Wish Case

Redesigning primary health care in India

Client: WISH Foundation

Domain: Healthcare

Duration: 3 Months

Tools: Ethnographic Research, Service Design, User Experience Design.

Primary Health Care is the missing link in India.

While governments try to do their best to offer care to citizens, the truth is that most facilities are under-utilised, understaffed, and undercapitalised. We took a patient-centric approach reasoning that first we have to offer something that patients would want and have to offer it in a way in which it makes sense and appealing to them. Over a series of several months, we spent time understanding patients, their families, doctors, and other stakeholders to create a holistic view of the ecosystem. We then identified and defined a series of interventions designed to increase patient engagement and trust with the primary care system

IN A NUTSHELL The Problem

The Approach

The Result

Much of India’s 900 million Base of Pyramid population, living on or below the poverty line, does not have access to reliable and cost-effective health care. Our goal was to help the Foundation develop a primary care offering for its population keeping in mind the constraints of the ecosystem.

Our team conductive qualitative research within three districts in Rajasthan with a primary focus of solving the challenge of providing physicians consultations, medicines, and diagnostic testing at the doorstep of the inhabitants in rural Rajasthan.

We provided the Foundation with tangible recommendations which have become an integral part of their strategy.

THE OPPORTUNITY No matter how one looks at it, this is a big challenge. In fact, the magnitude of the problem is difficult to comprehend. For much of India’s over 900 million Base of Pyramid (BoP) population, living on or below the poverty line, basic healthcare is beyond their means. The public healthcare system has not been able to keep up, leaving them little choice but to access more expensive private Healthcare, which often requires them to travel extensively and take time off from work. And unlike regular jobs these people don’t get any vacation or sick time. Either they work or they don’t get paid. The problem is so bad that each year 40M people are pushed into poverty due to unplanned healthcare expenses.

Our client was a leading Foundation in India, which approached us to help improve access to reliable and cost effective healthcare in rural India. Their hypothesis was that a low-cost telemedicine technology would be the answer enabling patients to get care where they live eliminating the need for them to travel hundreds of miles to get care.

THE PROCESS As with most Design projects, we started by conducting several weeks of in-depth ethnographic research. We conducted research in three rural districts with several stakeholders including physicians, pharmacists, nurses, and patients as well as their caretakers. We also investigated local clinics and diagnostic testing facilities.

Various aspects of the end users’ lives were observed and documented to gain a thorough understanding of their lifestyle, education levels, use of technology, use of current medical facilities and their trust in the doctors and health care centers.

Also as with most Design projects, we ended up realizing the problem we thought we were investigating was not the actual problem. We thought we were solving the problem of access - i.e. how do you ensure there are enough providers and that the care is affordable? As we learned, the challenge was not of physical access but of behavior - i.e. how do we get people to trust their local government appointed care providers who they only have negative experiences with?

Based on the insights identified during the research phase, the team identified several service delivery systems concepts and detailed out not only the what needs to be delivered but also, the how it needs to be delivered. The care providers needed to gain the trust of patients and their families first. Only then would the question of providing care even arise.

They needed to say the right things in the right tone and, most importantly, be available whenever the need arose.

THE RESULT We provided the Foundation with tangible recommendations which have become an integral part of their larger strategy.