper. This paper is not too heavy or thick and can be easily written on. The printing suggested is Offset as it best suited for bulk printing and saves on cost.

The booklet style with a foldable centre page

9.1.4. Type and Colour: ~ Colour Selection

An important decision while creating a visual language is colour and type to be used in the card. While designing and from the experience in field work, it was understood that colour was a very sensitive and subjective topic and varied from country to country. This was affirmed in visual mapping stories as well. While users in India preferred Green, Yellows and Reds, Kenyan users preferred their current health card color, Purple. Meanwhile people in Indonesia had no such particular preference. Creating a colour which would be universally acceptable is a tall order, so the best route was to

CMYK Values: C ~ 28; M ~ 0; Y ~ 63; K ~ 0

CMYK Values: C ~ 7; M ~ 28; Y ~ 36; K ~ 0

CMYK Values: C ~ 22; M ~ 0; Y ~ 6; K ~ 0

CMYK Values: C ~ 3; M ~ 0; Y ~ 39; K ~ 0

create a colour palette of options with variations so that each country could choose one of the colours which best suited its cultural and social context as the base colour of the card with illustrations on it as

Light green was preferred by many users in India as it signified health, growth, care and progress. Some people also suggested that since

line art.

mothers should have a lot of greens

This would also help in reducing the

show her the promise of good

cost of printing the cards in bulk.

nutrition and a healthy child.

in their diet, a green card would

We often use the phrase â&#x20AC;&#x153;Pink of

Yellow in India was associated

Health.â&#x20AC;? Thus, this soothing colour

with flourishing crops. So it was

of pink seemed appropriate as

one of the favored colours. It was

one of the options. A few users in

Sky Blue (as referred to by many

also chosen in Kenya where users

Indonesia thought pink is a tender

users) this pale shade of blue was

felt that a bold and striking colour

colour that shows a delicacy and

also preferred by many users in

like yellow would make the card

innocence of a child.

India and Kenya.

noticeable and in sight all the time.

~ Type Selection

The type chosen for the card had to be simple and non-characteristic to increase its chances of a universal appeal. Hence, a sans serif typeface

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Child Health Record Champagne & Limousines Bold, 16 pt.

seemed the best fit. For the headers and the body text. Though the text in the card is to be kept minimal, the typeface chosen had to be clean and easy to read. Interestingly, the type style would change as per the country because the script on the card would change depending on

Child Health Record Child Health Record

Major Diseases:

Child Health Record Child Health Record Child Health Record

and Tetanus (locked jaw). Diphtheria mainly

Child Health Record

Ubuntu Regular; Ubuntu Bold; 16 pt.

that countryâ&#x20AC;&#x2122;s language.

Child Health Record Child Health Record Child Health Record Child Health Record

Gotham Thin; Gotham Book; Gotham Medium; Gotham Bold; Gotham Black; Gotham Ultra; 16 pt.

prevents throat infection, whooping cough affects the throat and spreads when an infected person coughs or sneezes. Symptoms include a sore throat, a high temperature and breathing difficulties.

Header: DIN TT Bold, 16 pt.; Body Text: Georgia, 8 pt., 13 pt. leading

Major Diseases:

Tuberculosis (TB) is a bacterial disease which

Sometimes called lockjaw, tetanus can cause painful spasms of muscle contraction. The disease can be fatal. It is caused by bacteria found in soil and animal manure. It can enter the body through a cut or a wound. It can also

commonly affects the lungs. It spreads when

be caught through animal bites.

Major Diseases: a person with the active disease coughs or sneezes. People with active TB have bouts of

DIN Light Regular, DIN Pro Regular; DIN Medium Regular; DIN TT Bold; 16 pt.

DTP (Diptheria Tetanus Pertussis) Vaccine

coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats.

Header: Gotham Bold, 16 pt.; Body Text: Warnock Pro Regular, 8.5 pt., 13 pt leading

Header: Ubuntu Bold, 16 pt.; Paragraph 1~ Body Text: Bell MT Regular, 8.5 pt., 11 pt leading; Paragraph 2 ~ Baskerville Old Face Regular; 9 pt.; 12 pt. leading

~ Type Selection

Major Diseases:

and Georgia Regular was chosen for

Measles Vaccine prevents the body from

OPV (Oral Polio Vaccine) protects the child

body text.

fever, cold and rash. Measles used to be the

from Polio. The polio virus attacks the brain

most common childhood illness before the

and the spinal cord and can cause paralysis. It

vaccine was introduced. It is highly infectious,

is spread by contact with the faeces, mucus or

and spreads when a person with measles

saliva of an infected person. Children can be

sneezes or coughs. It starts as a bad cold with

vaccinated with the oral polio vaccine (OPV)

fever. A rash appears usually after two days.

as well as the injectable polio vaccine (IPV).

Measles can lead to bronchitis, bronchiolitis,

ORV (Oral Rotavirus Vaccine) prevents the

ear infections, croup, and in rare cases,

body from Diarrhoea.

Whooping cough is highly infectious. It is spread through coughing and sneezing. It starts as a cold, but in time the coughing spasms, with their characteristic â&#x20AC;&#x153;whoopâ&#x20AC;?, get more severe and can go on for several weeks. In babies and young children, it may even lead to pneumonia, vomiting, weight loss and, more rarely, brain damage and death. Your child will be protected from the whooping cough by the DTP vaccine. Go to our immunisation scheduler to know when to vaccinate your baby.

Ubuntu Bold was chosen for headers

Ubuntu has been chosen because it is a simple, clean typeface which has a contemporary style and it conveys a precise, reliable and free attitude. Being an open font, it shows wide availability and typographic flexibility. Since it is under an Open License, it can be modified, improved or experimented with. It is available

complications to the nervous system (like encephalitis).

Rotavirus is the leading cause of severe diarrhoea in children, particularly babies

is many written scripts/languages so

The Pneumocoocal conjugate vaccine prevents

between three months and two years of age.

it is quite universal in that sense.

the body from Pneumococcus Bacteria.

The virus spreads through person-to-person

Pneumococcal bacteria are common and

contact, airborne droplets, or contact with

spread when an infected person coughs or

contaminated toys. A child infected with the

sneezes. They cause serious illnesses such as

rotavirus suffers from projectile vomiting and

meningitis, septicaemia (blood poisoning) and

very watery diarrhoea, often with fever and

pneumonia. One in ten cases of meningitis

abdominal pain.

Georgia Regular was chosen as the typeface for body text as this font works great for normal and capitalised text. While kerning, the letters always look good as they fill the space in between, not add to it. It works well in small or big font sizes. Using a combination of sans-serif

is caused by the pneumococcal bacteria. Children who survive it usually have longterm health problems like deafness, epilepsy and learning difficulties.

typefaces as headers with serif typefaces as body text brings in a sense of balance and ease of reading.

Header: Ubuntu Bold, 16 pt.; Body Text: Warnock Pro Regular, 8.5 pt., 13 pt leading

Header: Ubuntu Bold, 16 pt.; Body Text: Georgia Regular, 8 pt., 13 pt leading

Hep B (Hepatitis B) prevents the body from swollen liver. Hepatitis B is a viral disease which causes irritation and inflammation of the liver. It is spread through contact with the body fluids of an infected person. Symptoms may not appear for up to 6 months after the time of infection. Early symptoms may include appetite loss, fatigue, fever, muscle and joint aches, nausea and vomiting, yellow skin and dark urine.

Header: Ubuntu Bold, 16 pt.; Body Text: Baskerville Old Face Regular; 9 pt.; 12 pt. leading

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

10. CONTENT

STRUCTURE 10.1. Content Categories

10.1.1. Unique Identification:

child in the family. It also becomes

~ Developing of a new

another new number for the

In most countries, the first level

the card.

identification number method of identification in a card during the process of immunization is the name of the child followed by the

In the absence of a unified way of generating the number, a new

name of the father, mother etc.

methodology of identifying children

In some countries a separate

only when the child has not been

identification number is also given on the card which could be a number generated by the healthcare facility or a passport number etc. Identification parameters in the current Bihar health card, Patna, Bihar

caregiver to memorise if absent on

This is semi-effective as the identification number can get confusing if there is more than one

by numbers can be adopted. This is able to be identified by name.

22 The identity pages on the front covers of the both the health cards in Bandung, Indonesia

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Everyone now-a-days has a mobile, even in rural areas. This new method would have the familyâ&#x20AC;&#x2122;s mobile number followed by the birth order of the child, incase of multiple children in the family. People already know their mobile numbers so memorising it is not an issue, even if that number is absent on the card. The system is flexible. This image shows how it works. For e.g. if a family has three kids and the identification of second child needs to be filled in, this is how it would be done. birth order of the child

Identification Number :

mobile number

~ Family photograph as a

~ Another address cited as a

If the mobile number as a

Sometimes even the address can be

secondary level of identification

confirmation of identity

parameter for identification is not

used as an identifier in case the first

successful, a family photograph can

two safety nets fail. During field

act as a safety net.

work, it was noticed that mothers often go back to their maternal

It is known that a child’s face

homes during the time of delivery

during that phase is not ideal

and that leads to wrong information

for identification as it keeps on

on the card or forgetting to carry

changing with time, but pictures of

the card.

the family members who bring the

In this scenario, the child’s first immunization could get missed. Giving another address as an identifying parameter could make sure that even if the child is delivered at the mother’s maternal home, when she comes back to her husband’s house, the second address on the card would help in identifying the child and updating any missed vaccinations

child for identification can be used

or information.

as identifiers. During field work, it was observed

Address One:

that the child is often taken by

5, Shanti Vihar, Parsa Bazaar, Patna, Bihar

relatives or grandparents for immunization. Many times they are unable to recollect the right information for identification.

PHC Name:

They might even forget the mobile

Parsa Bazaar PHC, Patna, Bihar

number but incase of a family photograph the health worker can immediately trace the identity of the child. It would also help in case the healthcard is misplaced or lost.

The family photograph clicked at the PHC with child, mother, father and immediate family members

To be filled only when shifting to a new location.

Address Two:

The idea is that the picture of the

Bihar

family is clicked at the PHC itself when the child is born.

6, Mandir gali, Hadtali Chowk, Begusarai,

PHC Name:

Teghda PHC, Begusarai, Bihar

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

~ QR code as a digital recogniser of child’s or family’s identity

In countries where technology is highly evolved, the fourth level of identification, in case all of these methods fail, is a Quick Response

Health record

scan

(QR) code. The way it would work is that when the card is issued to a child, all his information is fed into the PHC database, which in turn generates a code for that child. Incase of any problems or to fast

Health Record Information

track identification, the health worker would need to scan the QR code and all the information of the child and his/her family would appear on the computer screen.

Identification Number: 8130379715-02 The schematic of how information from a QR code gets transferred to any digital interface after scanning

Father’s Name: Mother’s Name: Address One: PHC Name: Address Two: PHC Name:

10.1.2. Immunization Schedule: ~ Detailed information on the vaccinations, Signature for

authentication and Space for extra information

Currently, the information columns that the immunization schedules have are abbreviations of vaccinations, date given, next due date. The new design proposes to add more information to the schedule like full names of vaccinations, specific diseases they prevent and extra space for signature of the health worker giving that particular vaccination to prevent data fudging and notes.

Immunization schedule of the current Bihar Health card

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Birth

6 weeks

10 weeks

14 weeks

9-12 months

15-18 months

16-24 months

uptil 5 yrs

5 - 6 yrs

Ist Dose, 0.1ml, Inter BCG (Bacillus Calmette - Guerin)

dermal, Left Upper Arm

Ist Dose, 0.5ml, Intra muscular, Antero lateral Hep B (Hepatitis B)

OPV 0,1,2,3 (Oral Polio Vaccine)

side of mid thigh

1st Dose, 2

2nd Dose, 2

3rd Dose, 2

4th Dose, 2

drops, Oral

2nd Dose

3rd Dose

2nd Dose, 0.5ml,

3rd Dose, 0.5ml,

Intra muscular,

Antero lateral

side of mid thigh

2nd Dose, 0.5ml, Sub cutaneous, Right upper arm

3rd Dose, 0.5ml, Sub cutaneous, Right upper arm

Penta (Pentavalent Combination), Not given in India

Ist Dose

Ist Dose, 0.5ml, DPT DPT 1,2,3 1,2,3 (Diptheria (Diptheria Pertussis Pertussis Tetanus) Tetanus)

Hep B 1,2,3 (Hepatitis B)

Intra muscular, Antero lateral side of mid thigh

Ist Dose, 0.5ml, Sub cutaneous, Right upper arm

The immunization Schedule has been continued in the next page

The Immunization Chart with full names of vaccines, dosage quantity and site of giving the vaccination

10 & 16 yrs

Birth

6 weeks

10 weeks

14 weeks

PCV (Pneumococcal Conjugate Vaccine), Not given in India

Ist Dose

2nd Dose

3rd Dose

ORV (Oral Rotavirus Vaccine), Not given in India

Ist Dose

2nd Dose

3rd Dose

9-12 months

15-18 months

16-24 months

uptil 5 yrs

5 - 6 yrs

10 & 16 yrs

1st Dose, 0.5ml, Measles

Sub cutaneous, Right upper arm

Vitamin A, 1 - 9 doses

1st Dose, 1ml, Oral

2nd to 9th Dose, 1ml, Oral, every six months

0.5ml, Intra DPT Booster (Diptheria DPT 1,2,3 (Diptheria Pertussis Tetanus) Pertussis Tetanus)

muscular,

0.5ml, Intra

Antero

muscular,

lateral side of

Upper arm

mid thigh

OPV Booster (Oral Polio Vaccine)

Japanese Encephalitis (to be given along with DPT and OPV Boosters)

2 drops, Oral

0.5ml, Sub cutaneous, Left upper arm 0.5ml, Intra

TT (Tetanus)

muscular, Upper arm The immunization Schedule has been continued from the previous page

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

BCG vaccine protects the child

Whooping cough is highly

a person with measles sneezes

can be vaccinated with the oral

infectious. It is spread through

or coughs. It starts as a bad cold

polio vaccine (OPV) as well as the

Tuberculosis (TB) is a bacterial

coughing and sneezing. It starts

with fever. A rash appears usually

injectable polio vaccine (IPV).

vaccines seemed needed in the

disease which commonly affects

as a cold, but in time the coughing

after two days. Measles can lead

health card.

the lungs. It spreads when a person

spasms, with their characteristic

to bronchitis, bronchiolitis, ear

with the active disease coughs or

â&#x20AC;&#x153;whoopâ&#x20AC;?, get more severe and can

infections, croup, and in rare cases,

sneezes. People with active TB

go on for several weeks. In babies

complications to the nervous

have bouts of coughing, sometimes

and young children, it may even

system (like encephalitis).

Rotavirus is the leading cause

with sputum or blood, chest pains,

lead to pneumonia, vomiting,

weakness, weight loss, fever and

weight loss and, more rarely, brain

The Pneumococcal conjugate

particularly babies between three

night sweats.

damage and death.

vaccine prevents the body from

DTP (Diptheria Tetanus

Hep B (Hepatitis B) prevents the

Pneumococcal bacteria are

person contact, airborne droplets,

infection, whooping cough and

common and spread when an

or contact with contaminated toys.

Hepatitis B is a viral disease which

infected person coughs or sneezes.

A child infected with the rotavirus

causes irritation and inflammation

They cause serious illnesses such

suffers from projectile vomiting and

Diphtheria mainly affects the

of the liver. It is spread through

as meningitis, septicaemia (blood

very watery diarrhoea, often with

throat and spreads when an

contact with the body fluids of an

poisoning) and pneumonia. One in

fever and abdominal pain.

infected person coughs or sneezes.

infected person. Symptoms may not

ten cases of meningitis is caused

Symptoms include a sore throat,

appear for up to 6 months after the

by the pneumococcal bacteria.

a high temperature and breathing

time of infection. Early symptoms

Children who survive it usually

difficulties.

may include appetite loss, fatigue,

have long-term health problems

fever, muscle and joint aches,

like deafness, epilepsy and learning

nausea and vomiting, yellow skin

difficulties.

It is important for the parents to know how these vaccines help their child, so a few lines on some of these

from Tuberculosis or TB.

Pertussis) Vaccine prevents throat Tetanus (locked jaw).

Sometimes called lockjaw, tetanus can cause painful spasms of muscle contraction. The disease can be fatal. It is caused by bacteria found in soil and animal manure. It can

body from swollen liver.

and dark urine. Measles Vaccine prevents the

body from fever, cold and rash.

Pneumococcus Bacteria.

OPV (Oral Polio Vaccine) protects the child from Polio.

The polio virus attacks the brain

Measles used to be the most

and the spinal cord and can cause

a wound. It can also be caught

common childhood illness before

paralysis. It is spread by contact

through animal bites.

the vaccine was introduced. It is

with the faeces, mucus or saliva

highly infectious, and spreads when

of an infected person. Children

enter the body through a cut or

ORV (Oral Rotavirus Vaccine) prevents the body from Diarrhoea.

of severe diarrhoea in children, months and two years of age. The virus spreads through person-to-

Source: www.babycenter.in www.immunize.org www.vaccineinformation.org www.wikipedia.com www.cdc.gov

~ Linking the immunization

schedule with growth (height/

Birth

weight)

To ensure that parents understand Date Given:

the importance of routine immunization, linking the height and weight of the child to the schedule would indicate the positive

BCG (Bacillus Calmette - Guerin)

Hep B (Hepatitis B)

Normal Range: Height in cm: Girls ~ 47 - 53 Boys ~ 47 - 57 Weight in kg: Girls ~ 2 - 4 Boys ~ 2.6 - 4.2

growth of the child. Along with

OPV 0 (Oral Polio Vaccine)

the height and weight, the ranges of expected height/weight would Next Due date:

also be given so that if the child was not growing in either of these parameters, the parents and health

Height

worker would know. The main function of adding this information area here is for positive

Weight

reinforcement of the idea that with Name & Signature of Nurse

Anita Devi

every immunization, the child grows and remains healthy. The visualisation on the left shows how the immunization can be

The schematic of how growth of a child can be mapped and linked with the immunization schedule along with the signature of the nurse for authentication

linked to mapping the growth of the child.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

10.1.3. Information on healthcare categories:

10.1.4. New information categories:

~ Additional vaccinations, Notes

As mentioned in the field insights

The new design entries had

vaccination drives occuring

section (on page 112, Volume One),

proposed many new information

users demanded detailed healthcare

fields to be added in the card but

information with emphasis on

only the ones that seem feasible for

important sections and non-

the users across all locations have

abstract illustrations depicting the

been chosen.

information. The new design proposes to have sections on milestones in the childâ&#x20AC;&#x2122;s

~ Hotline number/PHC number/ head ANM/Nurse number Sometimes parents need

growth; breast-feeding, nutrition,

information or help during

bathing, safety precautions and

emergency situations. At such

childcare. However, to keep the

times, incase the local ASHA

information simple and effective so

cannot be contacted, a helpline

as to not overwhelm the parents is

number of the nearest PHC or a

the key.

head nurse would help them. ~ Allergies

Another category that was needed in the card was an allergies section which would help health workers identify adverse reactions any child would have with respect to any vaccination or medication. ~ Blood group, Medical history

These categories would help incase the child needs immediate blood transfusion or needs immediate medical assistance.

Incase of an endemic or epidemic, could be filled in the additional

vaccinations section and the notes section would help incase the nurse or doctor would want to add some more information on the patient.

32 The progression of the how the health card opens from the cover page to the last page

10. CONTENT STRUCTURE

Contd ...

10.2. Content Architecture

The first section of the booklet opens with the Unique Identity page along with essential details of the child and the family. This opens into the second section on the Letter of Acknowledgement which is a special note issued by the PHC where the child is born. This letter is for the parents congratulating them on their new born and asking them to vaccinate and take care of their child for a healthy future. This letter is signed either by the head of the PHC or some official of a higher rank and importance so that it leaves an impact on the parents. The third section, which is openable flap looks at the information on vaccines. It has full forms of the vaccinations, data on how each vaccine protects the child from diseases and why is it important for parents to vaccinate their children.

Section of the card on Vaccine information, the diseases it protects aginst and the need to vaccinate

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

This is the center spread of the booklet which opens into an extendable flap. The flap has vaccine information on the backside and the immunization schedule as a continuous spread

Section of the card that deals with the immunization schedule as an extendable flap

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

The follow up of the immunization

The Final section of the booklet

numbers of the PHC or the head

schedule is a section on allergies

is on the milestones during the

Nurse/ANM.

and notes. It is along with the

growth of the child. It marks the

immunization schedule so that the

important phases as the child

health worker or doctor can write

develops with respect to his/

down notes/appointments and any

her behaviour, physical activity,

other information on the patient.

responses and movement.

The health care section is next

The booklet finally closes into

which has specific pages on breast

the back cover which would have

feeding, nutrition and danger signs.

important information like hotline

The Notes, Allergies and beginning of the healthcare section of the card.

The final section of the card on the milestones of a childâ&#x20AC;&#x2122;s growth and the back page.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Context of use:

~ Using the new card framework

A child identification number

of the card which have to be filled

The illustrations and icons used in

would be generated simultaneously

by the health worker only, place

the card are merely placeholders,

As the proposed health card

along with the sticker and written

for checking due dates and phoen

but indicative of the kind of visual

the beneficiaries i.e. The parents,

framework has a unique

on the slip. A copy of the slip would

numbers for the health worker or

content that needs to be finalised

relatives and other family members.

identification system in two ways

be kept with the PHC for records

PHC in case of any emergency

after field testing and validation for

A segment of the card pertaining to

- the family photograph and the

and another would remain with

the identity would be torn off and

identification page, this would be

the beneficiaries. Hence when the

kept with the PHC for records and

recorded and taken note of by the

beneficiary came for the next visit,

data transfer for the digital system.

health worker at the PHC when

the healthworker would just scan

confirmed by the ASHA (Nurse).

the QR code for identification and

The Nurse would identify the child

incase the beneficiary forgets the

from any one/ or more of these

card, they would ask for the child

parameters in the card - The family

identification number (which is

photograph, Mother/father’s name

easy to recollect) and would feed it

and details, Proof of address and

in the system to access the child’s

the child identification number.

previous record.

PHC using the QR code for digital

health information of the child for

The Digital (QR Code) tearable

The Health worker would also take

then be sent up the hierarchal chain

allergies, other medical conditions,

slip would work incase of digitally

the mother through the entire card

for collection and storage as patient

~ Ownership of the healthcard: The health card will be owned by

~ Ownership of the health information:

The information in the card would be for the beneficiaries. The information copied from the card pertaining to identity, vaccinations given and due dates,

in the system:

All the information in consequent visits would be recorded in the card

The information used in this

for the beneficiaries’ and ASHAs’

framework as content has been

referral and be recorded in the

adapted from the WHO guidelines

PHC registers for backup. This

and validated during field work in

information would then be typed

each location by the health workers.

out from the registers into the system through the data operators in the PHC (in the absence of the scanning). The information would

blood group etc would be recorded

advanced PHCs. The information of

in case of the giving it out for the

records and in the state government

in the PHC in the health workers’

the child would be recorded directly

first time and point out sections

data based health system.

on the system and generated

like the health information, danger

second layer of information would

through a QR sticker specific to the

signs and milestones. She would

belong to the Health Ministry of the

child’s identification and would be

tell the mother to follow up with

Government of India.

stuck on the placeholder for the ID

her/him or the ASHA (midwife)

in the PHC.

incase of questions and doubts. She would also point out specific parts

11. FINAL PROPOSED

HEALTH CARD FRAMEWORK

that specific region.

Needless to say that this proposed framework would have its own set of problems and restraints that would need to be addressed later on but it will definitely be a step up and look at trying to resolve the issues mentioned in the existing card. It will also aim to bring in a sense

Specifications of the card:

of uniformity, accountability, value

a center stapled, handbook/

been missing in the health cards.

The proposed framework is booklet of 16 pages in A5 size, printed on 120-130 gsm paper for inner pages and 200 gsm for the cover. It has information on identity, health, notes, missed/ off schedule vaccination, mother’s pregnancy record, appointments, DIY milestones and vaccine information, as the essentials.

and usability which till now has

Thus, the design framework provided is not the end but the beginning of creating an approach to an improved healthcard.

The cover page of the healthcard with the family picture, validity of the card, place of issue and childâ&#x20AC;&#x2122;s ID.

Paste family photograph clicked at the PHC, here.

The Child Health Record Issued on:

City/Town/Village, State, Country:

Child Identification Number:

Valid till:

Letter of Acknowledgement

Congratulations on your baby

You must be feeling like proud and happy parents. However, to ensure that your child leads a healthy life, it is important that he/she receives all the necessary vaccinations and proper healthcare. You will receive all the help you need from Doctors and Health workers but ultimately, you are the parents and the onus is on you. So, please make sure that you read this card properly, keep it safe and bring it everytime you come for immunizations or a health check-up. From today onwards, this booklet is the identity of your childâ&#x20AC;&#x2122;s holistic development. Treat it with utmost care and respect. We issue you this Letter of Acknowledgement and in turn, ask you to pledge as parents, that both you and your family, will help us to nuture your childâ&#x20AC;&#x2122;s future. Thank you. We wish you all the very best.

Signature of Parent

Date

Signature of MOIC

A Letter of Acknowledgment congratulating the parents and asking them to take an oath to get their children immunized regularly and treat the card with care. This is to add an emotional connect and a sense of responsibility to the card.

Identification This section is for identification of your child, your family and you. It is important to fill this section correctly and carefully so

The Unique Identification section (front)

that the following health check ups and immunizations of your child do not get mistracked. This information is to be filled by the health worker only.

Mother’s Name:

Father’s Name:

Child’s ID Number:

Date of Birth:

Gender: Date

Month

Year

(F)

(M)

Father’s Medical History:

Blood Group

Mother’s Medical History:

Blood Group

Tear Here

ID for Digital Tracking:

Mobile number followed by the birth order of the child To be torn by the healthworke (PHC copy)

ID for Digital Tracking:

Mobile number followed by the birth order of the child The Unique Identification section (back)

Guardianâ&#x20AC;&#x2122;s Name: To be filled in the absence of a parent.

Guardianâ&#x20AC;&#x2122;s Relationship to the Child:

Address One:

PHC Name: Current address and PHC name to be filled.

Address Two:

PHC Name: To be filled only when shifting to a new location. Tear Here

Information on Vaccines It is important for you to know why these vaccinations are given to your child and what diseases they protect him/her from. Incase you have more questions on this, feel free to discuss it with your health worker.

BCG (Bacillus Calmette - Guerin) vaccine protects the child from Tuberculosis or TB.

1 Dose

Tuberculosis (TB) is a bacterial disease which commonly affects the lungs. It spreads when a person with the active disease coughs or sneezes. People with active TB have bouts of coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats.

DTP (Diptheria Tetanus Pertussis) vaccine prevents throat infection, Whooping cough and Tetanus (locked jaw).

Diphtheria mainly affects the throat and spreads when an infected person coughs or sneezes. Symptoms include a sore throat, a high temperature and breathing difficulties. Sometimes called lockjaw, Tetanus can cause painful spasms of muscle contraction. The disease can be fatal. It is caused by bacteria found in soil and animal manure. It can enter the body through a cut or a wound. It can also be caught through animal bites.

3 Doses

1 Booster

vomiting, weight loss and, more rarely, brain damage and death.

Detailed information on Vaccines

Hep B (Hepatitis B) prevents the body from swollen liver.

Hepatitis B is a viral disease which causes irritation and inflammation of the liver. It is spread through contact with the body fluids of an infected person. Symptoms may not appear for up to 6 months after the time of infection. Early symptoms may include appetite loss, fatigue, fever, muscle and joint aches, nausea and vomiting,

3 Doses Measles vaccine prevents the body from fever, cold and rash.

yellow skin and dark urine.

Measles used to be the most common childhood illness before the vaccine was introduced. It is highly infectious, and spreads when a person with measles sneezes or coughs. It starts as a bad cold with fever. A rash appears usually after two days. Measles can lead to bronchitis, bronchiolitis, ear infections, croup, and in rare cases, complications

1 Dose The Pneumococcal conjugate vaccine prevents the body from Pneumococcus Bacteria.

to the nervous system (like encephalitis).

Pneumococcal bacteria are common and spread when an infected person coughs or sneezes. They cause serious illnesses such as meningitis, blood poisoningand pneumonia. Children who survive it usually have long-term health problems like deafness, epilepsy and learning difficulties. This vaccine is not given in India.

3 Doses OPV (Oral Polio Vaccine) protects the child from Polio.

The polio virus attacks the brain and the spinal cord and can cause paralysis. It is spread by contact with the faeces, mucus or saliva of an infected person. Children can be vaccinated with the oral polio vaccine (OPV) as well as the injectable polio vaccine (IPV).

3 Doses + 1 Booster

Detailed information on Vaccines

The complete immunization schedule as an extendable flap, size ~ A3 vertical, centre spread of the booklet

A color hierachy option for the immunization schedule as an extendable flap, size ~ A3 vertical, centre spread of the booklet

A close-up of the immunization table as sections.

Immunization Schedule This the vaccination chart for your child. It has to be filled only by the Nurse/ANM at the PHC. Please ensure that the date of receiving the vaccination and next due date has been clearly marked in this table. Also, make a note of the next date of immunization.

14 Weeks 10 weeks

Date Given: Date Given: OPV 0 (Oral Polio Vaccine)

OPV 0 (Oral Polio Vaccine)

Penta (Pentavalent Combination)

PCV (Pneumococcal Conjugate Vaccine)

Normal Range: Height in cm: Girls ~ 47 - 53 Boys ~ 47 - 57 Weight in kg: Girls ~ 2 - 4 Boys ~ 2.6 - 4.2

Hep B (Hepatitis B)

Next Due date: Next Due date: DPT (Diptheria Pertussis Tetanus)

ORV (Oral Rotavirus Vaccine)

DPT (Diptheria Pertussis Tetanus)

Weight

Height

PCV (Pneumococcal Conjugate Vaccine),

Normal Range: Height in cm: Girls ~ 47 - 53 Boys ~ 47 - 57

Weight in kg: Girls ~ 2 - 4 Boys ~ 2.6 - 4.2

Height

Weight

Name & Signature of Nurse Name & Signature of Nurse

The immunization schedule for the mother spread out in three phases including the three Ante-natal and vital signs checkups.

This is the additional vaccines and missed vaccines section of the card for Health Workers and Doctors to track and record vaccinations for unprecedented vaccine drives or missed vaccines.

Medical Notes

This is the Medical Notes section of the card for Health Workers and Doctors to note down any other information about the childâ&#x20AC;&#x2122;s development

This section is for the Health workers or Doctors. They can make notes or list down any abnormalities/medical conditions if necessary. Please make make sure that they discuss these notes with you while writing them down.

Date (Day/Month/Year)

Name of the Doctor/Health Worker

Signature

Notes

Allergies and Other Information

Blood Group A+

A-

B+

B-

O+

O-

AB+

AB-

TB Results

HIV Results

Positive

Negative

This section is for the Health workers or Doctors. They can list down any allergies to vaccinations, medicines and/or food that your child might have. Please make sure you discuss this information with them in

Date:

detail before they write it down.

Date (Day/Month/Year)

Name of the Doctor/Health Worker

Signature

Name and Cause of Allergy

Treatment

Feeding & Nutrition Breast milk is the safest, best and most nutritious food for your baby in the first six months. It is full of vitamins and nutrients. It will protect your child from all diseases and help him/her grow.

Positions for breast-feeding: Find a comfortable place for you and your baby. Before breast-feeding, you can hold your baby in any of these three positions.

The ‘front hold’ or ‘cradle’ position

The ‘under-arm’ position

The ‘lying-down’ position

Getting a good hold while feeding: The pictures below show how you can hold your breasts while feeding so that you can be sure that your baby has a good feed everytime.

STEP

Information on breast-feeding from the Healthcare section Hold your breast in a ‘C’ or a

Aim the nipple towards your

The best hold is when you don’t

‘U’ hold. Make sure that your

baby’s upper lip/nose. The

feel any pain and your baby is

baby’s bottom lip and chin

baby’s lips should be wide

getting the milk.

touch your breast.

around your breasts.

Getting proper nutrition is the key for your baby’s growth and healthy life. The pictures below will show you what to feed and not feed your baby as he/she grows.

Birth to 6 months:

Information in detail on Feeding and Nutrition in phases of the baby’s growth

Feed your baby only breast milk when he/she feels hungry for the first six months, at least 8-12 times a day.

Breast-milk, 8-12 times a day

No water, soda, juice or solid food

No milk bottle

No formula or powdered food

6 to 8 months: Continue feeding your baby breast milk for 4-6 times a day. Begin adding porridge (milk+mashed rice) and other soft foods like mashed vegetables and fruits to the baby’s diet. Wait for 3-5 days before adding a new type of food.

No sugar or oil

Breast-milk, 4-6 times a day Porridge, 3 times a day Soft Foods

8 to 12 months: Continue feeding breast milk for 4 times a day. Give three meals a day to your baby. Add more variety of fruits and vegetables to the diet. You can now introduce mashed meats to the diet. Wait for 3-5 days before adding a new type of food.

Breast-milk, 4 times a day 3 meals in a day More types of fruits and vegetables Introduce mashed meats

12 months onwards: Add snacks to your babyâ&#x20AC;&#x2122;s meals Include breads and diary to the diet

Information in detail on Feeding and Nutrition in phases of the babyâ&#x20AC;&#x2122;s growth

Danger Signs These pictures show some of the danger signs you should be aware of. Incase your baby shows any of these symptoms, take him/her to the nearest PHC immediately!

A very high fever

A high fever with a rash

Lethargic

Illustrative examples of Danger Signs seen in the baby

5. Illustrative examples of Danger Signs seen in the baby. Also a reminder of the PHC helpline/ local health worker number

Shaking and jerking like a seizure or shivering movements

Vomiting or Diahrrea for 24 hours or more

During any of the above conditions or in an emergency situation, call your local healthworker/PHC helpline number given at the back of this card.

Milestones These pictures show the overall growth of your child. Every stage in your child’s life is marked by certain physical and emotional symptoms. The health worker will discuss your child’s progress and tick your responses in the boxes below. This will show you how well your child is developing. Incase of doubts, feel free to speak to the health worker.

Birth to 6 weeks: Recognises your voice Turns towards your breasts during feeding Responds through body language, fusses and cries

6 weeks: Starts to smile Raises head when lying down on the stomach Calms down when rocked, cradled or sung to

Instruction for the healthworker: Please ask about these symptoms in detail during every visit and tick in the boxes given. Have a conversation about the child’s progress with the family as well. If need be, please make notes in the Notes section of the card.

10 weeks: Can hold head up Coos, makes gurgling and other sounds Follows things with his/her eyes

The Miletones section as an interactive exercise, to increase dialogue between the child’s family and health worker.

14 weeks:

9 to 12 months:

15 to 18 months:

Facial Expressions

Begins to call you ‘mom’ or ‘mamma’

Begins walking and imitates actions

Body movement, reaches out for things

Begins crying when you leave the room

Can drink from a glass/cup

Interacts and responds to other people

Begins to crawl and copies gestures

Points to things he/ she finds interesting

19 to 23 months: Speech development, begins saying single words

23 months onwards: Turns pages of a book, begins reading, writing, telling stories

Begins walking, may climb steps

Shows affection for friends

Throws and plays with objects, begins playing with other children

Begins hopping, skipping, jumping and kicking

The Miletones section showing the phases in the child’s holistic development as he/she grows.

PHC Helpline Number

Phone Number of Head ANM/Nurse

Phone Number of local health worker

If lost or found somewhere, please return it to the person in the ID page or the PHC mentioned in that page or call any one of the numbers above.

Issued by the Ministry of Health State Government of Bihar India, 2014

The Backpage of the health card with the emergency contact numbers and lost and found message.

The Health card framework, in print

Various elements of the health card framework

Filling in and using various sections of the healthcard framework

Opening the immunization table spread in the booklet

65 In my introduction to this project,

the problem statement for us. He

of course!), or falling prey to the

I wrote about the current state

asked, “People ask us to get our kids

societal pressures or being unaware

of routine immunization, how

immunized. I ask, what is in it for

themselves that their duties exceed

the project fits into the realm of

us if we do that?”

beyond asking names, giving vaccinations and maybe a line or

immunization and health and how This question is surprisingly an

platform to create awareness and

answer to so may of our queries.

get conversations started. However,

People are so used to living in silos

Another aspect of looking at

as I conclude this project, I would

that they are unable to forsee how a

healthcare is the scope of decision-

like to share the bigger picture of

simple thing as immunization can

making with respect to users.

my entire journey of understanding

be a prerequisite for their healthy

Do mothers really take decisions

the health ecology of various

life, family or sustainability.

about their pregnancies and their children? or is it the mothers-in-law

countries these past few months, especially my own country, India.

12. CONCLUSION

two on healthcare.

crowdsourcing is an interesting

Compartmentalization and

who call the shots? In all of this, the

fragmentation of everything has led

father is observed to be absent. It is

The subtle nuances of human

to this short-sightedness. People

seen that his duties majorly revolve

behavior conditioned over so many

look at surviving day-to-day the

around taking his wife to the clinic

years, constraints, understanding,

same as being healthy.

during labor and bringing her back afterwards. Hence, the plan of the

context and intent, all get lost, if pitted against a serious topic as

The gaping hole in peoples’

child’s health in the aftermath is

immunization but traveling across

mentality is because of the

completely on the mother or the

the state of Bihar and listening to

unobliviouness towards looking at

other elders of the house.

stories and experiences from my

the bigger picture; the linking of

colleagues in Kenya and Indonesia,

duty and responsibility to health

In the absence of a primary

made me realise, that the picture of

with ulterior motives, creates a

caregiver who undertsands the

health is much more complicated

major disconnect.

need of medical care and can take decisions about the child makes

than immunization, in our country at least.

Unfortunately, the people

things even more difficult for the

responsible for joining these dots

health worker.

During one of our field visits, a

for parents have taken many a

parent put forth a very simple yet

shortcut in the garb of strictly

hard-hitting question, summing up

performing their duty (in theory

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Comparing the health systems of

help the ones who avail it, could

It is common knowledge that

One valuable lesson I learnt from

India with Kenya and Indonesia,

also be a valid factor.

health has become politicized

all this is that field work, as intense

and commercial, and to work in

as it may be, is an important aspect

deep-rooted. Literacy, mistrust,

Another aspect to look at during

such a field is not an easy task and

of not just research but design

ignorance, accountability,

such a project is the morality and

intellectual property regarding

too. And in the midst of all the

detachment from technology are

ethical issues regarding privacy

health data is one of the issues

trials and tribulations, one cannot

some of the factors which have

and access of data. As seen on

that comes up as a big challenge

forget that our roles in the work are

attributed to this.

field, we and our sponsors, as

even in academic projects. The

pre-defined. We are not there as

complete strangers were asking

freedom to share knowledge

social activists but researchers and

Looking at the landscape of health

and discussing sensitive and

and information with peers and

designers, so our objectivity cannot

in its entirety, the health card is at

private information from parents

colleagues to generate awareness,

be compromised at any point. As a

a tiny locus point. Maybe irrelevant

and nurses to use for our study.

trigger discussions and debates, is

designer, my inherent instinct is to

in the face of such pressing, larger

Though all permissions were in

often lost in the midst of the red

problem-solve but as a researcher,

issues but it is a beginning; the hope

place, one still questions as to how

tapism. One also has to make sure

I trained myself to question; look

of pin-pointing a start somewhere.

the privacy of these people and

that the true cause and objective

into the ‘hows’ and ‘whys’.

their stories is being maintained

of the project is not lost amidst all

It maybe a small endeavour but one,

throughout this process and not

the other agendas that are being

Hopefully this journey has not only

none-the-less, in the right direction.

getting compromised. Even as

fulfilled through the project. This

made a good researcher but a better

In the sum total of things, in

suggested in the framework, the

often comes up when working

designer. At the end of the day, we

perspective, the card may hold a

PHC and government have all the

with big research firms and donor

may not have solutions to all the

superficial and small part but it is

information of the beneficiaries.

agencies working in silos and not

problems that we see around us, but

important. Not just for people who

Who is making sure that this

collaborating with each other in

through the right approach, we can

fail to understand its importance

information is kept private and not

order to portray one upmanship

at least set the triggers in motion

but moreover, the ones who take

in the wrong hands or being taken

over the other.

and get the right conversations

the pains to try and use it but fail

advantage of?

the problems here are much more

started. That, for me, is the true Looking at all these scenarios, this

miserably due to its flaws. There are dangers of proposing a

project has taught me to look at

One may argue that drop outs in

framework based on information

research from the lens of a designer

the RI (routine immunization)

from three countries with a small

- problem solve but also question

cycle could be attributed to peoples’

data set of 120 odd subjects. As a

things; draw lines between being a

superstitions, myths or ignorance

designer it becomes challenging to

researcher and designer and align

but the failure of a healthcard to

ideate and validate design decisions

them, when needed.

based on such a small sample size.

meaning of design and research.

The facade of a house with a religious symbol painted on the door to ward-off evil, Parsa Bazaar, Patna, Bihar

68 13.REFERENCES

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Bibliography:

Webliography:

National Immunization Program Indonesia,

www.bmgf.org

2010-2014 - Directorate General for Disease

www.wordpress.in

Control and Environmental Health, Ministry of

www.nrhm.gov.in

Health Republic of Indonesia, 2010

www.nid.edu

1. Comprehensive Multi Year Plan

www.cks.in

www.who.int 2. Country Cooperation Strategy at a Glance:

www.gavi.org

Kenya - World Health Organisation (WHO)

www.unicef.org

Report

www.babycenter.in www.maha-arogya.gov.in

3. Child Immunization Cards: Essential Yet

www.immunize.org

Underutilized in National Immunization

www.vaccineinformation.org

Programmes, United Nations Childrenâ&#x20AC;&#x2122;s

www.wikipedia.com

Fund (UNICEF) - David W. Brown, The Open

www.cdc.gov

Vaccine Journal, 2012

www.wisegeek.com www.rpinstitutions.com

4. The Vaccine Delivery Innovation Initiative

www.wikipedia.com

Report - Center for Knowledge Societies (CKS),

www.facebook.com

2009-2010

www.twitter.com www.quora.com

5. User Centered Systemic innovation in Public Health: A case for the Bihar Innovation Lab Whitepaper by Center for Knowledge Societies (CKS) and Bihar Innovation Lab (BIL), 2012

www.qrcode.kawya.com

69 14.ANNEXURE

14.1. Field work guidelines Going for field work is no easy

personal space especially with any

task since it depends on a series of

digital media like cameras.

external factors - Usersâ&#x20AC;&#x2122; mind-set, environment while conducting

Phones need to be on silent mode

interviews, the social context, the

or swtiched off while conducting an

ambience of the surroundings, the

interview or discussion.

attitude of the moderator taking the interview, the comfort level

A consent form needs to be

established between the moderators

explained to and signed by the users

and the users and so on. Hence field

before any study.

work is set by certain guidelines which have been formulated to

Users should be aware that they can

make it easy, fun and smooth.

leave the interview or discussion if they feel uncomfortable.

The protocols (FGDs / personal

FGD with ANMs while they speak freely about the flaws of the current card, CKS Patna guest house, Boring Road, Patna, Bihar

interviews / discussions /

It is imperative to make the

shadowing of the users) need to be

participants aware of all video/

conducted with a field manual i.e. a

audio recording systems while

guide with a written script or a list

taking their consent.

of questions. Incase of a discussion or a While shadowing or interviewing

workshop, materials need to be

someone, it is tried as best as

provided by people conducting the

possible to not intrude in anyoneâ&#x20AC;&#x2122;s

discussion like a round table and

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Before beginning a discussion or

received card entries from around

to the more important ones, like

an interview, it is the onus of the

the world and would want your

taking their permission to record or

moderator to introduce himself/

inputs on them so that the cards

photograph them or their homes.

herself and the team first, followed

can be improved and made more

by a brief description of the

helpful in fulfilling your regular

Attire too plays an important role

organisation and project and then

responsibilities on field. We wish to

while conducting field research.

ask the users for an introduction.

understand which of these cards are

Formal or semi-formal traditional

more helpful for you, since you have

attire is advised while interacting

While doing so, thanking and

had experience of working on field.

with the users.

acknowledging the participants for

Please note there are no right or

their time is a required practice. For

wrong answers. We want all of

Similarly, while conducting such

example the moderator during this

you to participate so that we can

interviews in the company’s private

project had a ready script prepared

understand your opinions about

setting, participants’ comfort is

for an introduction which went like

what needs to be changed about the

primary. Offering refreshments, tea

this: The moderator said: “Good

existing health record cards.”

etc. is a part of the protocol.

you to the workshop. Thank you

Another important aspect of field

Checking equipment before

for taking out time to be here. My

work is knowing your role within

the discussions, and collecting,

name is ______. I am from _____.

the team structure and if need be,

archiving and digitising data at the

We have, as part of our team today,

stepping up to reprise someone

end of each day, planning for the

design researchers from CKS, a

else’s role. As it so happened,

next day and team meetings within

consulting firm in India. CKS

my earlier role was as to assist

the same location and cross location

partners with different kinds of

the moderator, note-taking and

for sharing insights, is also part of

companies to conduct research and

photography but in a few of the

the work.

design activities aimed at improving

latter sessions, I was asked to step

video) and an audio recorder.

existing products and services. Let

up and moderate the sessions.

The use of local terminologies is

project and what we are attempting

While conducting interviews or

long hours, bad weather, difficult

to achieve through this workshop.

discussions in the users’ homes or

terrain or unproductive discussions

Bill and Melinda Gates Foundation

villages, all their social customs and

with participants, but passion,

has launched an initiative to

practices need to be respected, from

dedication and motivation within

understand, redesign and improve

the minutest ones like, taking off

the team is important to keep up

health cards for children. We have

slippers while entering their homes

the morale!

morning everyone. We welcome

chairs for participants; stationary Utsav from the Bihar team checking the video recording of an FGD via wall projection, CKS Patna guest house, Patna, Bihar

(pens, pencils, paper), diaries for note-taking, cameras (both still and

advised as much as possible while speaking to participants. Also, language to be used should be simplified and sensitized to the education level of the participants.

me tell you a bit more about the

Field work can be trying and tedious many times esp. due to

71 The guide for these discussions

Q. Apart from the card what other

use to identify the child?

had been in verbatim. The

immunization tracking methods

(10 minutes)

sections where the moderator/

have you used?

team were required to conduct the proceedings in a specific way, have been marked in italics. Protocol Guide for Health Workers:

The FGD begins with: a. Name b. How long s/he has been working and how long they have worked with the card c. Area that they cover

14.ANNEXURE

Q. How do you use the

Contd ...

14.2. Questionnaires for all users and Locations

immunization card?

Phase 1 - Cue card based activities:

(a). Unique identity

(b). Immunization schedule

(Moderator shows them paper based cards of unique identity parameters like name, photograph, birthmarks, biometrics and finger prints etc.).

(c). New function fields

Q. These are a few new

(e). Color

been submitted, that could be

(d). Visual metaphor (f). Material & form

(a). Unique Identification cue

cards {No. of cue cards - 4} Paper based voting (10 - 15 minutes)

identification ideas that have added to the card (a photograph of the mother and the baby, marking birthmarks on the card) / technology (barcodes). What do you think of these ideas?

Probe: To understand the important

(Moderator facilitates discussion for

fields for identification and

a couple of minutes, on pros, cons

(Probe into the entire use case

openness to the use of technology as

etc.)

scenario; when do they issue it to the

an aid.

mother, how do they use it?)

Q. If we could introduce only one (5 minutes) Moderator begins with

of these new identification ideas,

Can you think of any interesting

an open ended discussion, where

which one do you think will help

experiences that you may have had

participant experiences of handling

you accurately track the identity

with the present immunization

verification of identities on the card

of a child in the best way possible?

card, good or even otherwise?

are discussed and the problems they

Please note your name and the code

have faced for the same.

of the idea on the post-it in front of you.

Q. What are the problems that you experience on field with the present

Q. How do you generally verify

health record cards?

the identity of the child? What

Q. Thanks. Please tell us (one by

challenges have you faced in

one) about the choice you have

(Moderator facilitates a brief

checking the real identity of a child?

made and why you think this is the

discussion).

What are the other methods you

best compared to others.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

(Moderator facilitates a brief

of 2, I’d like you to go through

Q. Thanks. Please tell us (one by

in the card. Here are some of them.

Probe: Counseling information

discussion on the same).

the 5 cards that I am giving to

one) about the choice you have

(Place cue-cards on table). Please

given in terms of time and growth

you. Just take a minute or two to

made and the reason for the same.

have a look.

representation.

clarify something in the card, you

(Moderator facilitates a brief

(Moderator facilitates the

may discuss with your partner. (3

discussion and then asks them to

discussion. In case the categories are

Growth Charts (8 – 9 mins).

minutes)

read/show/hold up their choice

not self evident to the participants,

Q. How do you track the growth of

and discuss what did they liked

an explanation will be given to them

the child at present?

Now, I’ve written some basic

in the table; probes into why

regarding the same).

information on this white board.

they choose those cards and the

(b). Immunization Schedule cue cards {8 cue cards} (30 minutes) Probe: Ease in understanding of

see these cards. If you want to

information, clarity, time taken to fill. The routine immunization schedule is at the heart of our research with this card. We want to understand how to design this in the best and most effective way. (Moderator shows the existing card and points to the immunization schedule).

Name of the child: Shiv Kumar

comprehensibility of the data field).

(Moderator places cue cards on the Q. If we could only add one or two

table).

of these data fields, which ones do

Date of BCG: 14th Dec. 2013

Q. Now I would like you to

you think will help add value for

These are some new ways in which

OPV1: 14th Dec. 2013

collectively discuss and vote for the

you and the beneficiaries most?

designers have designed the growth

top 2 (ranked 1st and 2nd) and the

Please note your name and the

charts. We would like you to take 2

calculate this on your own, based

bottom 1 and tell us why? There are

codes of the 2 top ideas on the post-

to 3 minutes to review them.

also these three ideas that I want

its in front of you.

LOT NO. : A3121

what you think of them.

Q. Thanks. Please tell us (one by

HEP B: 14th Dec. 2013

NEXT DUE DATE: Please on the date given.

Q. So, what do you think of them?

to share with you and understand one) about the choice you have

(Moderator facilitates a brief

Q. Can you tell us a little about

I would like you to fill this

(Show and explain radial, bird

made and why you think this is the

discussion on pros and cons

the immunization schedule in the

information into the 5 cards

icons, tree design – facilitate brief

best, as compared to others.

etc., probes into the visual and

existing card? Can you recollect if

in front of you. Please do this

discussion).

you’ve ever had a challenge while

individually. We have cards for all

reading it? If yes, what kinds of

of you. Please do not discuss while

problems occurred?

you are filling them. If you have

(Moderator facilitates brief

on your experience of filling these

Probe: Prioritization of new

discussion).

cards, I would like you to analyse

information.

any questions, please ask me. Based

(c). New Information Fields /

Value {5 cue cards} (15 minutes)

and decide the ones that according Designers have created new ideas/

to you are best (2 of them perhaps)

Q. Designers have come up with

new ways of representing the

and which one you liked least. So

some new ideas of what new kind

immunization schedule. In groups

top 2 and bottom 1.

of information could be introduced

informational styles and acquires (Moderator facilitates brief

understanding of preference

discussion).

patterns, asks why).

Is there any other kind of

Q. Which of these according to

information that should be included

you is best (2 cards) and worst

in the card? How would it add value

(1 card) in terms of ease of use

to the card?

and understanding by you and

d). Visual Metaphor cue cards (15 minutes)

beneficiaries? Please note your name and the codes of the 2 top ideas on the post-its in front of you.

Q. Thanks. Please tell us (one by

understanding of preference

(Moderator displays cards on the

one) about the choice you have

patterns, asks why?).

table).

Q. Which of these according to you

Q. Which color out of these would

are the best (2 cards) and worst (1

you choose for the immunization

(Moderator facilitates a brief

card) for the purpose of making

card?

discussion).

beneficiaries understand and

made and why you think this is the best, as compared to others.

Healthcare Counselling

information (5 – 7 minutes) Q. How do you counsel mothers on how to take care of the child at present? Do you have a provision

(Group discussion on choosing which

and the codes of the 2 top ideas on

colors work or don’t work and why).

(e). Color cue cards {3+2 cue cards} (20 mins. tentative)

Phase II – Voting on the entire

individual choices in the post-its in front of you.

card {15 cards} (30 minutes)

Q. Thanks. Please tell us (one by

Probe: on what basis they are

made and the reason for the same.

one) about the choices you have

making their choice.

remember? Please note your name the post-its in front of you.

-------- Tea & Snack break -------

Colour Coding: Color as a

function in terms of information system and coding.

(Moderator facilitates a brief (Moderator displays all the cards on

Q. Now I would like you to Thanks for your wonderful feedback

collectively discuss and vote for the

on the cards presented till now.

top 3 (ranked 1st and 2nd) and the bottom 1 and tell us why these are

in your card that supports the

Probe: Cultural context of color,

(Moderator displays colour coding

We were showing you different

information you give them?

preferences based upon personal

cue cards on the table).

parts of the cards to get specific

experiences, Color as an indicator

discussion).

the table).

your choices?

feedback. Now I’d like to present

We have now come towards the

(Moderator places the cue cards on

of segregation of information, Color

Color has been used in the design of

the complete cards that have come

end of this discussion. Do you have

the table).

as an indicator of importance, Color

these cards. Please take a minute to

in. There are different kinds of

any last minute thoughts that you

as an indicator of prioritization. We

see them.

entries that have come in. Please

would like to share with us?

These are some new ways in which

are looking for quick responses and

designers have visualized or drawn

open ended discussions.

healthcare information. We would like you to take 2 to 3 minutes to review them. Q. So, what do you think of these? (Moderator facilitates a brief

Discussion on color in a social context or as an aesthetic.

take a look at these cards. You Q. What do you think of these?

have 15 – 20 mins to look at all

Thank you so much for your time

(Discussion. If the respondents have

of them. You can even note down

and co-operation. Hopefully your

not understood the coded function,

things you like or dislike and any

insights and feedback will help us

explain colour according to time or

other thoughts you may have while

improve and design a better card.

according to vaccine).

viewing the cards and then we’ll have a discussion on them.

Q. If you had to choose a colour for a healthcard which one would it be

Q. Which one do you prefer and

and why? (Discussion).

why? (Collective discussion and

Based on your review of these cards,

choice).

I would like you to analyse and

discussion on pros and cons etc., probes into the visual and

Q. Which colour do you associate

decide your 3 favourite ones and

informational styles and acquire

with health? (Discussion).

which one you liked least. So top 3 and bottom 1. You can note your

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Snippets from field trips to Begusarai, Dandari, Mehamahangarh and Katahri to engage users for interviews about the health system in Bihar

A foggy, cold, winter morning before an FGD, CKS Patna guest house, Patna, Bihar

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Phase 1 - cue card based activities:

(a). Unique Identification cue

cards (4 cue cards) (15 minutes)

14.ANNEXURE

family? Has it ever happened that you got confused as to which health card you have to carry for the vaccination? Q. If you could make one suggestion

(Moderator to encourage an open

to the existing card to better

discussion so that a variety of

identify your child, what would that

problems encountered on field can

one suggestion be?

be identified). (Initiate an open ended discussion

Contd ...

14.2. Questionnaires for all users and Locations

Protocol Guide for Beneficiaries: Beneficiaries had to introduce themselves as per the following headers: a. Name b. Occupation (if any) c. Number of Children d. Who takes the child for immunization? e. Has your child missed any vaccination? f. Do you carry a health card every time you take your child/ children for immunization? g. What kind of problems have you experienced/faced with the present health record card?

Probe: Is there a/any need to

as to what those changes could

reinforce security of unique identity?

possibly mean. For example, do they believe than an additional data

Q. All of you have at one point or

field needs to be added? In case no

the other, taken your children for a

responses are received, then further

vaccination. In all these instances,

discussions will be facilitated by

has it ever happened that the ANM

the cue cards that we show in this

has found it difficult to identify

section).

your child? We have a few cue cards with us. Have you faced problems like, the

We want you to please have a look

photo/writing getting smudged or

at these cue cards one by one and

that the card has worn out thus

tell us which are the two best ones

making it difficult for the ANM to

or and one that you think is not

identify the child?

needed.

How many children do you have?

(The cards are explained one by one

How do you manage tracking their

to the participants).

health information? Are you able to identify which card belongs to which child of your

(b). Immunization Schedule cue

cards (8 Cue Cards) (20 minutes)

We will now be looking at the

a. Providing information that you

important and should be added to

growth charts and healthcare

(This will be followed by a

immunization schedules. We

need for your child

the current card and why? Similarly

counseling information).

generalized discussion on understanding the reasons behind

which are not important?

would like to start this section, by understanding the importance

b. Information that is easy to

that you associate with the

understand

immunization card. One by one, please present the card

(d). Visual Metaphor (5 Cue Cards) (10 minutes)

Q. What kind of information do you

the choices made by them).

think needs to be present on the card itself?

Q. Is there a specific color that you associate with health?

Probe: Ease of comprehension

that has been chosen by you (paper

Visual metaphor Cue cards

Q. From the different kinds of cue

and understanding, understand

based voting) and tell us why you

(includes growth charts and

cards that you see, which cue card

What should be the color of a

perceived importance of the

think the card is better than the

healthcare counseling information)

do you think has information that

health card and why?

immunization schedule

other cards.

is most needed and isnâ&#x20AC;&#x2122;t there in the Probe: Understand primary source

Q. Do you think immunization

(Following this activity, the

of receiving healthcare related

cards help you to recall the due

moderator has to initiate a

information.

date for next vaccination and keep a

discussion to understand which the

record for last vaccination?

key aspects of an immunization

Q. If you have any doubts regarding

table are).

vaccination taken or importance

(Following this discussion the participants will be shown the cue cards of the immunization table. The cue cards to be provided are

(c). New Information Fields (5 Cue Cards) (10 minutes)

of the vaccination given or about identifying the symptoms of any disease who will you ask for help?

present card?

(f). Material & form (5 minutes)

Where do you think this

Probe: Understand openness to

information should be placed in the

the use of different materials for

card?

the card itself, storage, portability,

(e). Color (5 Cue Cards)

durability.

(3 minutes to see all cards)

We are looking at modifying

(In this section, varied cards will

health card; we also wish to

different sections of the existing

cards that have previously been

Probe: Preference and their

Probe: perceived importance of the

be shown to respondents. The cards

understand whether the use of

filled by ANMs).

understanding of data fields,

ANM/ASHA in this relationship.

shown will be a mixture of cards

different materials can help make

with background color and color for

the card better.

observation of new data fields, These are various immunization

information comprehension.

tables in front of you. Please take

(Once the participants give their

information). (The moderator will suggest use

responses, direct the conversation

five minutes in order to go through

(The moderator gives 5 different

into a discussion on whether there

These are some cards that have

of materials other than paper like

all the entries. We want you to

cue cards, with different data fields

is a need to have healthcare related

been presented and we wish to

wood, metal, plastic etc.).

select one cue card individually that

present in them).

information on the card itself.

understand from you which of these

Based upon responses received, the

colors are better for conveying the

Q. Do you think that at present

Q. From the new data fields,

following questions can be asked).

importance of the card?

there is a need to change the

which two do you think are most

Moderator shows cue cards of

you think is the best card, on the basis of these two points:

material that is used to make these cards?

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

If that is required, which material would be the best and why? -------- Tea & Snack break ------Value perception: (12 minutes) (Moderator to ask individually) Out of all the cards, if you had a chance to take one home, which one would it be and why? Phase II- Collective Voting

Paper based voting: (10 - 15 mins.) We will now show you top 12 cards that the ANMs have selected and you have to select top 3 cards as a group. You can discuss with each other if you wish to. (Moderator to initiate open ended discussion keeping in mind all the parameters of the card. Based on open ended discussion and collective voting we select the top 3 from the beneficiaries.) We have now come towards the end of this discussion. Do you have any last minute thoughts that you would like to share with us?

Thank you so much for your time and co-operation. Hopefully your insights and feedback will help us improve and design a better card.

Images from the brainstorming sessions during field work, CKS guest house, Patna, Bihar

79 14.ANNEXURE

Contd ...

14.3. London workshop agenda and Final evaluation form

As mentioned earlier, there was a phase in the project which required planning and creating guidelines for a workshop in London with experts from other, well known organisations to review and choose winners from the final cards. This is a detailed agenda and choreography, including activities, planned for the jury members of the workshop. Objective of the workshop:

~ Presenting key insights from focus group discussions conducted on field. ~ Identifying strongest records through voting and discussion ~ Collaboratively brainstorming design recommendations ~ Critiquing the crowdsourcing process and exploring new areas of application of new ideas.

The detailed agenda:

10:00 a.m. to 10:45 a.m.:

The jury members:

key insights and themes from the

David Brown - UNICEF

focus group discussions by Divya

Mercy Ahun

Datta (CKS).

Data Sharing; Presentation of

Aditya Sood - CKS Tim Wood - Gates foundation

10:45 a.m. to 11:30 a.m.:

Marta Gacic-Dobo - WHO

Design Entries Review; Participants

Brenda Sanderson - IxDA

move to the ‘cards exhibit area’ and

Divya Datta - CKS

they review all cards, while making

Skye Gilbert - BMGF

notes of their initial thoughts;

Workshop Day 1 9:30 a.m. to 9:45 a.m.:

CKS will display 30 entries on the table with an ‘insights cue-card’, attached to each entry, capturing key responses from users.

Introduction to the ‘Records for Life’; Welcome note and

11:30 a.m. to 12:15 p.m.:

introduction to the vision behind

Initial Thoughts Discussion;

the project by Skye Gilbert (BMGF).

Participants discuss their first reactions, early thoughts and

9:45 a.m. to 10:00 a.m.:

feedback through a stimulus

Energizer Exercise and Mutual

response exercise.

Introductions; Energizer sessions could be ball throwing, rapid Q and A, breathing exercises etc to energize participants; Expectations

12:15 p.m. to 12:45 p.m.: Lunch Break

for the workshop are set, the

12:45 p.m. to 2:30 p.m.:

workshop agenda and tools are

Rating Cards Basis Specific Criteria;

introduced by Divya Datta (CKS).

Participants (pairs) rate/vote on the

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

cards on pre-defined criteria for

4:10 p.m. to 4:45 p.m.:

11:15 a.m. to 12:15 p.m.:

public health / other development

instance i.e. an axis of practicality

Individual Voting of top cards;

Drafting Design Guidelines;

challenges that this methodology

of implementation, feasibility of

Each participant votes for their

Participants form groups (3 groups

can be successfully applied to;

immediate roll-out versus future

top card by filling an evaluation

of 3 participants each); they are

They create challenge briefs for a

rollout, ease of digital transition v/s

form which will be provided by

given a template to draft design

crowd sourcing design approach

reliance on technology, value for

CKS; The individual votes will be

guidelines forming the basis

(in groups) and give mutual

health-workers v/s beneficiaries,

kept undisclosed till the next day

of principal findings and ideas

presentations; To be moderated by

amount of orientation required to

morning when the winners would

from the last day; Session to be

Divya Datta (CKS).

use the card etc which would be

be announced.

moderated by Divya Datta (CKS).

followed by participants presenting

4:45 p.m. to 5:00 p.m.:

and discussing their rating/choices;

Brief Discussion about the next day

12:15 p.m. to 12:45 p.m.:

Exercise to be moderated by Divya

agenda and wrap-up.

plotted on multiple Cartesian axes,

Datta (CKS).

Workshop Day 2

Lunch Break

2:45 p.m. to 3 p.m.: Tea Break

3:45 p.m. to 4:15 p.m.:

12:45 p.m. to 1:45 p.m.:

Charting the future; CKS talks

9:30 a.m. to 9:45 a.m.:

Mutual Presentations &

about immediate steps on Records

2:30 p.m. to 3:00 p.m.:

The workshop begins with the

Discussions; Participants present

for Life process and asks for advice

Elimination round; Participants

announcement of the winning

their design recommendations to

on how to take some of these

vote on 2 cards for elimination

entry and ranking of the cards;

each other for open debates and

recommendations forward; This

using stickers provided and discuss

Moderated by Divya Datta (CKS).

discussions.

session is to be moderated by Skye

9:45 a.m. to 10:30 a.m.:

1:45 p.m. to 2:15 p.m.:

Evaluation Discussion; Participants

Participants reflect on the process

3:00 p.m. to 3:50 p.m.:

individually discuss their choices

of crowd sourcing adopted for this

4:15 p.m. to 4:30 p.m.:

Top Rated cards to be chosen;

and the reasons for the same;

project to assess its pros and cons,

Workshop ends; Vote of Thanks to

Participants select and vote on

Moderated by Skye Gilbert (BMGF).

through call-outs and discussions;

be given by Skye Gilbert (BMGF).

Gilbert and Divya Datta (BMGF and

reasons for their choices; to be moderated by Divya Datta (CKS).

To be moderated by Skye Gilbert

the 3 most promising concepts

(BMGF).

CKS).

The evaluation form:

using stickers provided and discuss

10:30 a.m. to 11:15 a.m.:

reasons for their choices; Session

Design Recommendations / Key

to be moderated by Skye Gilbert /

Thematics; Call out session on

2:15 p.m. to 2:45 p.m.:

form that was designed for the

Divya Datta (BMGF / CKS).

design recommendations, followed

Exploring new areas of application

jury members. It has a tick-system

by discussion; Moderated by Divya

flowing from the previous

method, total marks to be given

Datta (CKS).

discussion; participants brainstorm

with sections in basic three headers

and identify other real-time

and marked in a separate color.

3:50 p.m. to 4:10 p.m.: Tea Break

The following page shows the

The final evaluation form designed for the jury members of the London workshop to choose the winners of the contest.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

14.ANNEXURE

Contd ...

14.4. The Records for Life winnersâ&#x20AC;&#x2122; certificate

The outcome of the London workshop was announcing the winners of the Records for Life contest for which a certificate of merit and recognition had to be created. This was to be given on behalf of BMGF in the ceremony. The template for this certificate was already given by BMGF. Just a few adjustments had to be done. The final certificate is on the next page.

The certificate of recognition given to winners of the Records for Life contest in the awards ceremony.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

14.ANNEXURE

Contd ...

14.5. Stakeholders and Key players Headquarters ~ Geneva,

Assembly finishing on 24 July

Head ~ Margaret Chan

International dâ&#x20AC;&#x2122;HygiĂ¨ne Publique

Switzerland

Parent organization ~ United

1948. It incorporated the Office and the League of Nations Health

Nations Economic and Social

Organization. Since its creation,

Council (ECOSOC)

it has played a leading role in the

Official website ~ www.who.int

eradication of smallpox.

The two major stakeholders in the

WHO is a specialized agency of

Its current priorities include

project, CKS and BMGF have been

the United Nations (UN) that is

communicable diseases, in

written about earlier. The other

concerned with international public

particular, HIV/AIDS, malaria

stakeholders in the project were:

health. It was established on 7 April

and tuberculosis; the mitigation of

1948, headquartered in Geneva,

the effects of non-communicable

Switzerland. WHO is a member of

diseases; sexual and reproductive

the United Nations Development

health, development, and aging;

Group. Its predecessor, the Health

nutrition, food security and

Organization, was an agency of the

healthy eating; occupational

League of Nations.

health; substance abuse; and drive the development of reporting,

The main responsibility was to WHO - World Health Organisation:

Formation ~ 7 April 1948

Type ~ Specialized agency of the United Nations

publications, and networking.

help anybody in need of medical assistance. The constitution of

WHO is responsible for the World

the World Health Organization

Health Report, the worldwide

had been signed by 61 countries

World Health Survey, and World

on 22 July 1946, with the first

Health Day.

meeting of the World Health Source: www.wikipedia.com

GAVI Vaccine Alliance: Founded ~ 2000

Type ~ Public-Private Partnership Location ~ Geneva, Switzerland

Key people ~ Seth Berkley, Dagfinn Høybråten

Mission ~ Saving children’s lives

and protecting people’s health by increasing access to immunisation in poor countries

Official website ~ www.gavi.org Gavi brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry in both industrialised and developing countries, research and technical agencies, civil society, the Bill & Melinda Gates Foundation and other private philanthropists.

UNICEF - United Nations

December 11, 1946, to provide

through the National Committees.

Children’s Fund:

emergency food and healthcare to

It is estimated that 91.8% of their

children in countries that had been

revenue is distributed to Program

Type ~ Fund

devastated by World War II.

Services.

Head ~ Anthony Lake

In 1953, UNICEF became a

UNICEF’s programs emphasize

Parent organization ~ United

permanent part of the United

developing community-level

Nations Economic and Social

Nations System and its name

services to promote the health and

Council (ECOSOC)

was shortened from the original

well-being of children. UNICEF

United Nations International

was awarded the Nobel Peace Prize

Children’s Emergency Fund but it

in 1965 and the Prince of Asturias

has continued to be known by the

Award of Concord in 2006.

Formation ~ December 1946 Headquarters ~ New York City

Official website ~ www.unicef.org UNICEF is a United Nations Program headquartered in New York City that provides long-term humanitarian and developmental

Source: www.wikipedia.com

assistance to children and mothers in developing countries. It is one of the members of the United Nations Development Group and its Executive Committee. It was created by the United Nations General Assembly on

popular acronym based on this previous title.

Most of UNICEF’s work is in the field, with staff in over 190

UNICEF relies on contributions

countries and territories. More

from governments and private

than 200 country offices carry

donors and UNICEF’s total income

out UNICEF’s mission through

for 2008 was $3,372,540,239.

a program developed with host governments. Seventeen regional

Governments contribute two thirds

offices provide technical assistance

of the organization’s resources;

to country offices as needed

private groups and some 6 million individuals contribute the rest

Source: www.wikipedia.com

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

IxDA ~ Interaction Design

~ Public relations for IxDA

Founded ~ 2003

~ Internationalization of IxDA

Association:

Type ~ Not-for-profit

President ~ Robert Reimann

Official website ~ www.ixda.org

~ Outreach to businesses

The IxDA mission statement is ~ “We believe that the human condition is increasingly challenged by poor

IxDA is a novel kind of “un-

experiences. IxDA intends to improve

organization” in which there is no

the human condition by advancing the

cost for membership. It relies on its

discipline of Interaction Design. To do

passionate members to help serve the

this, we foster a community of people

needs of the international Interaction

that choose to come together to support

Design community. With more than

this intention. IxDA relies on individual

60,000 members and over 150 local

initiative, contribution, sharing and self-

groups around the world, the IxDA

organization as the primary means for

network actively focuses on interaction

us to achieve our goals.”

design issues for the practitioner, no matter their level of experience. It was founded in 2003 and incorporated as a not-for-profit in late 2005. Today, the IxDA is involved in initiatives relating to the following core topics: ~ Education and mentoring local groups ~ Interaction conferences

Source: www.ixda.org www. slideshare.net

Medical Officer-incharge (MOIC)

The key players for this project

need to exercise medical judgement

The Medical Officer-in-Charge

person is a liaison between doctors

were:

(MOIC) or the Chief Medical Officer (CMO):

ANM (Auxiliary Nurse Midwife)/Nurse

on certain cases. In general, this and hospital executives.

Though the MOIC was not included

Some of the main qualifications of

in the user sample of this project

this kind of job include an advanced

as he does not deal directly with

degree in medicine and a license to

the giving or filling of the health

practice, but not just any doctor will

card, he is still one of the major key

do. An MOIC is also expected to

players in the health system.

have both training and experience in management duties, so business

Frontline Health workers (FLHWs)

LHV (Lady Health Visitor)

A chief medical officer, also called

sense is also usually necessary. This

an MOIC , is typically the physician

is considered a leadership position

in charge at most hospitals. The

since doctors look to this person for

person in this position must have

guidance, so past leadership roles

a medical degree and be able

are helpful.

to practice in the medical field, but should also have experience

Additionally, communication

managing others.

and interpersonal skills are often needed since the MOIC should be

ASHAs (Accredited Self Help Activist)/ Nurse

The main responsibilities of this

able to relate to doctors in all fields,

position include overseeing all

and also needs to frequently talk to

doctors, and making sure that

department managers, patients, and

patients are safe and well cared

top executives.

for. An MOIC does not usually have to provide direct medical care

Mamta & Dai (traditional birth attendants)

to patients, but he should have The hierarchy of key players in the public health system

the knowledge to do so since he typically needs to train doctors that are new to the hospital, and may

Source: www.wisegeek.com

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Frontline Healthworkers:

community they serve, they play

Though the field of frontline

a critical role in providing a local

healthcare delivery (also called

context for proven health solutions,

community health) offers an

and they connect families and

immense amount of potential

communities to the health system.

health impact, it remains underutilized and in its infancy.

They are the first and often the only link to health care for millions of

Frontline healthcare workers

people, are relatively inexpensive to

consist of a network of healthcare

train and support, and are capable

professionals who may be called by

of providing many life-saving

various terms in specific hierarchies

interventions.

like nurses, ANMs, ASHAs etc depending on the country they

Frontline health workers are those

belong to, but their basic duties and

directly providing services where

responsibilities remain the same,

they are most needed, especially in remote and rural areas. Many

An FGD in progress with Nurses in Bandung, Indonesia

Frontline healthworkers or FLHWs

are community health workers

as they are called are healthcare

and midwives, though they can

workers delivering care outside of a

also include local pharmacists,

hospital or clinic setting. FLHW is a

nurses and doctors who serve in

term inclusive of many other terms,

community clinics near people in

such as community health workers,

need. Some physicians may also be

traditional birth attendants, and

considered frontline health workers

village health workers. These are

when they serve in local clinics and

typically non-professional workers

address basic health needs.

or workers that are not doctors, nurses, or physicianâ&#x20AC;&#x2122;s assistants.

Frontline health workers provide immunizations and treat common

Frontline health workers are

infections. They also help families

the backbone of effective health

identify conditions which require

systems â&#x20AC;&#x201C; they are often based in

higher levels of care and provide a

the community and come from the

link to that referral care. Families

rely on these workers as trusted sources of information who have valuable skills in preventing, treating and managing a variety of leading killers including diarrhea, pneumonia, malaria, HIV and

(a). Nurses or Auxiliary Nurse Midwife (ANM):

Educational background ~ 10+2 in any stream

Duration ~ 2 Years

community and others in the provision of health care. ~ Demonstrates understanding of and commitment of professional behavior.

tuberculosis. Frontline health

An ANM is an FLHW who:

workers are also increasingly

~ Demonstrates awareness of,

~ Demonstrates awareness of the

critical to addressing diseases like

and skills required in the nursing

necessity of belonging to profession

diabetes and heart disease that

process in the provision of health

organization.

impact the health and productivity

care and nursing of patients, esp.

of adults around the world.

the immunization process.

~ Demonstrates ability in selfawareness, self-evaluation in

~ Applies relevant knowledge

personal and professional life.

from humanities, biological and behavioral sciences in carrying out

~ Looks at promotion of health and

health care and nursing activities

precaution against illness.

and functions. ~ Shows sensitivity and skill in human relationship and communication in her daily work. ~ Demonstrates skill in the use of problem solving methods in nursing practices. ~ Gains knowledge of health resources in the community and the county. FGDs with Nurses/ANMs in Kisumu, Kenya and Patna, Bihar

~ Demonstrates leadership skill in working with the health team,

Source: www.rpinstitutions.com

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

(b). Lady Health Visitor (LHV):

~ using specialist healthcare

such as baby massage, exercise and

targets are being met and creating

A health visitor is a qualified nurse

interventions to meet the health-

child development.

health policies regarding the

or midwife with post-registration

related needs of individuals,

experience who has undertaken

families, groups and communities

~ working collaboratively with

further training and education in

as well as assessing and evaluating

childrenâ&#x20AC;&#x2122;s centres, schools,

~ planning and setting up health

child health, health promotion,

their effectiveness.

preschools and action groups in the

promotion displays.

provision of healthcare.

local community.

public health and education. Health

~ generating and maintaining

visitors work as part of a primary

~ working as part of a multi-

healthcare team, assessing the

disciplinary team, which may

~ providing emotional support

effective interactions with relevant

health needs of individuals, families

include GPs, midwives, community

regarding issues such as postnatal

external agencies, including other

and the wider community. They aim

nursery nurses, health visitorsâ&#x20AC;&#x2122;

depression, bereavement, disability,

healthcare professionals, social

to promote good health and prevent

assistants, healthcare assistants and

family and domestic violence.

services, local housing departments,

illness by offering practical help.

community staff nurses.

the police, teachers and probation ~ supporting government

officers, and utilising appropriate referral procedures.

The role involves working within a

~ advising and informing new

initiatives to tackle child poverty

community setting, often visiting

parents on issues such as feeding,

and social exclusion, such as

people in their own homes and

safety, physical and emotional

agreeing local health action plans

~ maintaining the standards and

supporting new parents and

development, immunisation and

as well as managing and leading

requirements of professional

pre-school children. Working as

other aspects of childcare.

interdisciplinary teams involved in

and statutory regulatory bodies,

their delivery.

adhering to relevant codes of

a health visitor may also include

conduct, understanding the

tackling the impact of social

~ providing support from early

inequality on health and working

pregnancy to a childâ&#x20AC;&#x2122;s early weeks

~ diagnosing minor conditions and

legal and ethical responsibilities

closely with at-risk or deprived

and throughout their childhood

prescribing low-level medication.

of professional practice and

the role depending on the country

~ working in partnership with

~ supporting and training new

like working with adults from the

families to develop tailored health

health visitors and support staff.

wider community.

plans addressing individual

maintaining the principles and

groups. There may be variations in

parenting and health needs. Activities vary according to the

practice of client confidentiality. Due to low payment and intense

~ maintaining and updating

job responsibilities, the need

records and other paperwork.

and demand for LHVs in India and other countries has been

nature of the individual role but

~ managing parent and baby

may include:

clinics at surgeries, community and

~ collecting, collating and analysing

running specialist sessions on areas

data to ensure that specific health

considerably reduced. Source: www.nrhm.gov.in

Following are the key components

~ The ASHAs receive performance-

of ASHA:

based incentives for promoting

~ ASHA is primarily a woman

universal immunization, referral

resident of the village married/

and escort services for Reproductive

widowed/ divorced, preferably in

& Child Health (RCH) and other

the age group of 25 to 45 years.

healthcare programmes, and construction of household toilets.

~ She is a literate woman with due

(c). Nurses or ASHA (Accredited FGD with nurses (ASHAs) in Bandung, Indonesia

Social Health Activist):

One of the key components of the National Rural Health Mission is to provide every village in the country with a trained female community health activist, ASHA. Selected from the village itself and accountable to it, the ASHA is trained to work as an interface between the community and the public health system.

preference in selection to those

~ Empowered with knowledge

who are qualified up to 10 standard

and a drug-kit to deliver first-

wherever they are interested and

contact healthcare, every ASHA

available in good numbers. This is

is a fountainhead of community

relaxed only if no suitable person

participation in public health

with this qualification is available.

programmes in her village.

~ ASHA is chosen through a

~ ASHA is the first port of call

rigorous process of selection

for any health related demands of

involving various community

deprived sections of the population,

groups, self-help groups,

especially women and children,

Anganwadi Institutions, the Block

who find it difficult to access health

Nodal officer, District Nodal officer,

services in the community.

the village Health Committee and the Gram Sabha.

~ ASHA is a health activist in the community who creates

~ Capacity building of ASHA is

awareness on health and its social

being seen as a continuous process.

determinants and mobilise the

ASHAs have to undergo series of

community towards local health

training episodes to acquire the

planning and increased utilisation

necessary knowledge, skills and

and accountability of the existing

confidence for performing their

health services.

spelled out roles.

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

~ She promotes good health

such as immunisation, Ante Natal

practices and also provides a

Check-up (ANC), Post Natal

minimum package of curative care

Check-up supplementary nutrition,

as appropriate and feasible for that

sanitation and other services being

level and make timely referrals.

provided by the government.

~ ASHA provides information to

~ She acts as a depot older for

the community on determinants

essential provisions being made

of health such as nutrition, basic

available to all habitations like Oral

sanitation & hygienic practices,

Rehydration Therapy (ORS), Iron

healthy living and working

Folic Acid Tablet(IFA), chloroquine,

conditions, information on existing

Disposable Delivery Kits (DDK),

health services and the need for

Oral Pills & Condoms, etc.

timely utilisation of health & family welfare services.

~ At the village level it is recognised that ASHA cannot function

~ She counsels women on birth

without adequate institutional

preparedness, importance of

support. Womenâ&#x20AC;&#x2122;s committees

safe delivery, breast-feeding

(like self-help groups or womenâ&#x20AC;&#x2122;s

and complementary feeding,

health committees), village Health

immunization, contraception and

& Sanitation Committee of the

prevention of common infections

Gram Panchayat, peripheral

including Reproductive Tract

health workers especially ANMs

Infection/Sexually Transmitted

and Anganwadi workers, and the

Infections (RTIs/STIs) and care of

trainers of ASHA and in-service

the young child.

periodic training are a major source of support to ASHA.

~ ASHA mobilises the community and facilitates them in accessing health and health related services available at the Anganwadi/subcentre/primary health centers,

Source: www.nrhm.gov.in

Shreya Anand from the Bihar team in a discussion with a group of ASHAs, Phulwari Sharif, Patna, Bihar

Traditional birth attendants provide

also herbalists, or other traditional

the majority of primary maternity

healers. They may or may not be

care in many developing countries,

integrated in the formal health care

and within specific communities in

system. They sometimes serve as

developed countries.

a bridge between the community and the formal health system, and

Traditional midwives provide basic

may accompany women to health

health care, support and advice

facilities for delivery.

during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated. They usually work in rural, remote and other medically underserved areas. TBAs may not receive formal education and training in health care provision, and there are no specific professional requisites such as certification or licensure. A traditional birth attendant may A microplan of a polio vaccination drive in the Phuwari Sharif neighbourhood, Patna, Bihar

(d). Mamta and Dai (traditional birth attendants):

A traditional birth attendant (TBA), also known as a traditional midwife, community midwife or lay midwife, is a pregnancy and childbirth care provider. She is known by various names in different countries for example Mamta and dai in India.

have been formally educated and has chosen to not register. They often learn their trade through apprenticeship or are self-taught; in many communities one of the criteria for being accepted as a TBA by clients is experience as a mother. Many traditional midwives are

Source: www.wikipedia.com

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Primary Health Centre (PHC):

~ Birth control programs: Services

Sometimes referred to as â&#x20AC;&#x2DC;public

under the national birth control

health centres, PHCs are state-

programs are dispensed through

owned rural health care facilities in

the PHCs. Sterilization surgeries

India. They are essentially single-

such as vasectomy and tubectomy

physician clinics usually with

are done here. These services, too,

facilities for minor surgeries, too.

are fully subsidised.

They are part of the government-

~ Pregnancy and related care: A

funded public health system in

major focus of the PHC system is

India and are the most basic units

medical care for pregnancy and

of this system.

child birth in rural India. This is because people from rural India

Presently there are 23,109 PHCs

resist approaching doctors for

in India. Apart from the regular

pregnancy care which increases

medical treatments, PHCs in India

neonatal death..

have some special focuses. ~ Emergencies: All the PHCs store ~ Infant immunization programs:

drugs for medical emergencies

Immunization for newborns under

which could be expected in rural

the national immunization program

areas. For example antivenoms for

is dispensed through the PHCs.

snake bites, rabies vaccinations, etc.

This program is fully subsidised. ~ Anti-epidemic programs: The PHCs act as the primary epidemic diagnostic and control centres for the rural India. Whenever a local epidemic breaks out, the systemâ&#x20AC;&#x2122;s doctors are trained for diagnosis. They identify suspected cases and refer for further treatment.

Teghda PHC, Begusarai, Bihar

Pictures of the diversity in landscape of all the locations, (top left corner) A view of Bangdung, Indonesia; (top right corner) An old church, Kisumu, Kenya; (bottom right and centre) Views of Parsa Bazaar, Patna, Bihar

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

Photographs Courtesy: Volume One

Photographs Courtesy: Volume Two

Center for Knowledge Societies

(CKS), New Delhi - 21, 45, 103, 104, 105,

(CKS), Patna Guest house, Parsa

108, 110, 112, 113, 114, 116 - 122, 128, 130

Bazaar, Phulwari Sharif, Bihar Sharif,

Center for Knowledge Societies

66, 80, 83, 84, 85, 86

(CKS), Patna Guest house, Parsa Bazaar, Phulwari Sharif, Bihar Sharif,

Center for Knowledge Societies

Patna City, Begusarai, Bihar - 23, 24,

(CKS), Kisumu, Nairobi, Kenya - 80, 86

32, 33, 34, 42, 59, 60 - 66, 84, 86 - 97, 107, 126, 135, 137, 138, 142, 145

Center for Knowledge Societies

82, 86

(CKS), Kisumu, Nairobi, Kenya - 33, 68, 72 - 75, 101, 106, 109, 111, 115, 129, 135, 136, 144, 149 Center for Knowledge Societies (CKS), Bandung, Jakarta, Indonesia 33, 69, 76 - 84, 138

15.CREDITS

Begusarai, Bihar - 1, 2, 6, 56, 57, 60, 65,

Google Images - 30, 31 Simran Chopra - 36, 37, 57, 70 Farid J. Bhuyan - 70 Center for Knowledge Societies (CKS), London, United Kingdom - 147

(CKS), Bandung, Indonesia - 22, 79,

Google Images - 75, 76, 77

Anupriya Arvind | PGDPD Graphic Design | Diploma Project | Records for Life | 2014

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