Swasthya: Visual Communication for Community Health : A Degree Project Documentation by Vineet Gedam

DEGREE PROJECT Swasthya: Visual Communication for Community Health Sponsor : Therefore Design, Pune

Volume : 1 OF 1 STUDENT : VINEET GEDAM PROGRAMME : Masters of Design (M. Des)

GUIDE : TARUN DEEP GIRDHER

2018 COMMUNICATION DESIGN FACULTY (GRAPHIC DESIGN)

The Evaluation Jury recommends VINEET GEDAM for the

Degree of the National Institute of Design IN COMMUNICATION DESIGN (GRAPHIC DESIGN)

herewith, for the project titled "SWASTHYA: VISUAL COMMUNICATION FOR COMMUNITY HEALTH" on fulfilling the further requirements by*

Chairman Members :

Jury Grade : *Subsequent remarks regarding fulfilling the requirements : This Project has been completed in ________________ weeks.

Activity Chairperson, Education

Originality Statement

I hereby declare that this submission is my own work and it

I hereby grant the National Institute of Design the right to archive

contains no full or substantial copy of previously published

and to make available my graduation project/thesis/dissertation in

material, or it does not even contain substantial proportions of

whole or in part in the Instituteâ&#x20AC;&#x2122;s Knowledge Management Centre

material which have been accepted for the award of any other

in all forms of media, now or hereafter known, subject to the

degree or final graduation of any other educational institution,

provisions of the Copyright Act. I have either used no substantial

except where due acknowledgement is made in this graduation

portions of copyright material in my document or I have obtained

project. Moreover I also declare that none of the concepts are

permission to use copyright material.

borrowed or copied without due acknowledgement. I further declare that the intellectual content of this graduation project is the product of my own work, except to the extent that assistance from others in the projectâ&#x20AC;&#x2122;s design and conception or in style, presentation and linguistic expression is acknowledged. This graduation project (or part of it) was not and will not be submitted as assessed work in any other academic course.

Vineet Gedam

Signature:

Date:

2 Copyright ÂŠ 2018 Student document publication, meant for Private Circulation only. All rights reserved. Master of Design, Graphic Design, 2015-2018, National Institute of Design, Ahmedabad, India. No part of this document will be reproduced or transmitted in any form or by any means, electronically or mechanically, including photocopying, xerography and videography recording without written permission from the publisher, Vineet Gedam and National Institute of Design, India. Trademark names are used throughout this document. Rather than putting a trademark symbol in every occurrence of trademark name, it is stated that the names are used only in an editorial manner and to the benefit of the trademark holder with no infringement of the trademark. Few photographs used in this document are sourced from the web and are used for representational purposes only. All illustrations and photographs in this document are Copyright by respective people / organisations. PLEASE NOTE: The colours shown throughout this document may not be the correct colour due to difference in printing process and pigments used for producing this document. Designed by: Vineet Gedam Edited by: Tarun Deep Girdher and Vineet Gedam E-mail: vineet.gedam@gmail.com Processed at: Siddhi Printech, Navrangpura, Ahmedabad-380002 Gujarat, India www.nid.edu Printed digitally in Ahmedabad, India May 2018

Swasthya: Visual Communication for Community Health

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“It’s not enough that we build products that function, that are understandable and usable, we also need to build products that bring joy and excitement, pleasure and fun, and yes, beauty to people’s lives.” Don Norman

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Gratitude

I wish to express my heartfelt gratitude to

My heartfelt gratitude to my guide Tarun

a number of people who have helped me in

Deep Girdher for helping me shape as

undertaking and completing this project.

a designer and working on giving me important lessons on design which I would

My deepest thanks to my mentors at

carry with me for the rest of my life. Your

Therefore Design, Dhun Patel, Vrishali

passion and enthusiasm for Graphic Design

Kekre Deshmukh, Gauri Barve Kale and

is always inspiring and contagious. Thank

Nitin Virkar, for having faith and giving

you for guiding me with patience and

me this amazing opportunity to work on

zeal and for all the wisdom that you have

a unique project like this. Your constant

imparted to us during our time at NID.

guidance during the project has helped me in numerous ways and made me more

A huge thanks to all the teachers who

sensitive towards design. Thank you

have guided and taught me at NID. I

Anupama and Ojal, my team mates in this

would like to thank Tridha Gajjar for her

project, for I learned immensely from

constant support and guidance. Thank

you on design, life and on having good

you Jagdish Kumar and Mona Prabhu for

fun. I would also like to thank all of my

valuable lessons on Graphic Design. I am

wonderful colleagues at Therefore Design.

also grateful to all the faculties who gave

Each of them is fun and helpful in their

me crucial feedback during my juries at

own way. It was truly wonderful to have my

NID. An important part of Graphic Design

first internship at a place like Therefore.

at NID is the Print Labs and I extremely

Swasthya: Visual Communication for Community Health

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grateful to its entire staff for their constant

I am extremely grateful and indebted to

help, support and guidance during various

Ramanujam Sir and his entire team at the

courses and projects. A big thank you to all

Telemedicine Centre in Araku for taking

my juniors, seniors and batch mates from

out time from their busy schedule and

other disciplines from whom I have learned

helping us conduct interviews and field

a lot. All the interactions with them have

research with such ease and comfort. I am

been enjoyable and enlightening. I feel

also thankful to rest of the Piramal staff for

privileged to have made friends with some

their cooperation during the project.

of the most creative minds in this country. Great thanks to Hrishikesh Kogje, my I would like to thank all my batch mates of

childhood friend and a Product designer

Graphic Design for helping me at various

(now also a Graphic Designer) from NID

points since the time I joined NID. Thank

from whom I first came to know about the

you Nikhil for teaching me the importance

institute. Thanks for all the dip-project

of being curious, hard-working and

advice, wonderful conversations and for

thoughtful.

your company during my initial months of stay in Pune.

Special thanks to my eternal room mates and friends, Shirish, Prashanth and Aditya

I express my deepest gratitude to my entire

for supporting me during difficult times

family for their support and for believing in

and giving valuable advice and motivation.

me always. Thank you Mummy, Pappa and Rajat for the love, strength and freedom.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Swasthya: Visual Communication for Community Health

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This section gives a brief description about the project and builds a background. It also introduces the sponsor Therefore Design and the client Piramal Swasthya. It

prologue

talks about the guide, the student and informs on the initial brief by the client. The section ends by detailing out the proposal prepared for this project.

Outline Sponsor and Client Guide and Student Project Brief and Proposal

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Outline The project was an effort to help Piramal Swasthya, a non-profit organisation, communicate better with the tribal communities of Andhra Pradesh for whom the organisation provided healthcare and nutrition facilities.

From the month of July till December

enables students to work in the industry

of 2017, I took on a project which was

and actualise all their design knowledge

part of my first internship as a Graphic

and skill sets in reality. However the

Design student. This documentation is a

project must be done with academic rigour

compilation of the process and learnings

incorporating systematic research and

that took place during the course of

informed design decisions.

that project. The project was an effort to help Piramal Swasthya, a non-profit

This final project is an opportunity for

organisation, communicate better with

students to demonstrate their expertise as

the tribal communities of Andhra Pradesh

independent practitioners of design. For

for whom the organisation provided

the same, I worked on a six month long

healthcare and nutrition facilities.

project with the firm Therefore Design in Pune, whose client, for this project, was

The end of a studentâ&#x20AC;&#x2122;s academic tenure at

Piramal Swasthya.

the National Institute of Design is marked by undertaking a Graduation Project with

Piramal Swasthya is a not for profit

a client organisation. This comprises

organization supported by Piramal

of a comprehensive project based on a

Foundation. It works for making

predetermined design brief.

Healthcare accessible, affordable and available to all segments of the population,

The students are expected to take up

especially those which are most vulnerable.

projects which are closely related to

The organisation is known for leveraging

their field of study at NID. This project

the power of technology for achieving

Swasthya: Visual Communication for Community Health

Prologue

the desired results while keeping the

Understanding communities and cultures

With records of the ideas, discussions

system economical and maintaining

which are almost diametrically opposite to

and decisions made during the project,

quality. For this project, Piramal Swasthya

that of the designer makes it a challenge

the document could serve as a reference

required a system which could help

for him or her to empathize. This challenge

for similar projects which deal with

communicate key messages to the tribal

should be then faced by taking careful

using visual communication design for

communities residing in the Araku region

steps during the design process. This

healthcare in rural contexts.

of Andhra Pradesh. The organisation

project gave me the opportunity to work

already runs two projects in the region

with challenges like these apart from

The entire journey during this project has

and the communication system would be

getting to learn the working methods of a

taught me a multitude of ideas; one of

integrated with the functioning of these

studio. Therefore Design, a studio based in

them being that design for rural audiences

projects.

Pune which works on projects which vary

needs to come directly from the ideas and

from Packaging to Branding to Product

conceptions of the audience itself rather

The project required understanding the

Design, was always a learning hub for me

than the designer. The designer only acts

context and the communities involved

throughout the internship. Working here

as a facilitator and not as a source for

in the system. For this, field research

brought in the opportunity to interact

the design. The project has taught me

was carried out in the form of interviews,

directly with clients, and understand

various aspects of researching on field

activities and observation. Apart from

the various stages of an industry based

and has helped me become more sensitive

research on field, talking to client and

project, right from receiving the brief to

towards the culture and issues of the tribal

experts, studying similar projects in other

print production. This document compiles

communities of India.

areas and secondary research helped

information about each stage of the

build a thorough understanding for

process followed during the project. This

critical analysis and ideation for possible

is done in a comprehensive and reflective

interventions and solutions.

manner so as to highlight the learnings.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Swasthya: Visual Communication for Community Health

Prologue

Institute

National Institute of Design The National Institute of Design (NID) is

the academic community at the institute

internationally acclaimed as one of the

to develop a system of education which

Graphic Design

foremost multidisciplinary institutions in

lays more emphasis on learning than on

Graphic Design is one of the disciplines

the field of design education and research.

mere instruction. Over a span of the last

which reside under the broader umbrella

The Business Week, USA has listed NID

57 years, the institution has made it a

of visual communication. The purpose of

as one of the top 25 European & Asian

point to lay emphasis on learning and to

Graphic design varies from information

programmes in the world. The institute

pursue innovation led designs through

dissemination, to communication to

functions as an autonomous body under

the development of the mind and skills of

persuasion. Although technologies are

the department of Industrial Policy &

designers. This technique has motivated

evolving and affecting the processes

Promotion, Ministry of Commerce &

students to perform better and has

involved in Graphic design, the basic

Industry, Government of India. NID has

given them an edge over other design

principles of efficient design remain the

been declared â&#x20AC;&#x2DC;Institution of National

professionals.

same.Â Apart from visual and aesthetic considerations, Graphic design also includes

Importanceâ&#x20AC;&#x2122; by the Act of Parliament, by virtue of the National Institute of Design

NID offers a wide spectrum of design

understanding the socio-cultural aspects,

Act in 2014.

domains while encouraging trans-

media and ethics which affect the designs.

disciplinary design projects. NID is a unique

The programme also aims at developing

The mandate for NID is to offer world-

institution with many problem-solving

sound research skills, critical judgment and

class design education and to promote

capabilities, depths of intellect and a

ability to think creatively. Graphic design

design awareness and application towards

time-tested creative educational culture in

offers various fields of study including

raising the quality of life. NID has taken

promoting design competencies and setting

typography, publication, illustration,

five decades of pioneering hard work by

standards of design education.

branding and information design.

Source: www.nid.edu

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Sponsor

Therefore Design Therefore Design is a multifaceted design

project. Apart from me, the team for this

house that offers services in Design

project comprised of Anupama Rao and Ojal

Research, Communication Design and

Khandpur, both final year students of the

Industrial Design. They work in synergy

under-graduate programme for Graphic

with businesses to identify opportunities

Design at MIT institute of Design, Pune.

and explore their potential through design. They consciously learn, experiment and

The studio has its own working process

evolve but never lose focus of the goal.

which it has developed over years of

Their projects range from a variety of

experience in the industry. The method of

fields including Packaging, Branding and

working varies and depends on the nature

Communication, Publication, Design

of the project. It was enlightening for

Research, Experience and Product Design.

me to work with and learn some of these methods. Working at Therefore Design has

Founded on 1st November 2009, Therefore

helped me develop a better eye for details

Design is led by Vrishali Kekre Deshmukh,

and aesthetics.

Nitin Virkar, Gauri Barve Kale & Dhun Patel, a group of multi-disciplinary individuals who are passionate about design. I was primarily mentored by Dhun and Vrishali during the course of the project, though rest of them also provided valuable guidance at various points in the Top: Installation of the Therefore Design logo in the studio Above: Ojal Khandpur (Left), Anupama Rao (Centre) and Vineet

Swasthya: Visual Communication for Community Health

Prologue

Client

Piramal Swasthya Piramal Swasthya is a registered not

They are present across India in 13 states

for profit organization supported by

with a 3600+ strong employee team

Piramal Foundation and believes in

comprising of 490+ Doctors and specialists.

‘Democratizing Healthcare’ – making

Their innovative technology based solutions

Healthcare Accessible, Affordable and

have helped State Governments to address

Available to all segments of the population,

the issue of Availability and Accessibility of

especially those most vulnerable. In order

quality Healthcare to vulnerable sections of

to achieve this goal, they leverage cutting

society.

edge information and communication

Piramal Swasthya is bridging the last mile

technologies to cut costs without

gap in Primary Healthcare service delivery

compromising quality as well as Public-

and it is technology and innovation that

Private-Partnerships to scale its solutions

enables and makes this possible to reach

throughout India.

the most remote and vulnerable population. Their service delivery channels – Remote

Piramal Swasthya envisions a future in

Health Advisory & Intervention Service,

which all vulnerable groups have the

Community Outreach Program – Mobile

necessary information to make informed

Health Services and Telehealth Services are

decisions regarding their health and

all conceptualized around technology.

Accessible, Affordable and Available high quality health infrastructure to support the

Source: www.piramalswasthya.org

realization of those decisions.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Guide

Tarun Deep Girdher Tarun Deep Girdher is a Senior Faculty of

(NOTA) option and Right To Information

Graphic Design at the National Institute of

Act are examples of this work. He also has

Design with over 20 years of professional

expertise and years of valuable experience

experience. He holds the position of

in designing for socially relevant areas

Head at the Print Labs of the institute

like education, healthcare, gender studies,

and teaches courses such as Typography,

disaster awareness and accessibility.

Printing Technology, Publication Design

Photograph by Mani Maran At the NID print labs

Swasthya: Visual Communication for Community Health

and Environmental Perception. His

His course on Experimental Relief and

passion for Hand lettering, Book binding

Screen Printing gave us a good hands-on

and designing calendars is inspiring.

experience and helped us discover our love

He is known for his works for various

for print. Discussions with Tarun often

government agencies like the Election

make you question each and every detail of

Commission of India and Ministry of

your work. He encourages to look at things

Human Resource Development. The

from different perspectives and reflect

design for the logo of None Of The Above

upon our learnings.

Prologue

Student

Vineet Gedam

Photograph by Nikhil Mittal

The beginning of my four years of

based on our own interests or experiences.

engineering, also marked the revival of

These projects helped me build an

my childhood enthusiasm for creating

understanding on subjects like disability,

hand-drawn pictures. Creating artworks

voter awareness and cinema culture.

for college festivals, participating in art

Each of these projects brought with it a

contests and sketching in spare time, led

unique set of learnings and realizations.

to the realization to explore this skill and

Towards the end of the second year, I got

try out design. At that time, my perception

the opportunity to work on a short project

on Graphic Design was slightly different.

for creating visual identity and collaterals

The year I graduated from my engineering

for an event on design education at

college was the same year I joined NID, so

NID. A course in the fourth semester on

I didn’t have any work experience prior to

research and design for rural context called

NID. The first semester was quite hands-

‘Learning From the Field’ fascinated and

on with the Foundation course helping us

influenced me to take up this project with

polish our basic skills. My understanding

Therefore Design. The project for Piramal

on Graphic Design enhanced as each course

Swasthya gave me ample challenges and

unfolded. For our classroom projects, we

scope to learn more about design processes

were given the freedom to choose themes

and understanding different cultures.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Project Brief and Proposal

Piramal Swasthya has been working in the

achieve their objective ofÂ communicating

Araku region for about five years now and

key messages to theÂ communities and if

realized the need for a communication

possible initiate behaviour change in them.

strategy for their ongoing projects in the region. The project brief was to design a

The project was divided into five phases as

system which would help the Piramal staff

shown in the proposal and timeline. A lot

disseminate key messages to the tribal

of different factors affected the planned

communities for which they worked. A

time line. The actual sequence of events

team at Therefore Design had already

and time line would be detailed out in the

started working on the project in which

upcoming chapters.

they had conducted a field visit to the communities. The team had collected information and insights regarding the communities and the system in place. When we entered the project, we were given the opportunity to conduct a fresh new survey. The scope of work entailed field research to understand the people and the communities, arriving at insights and designing solutions to help the client Acceptance letter from Therefore Design Swasthya: Visual Communication for Community Health

Prologue

GRADUATION PROJECT PROPOSAL Communication Design for Piramal Swasthya

Background

India ranks 2nd in the field of underweight children below the age of 5 years and 47th in terms of Infant Mortality rate in world*. Unavailability and delays in obstetric care coupled with poor quality of service in government hospitals have contributed to maternal deaths as well.** Deaths due to complications like anemia and obstructed labour are preventable with provision for proper care and timely treatment. Two of Piramal Swasthya’s projects; Project Asara and Project Gosthani are functioning in the Araku valley of Andhra Pradesh where habitations of tribal communities are located. These projects are employing different methods to tackle the problems of Mother and Infant Mortality Rates.

(working title)

Objective

STUDENT

Scope of Work

Vineet Gedam S1501115 Semester 4, M.Des 2015 Graphic Design vineet_g@nid.edu (+91) 8652789208

GUIDE Tarun Deep Girdher Senior Faculty, Graphic Design, National Institute of Design tarundg@nid.edu (+91) 9825024076

SPONSOR Therefore Design Pvt. Ltd. Bungalow No. 3, Survey no. 81, North Main Road, Behind One Lounge, Koregaon Park Annex, Mundhwa, Pune Dhun Patel (+91) 9881739810 dhun@thereforedesign.co.in

The project objective is to help Piramal Swasthya’s teams to disseminate key messages for the communities that they are working with, by developing visual communication strategies for them. The scope of work entails field research to understand the people and the communities, arriving at insights and designing solutions to help the client achieve their objective of communicating key messages to the communities and if possible initiating behaviour change within them.

Phase 1 : Information Collection

Phase 3 : Ideation

Understanding the communities, looking

Brainstorming and conceptualizing based

at case studies from other initiatives and

on the analysis. Laying out several ideas

researching on communication strategies

and options to choose from

for rural uneducated audience

Phase 4 : Prototyping

Phase 2 : Analysis

Preparing prototypes of final concepts and

Structuring the collected information and

testing. Making changes based on feedback

analyzing it to find opportunities for a

and test results

possible solution

Phase 5 : Documenting

Deliverables

The deliverables would be a visual communication strategy along with tools and material for efficiently disseminating messages on nutrition and health care for tribal communities.

Methodology

The project is divided into the following phases: Phase 1 : Information Collection Understanding the communities, looking at case studies from other initiatives and researching on communication strategies for rural uneducated audience Phase 2 : Analysis Structuring the collected information and analyzing it to find opportunities for a possible solution Phase 3 : Ideation Brainstorming and conceptualizing based on the analysis. Laying out several ideas and options to choose from Phase 4 : Prototyping Preparing prototypes of final concepts and testing. Making changes based on feedback and test results Phase 5 : Documenting

Tentative Timeline Jul

Aug

Sep

Oct

Phase 1

Nov

Timeline Jul

Aug

Sep

Oct

Phase 1

Nov

Dec

Phase 1

Dec

Phase 2

Phase 1 Phase 2 Phase 3

Citations: *As per World Health Statistics report 2012 **www.piramalswasthya.com/what-we-do/ maternal-and-child-health/

Phase 3

Phase 4 Phase 5

Phase 4 Student

Guide

Phase 5 Final draft of the project proposal

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Swasthya: Visual Communication for Community Health

Prologue

Contents

ideation

prologue

114 Inspiring Stories from the field 116 Finding Themes 118 Creating Insight Statements

Outline

123 â&#x20AC;&#x2DC;How Might Weâ&#x20AC;&#x2122; questions

Sponsor Client Guide Student Project Brief and Proposal

introduction

126 Creating Frameworks 130 Brainstorming

22 Why This Project

134 Context, Content, Communication

24 Piramal Swasthya

148 Concepts

26 Background

deliverables inspiration

196 Final concepts 212 Prototypes to test

30 The Projects in Araku 40 Demographics of the Region 44 Research by Therefore Design 52 Talks with the Client 56 Framing the Design Challenge 60 Recruiting Tools 62 Secondary Research

epilogue

220 Conclusion 222 Retrospect 228 References

84 Expert Views 92 Field Research 106 Stakeholder Mapping 108 Extremes and Mainstreams 110 Analogous Inspiration

Graduation Project

230

appendix

Vineet Gedam | Graphic Design | M. Des 2015

Swasthya: Visual Communication for Community Health

Prologue

1 This section introduces the organisation Piramal Swasthya and talks about its beliefs and objectives. It is also discussed as to what makes this organisation different from others and what kind of projects has it taken up different parts of the country. The section

introduction

also explains the background of the issue that has made Piramal to take up these projects.

Why This Project Piramal Swasthya Background

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

1.1

Why This Project When the opportunity of working on this graduation project was presented to me, my mind went back to all of these experiences and understandings gained at the institute, which made me more than excited to start with it.

As a designer, it becomes imperative for

closely connected to understanding tribal

him/her to have an understanding of the

communities, I would like to share my

issues, histories and cultures contained

thoughts on the subject. Several debates

in the society for which he/she designs.

and discussions were conducted in that

Every semester at NID contains a full

SLA module to understand the issue.

week dedicated to a special course which

During these discussions, we talked about

most of us eagerly look forward to: the

education and development of the tribal

Science and Liberal Arts (SLA) course. Each

people but since we did not know about

of these courses bring to us interesting

these communities in depth, we only

themes to understand, digest and reflect

spoke from a singular perspective. Most

upon. The sessions in these courses

of us were of the view that development

comprise of thought provoking discussions

is extremely important for these people

on various issues, presentations, film

and including them in the mainstream will

screenings and a final assignment to

only do them good. But as I started getting

help us reflect on our understanding

to know more and more about the tribal

and perspective on the issue or theme.

way of life and their situation, I realized

It was during one such course that I

that straightaway imposing development

was introduced to the subject of Tribal

on them is not a sensitive solution

Studies. The course aimed at discussing

to the problem. When we talk about

and understanding the democratization

integrating the tribes in the mainstream,

and empowerment of tribal people in

we need to think as to how we can do that

India. Since this graduation project is also

thoughtfully and if at all there is a need

Swasthya: Visual Communication for Community Health

Introduction

to do so. The complete merging of tribes

be thought of for a positive impact. This

and knowledge on conducting research in

with non-tribal groups might bring with

education could be such that it would make

rural areas and drawing insights from our

it an elimination of cultural differences

the tribes aware about the importance of

observations. It was a completely unique

between the two groups, which if not done

their own culture and environment rather

experience which taught us a multitude

systematically and sensitively might lead

than glorify those notions of development

of lessons. Knowing the importance

to elimination of a rich culture.

which are built on exploitation of nature.

of observing and understanding the

But development in some sense might

communities with an open and unbiased

Contemplating on this subject also

also help the tribal people as it will create

mind helps greatly in empathizing with

made me think about the notion of

opportunities for better healthcare for

the people. One also needs to be sensitive

development and its necessity. How

them. This is what the organizations in

while working with such communities by

does one define development? Do the

this project are trying to achieve. Then

respecting and understanding their beliefs

so-called “backward” tribals really need

again, the tribal cultures also have a rich

and perceptions.

development? Towards the end of the

tradition of natural medicine which also

course, I somehow, but not completely,

needs to be preserved. While talking to

When the opportunity of working on

came to the conclusion that a calculated

a traditional healer during my visit to

this graduation project was presented to

balance needs to be achieved when

tribal villages, I came to know that some

me, my mind went back to all of these

integrating tribals with the larger society;

organizations are trying to preserve this

experiences and understandings gained at

a balance which takes into account not just

tradition by organizing sessions with the

the institute, which made me more than

their empowerment, but also preservation

people on healthcare and medicine.

excited to start with it. The project was a

of their distinct characteristics and

huge challenge for me and the following

cultures. When it comes to education,it

Another course in the fourth semester

months were a mixture of trials, errors,

won’t make sense to give them the same

at NID also had a similar theme of

experimentation and learnings.

education which is given in urban settings.

understanding communities based in

Customized education and development

rural contexts. This course titled ‘Learning

plans for different communities need to

From the Field’ helped us gain experience

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

1.2

Piramal Swasthya Piramal Swasthya envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their health.

Piramal Swasthya is a registered non-

(Piramal Swasthya being one of them)

profit organisation supported by the

through which it pursues its CSR activities.

Piramal Foundation. Piramal Foundation is a philanthropic arm of Piramal Group.

Piramal Swasthya believes in

The foundation undertakes projects

Democratizing Healthcare, that is, making

under four broad areas â&#x20AC;&#x201C; healthcare,

healthcare accessible, affordable and

education, livelihood creation and youth

available to all segments of the population,

empowerment.

especially those most vulnerable. In order to achieve this, they leverage cutting

Piramal Swasthya was earlier known as the Health and Management Research Institute

These projects are rolled out in partnership

edge information and communication

with various communities, corporate

technologies to cut costs without

citizens, NGOâ&#x20AC;&#x2122;s and government bodies.

compromising quality as well as Public

The Piramal Group is a diversified global

Private Partnerships to scale its solutions

business conglomerate, which has

throughout India. Piramal Swasthya

presence across various sectors such as

envisions a future in which all vulnerable

healthcare, life sciences, drug discovery,

groups have the necessary information to

healthcare information management,

make informed decisions regarding their

specialty glass packaging, financial

health and have accessible and affordable

services and real estate. The CSR activities

high quality health infrastructure to

of the company are undertaken as projects

support the realisation of those decisions.

or programmes or activities, either new or ongoing in line with its CSR Policy. The Company has established various entities

Swasthya: Visual Communication for Community Health

Introduction

Piramal Swasthya, earlier known as Health Management and Research Institute (HMRI), has signed a deal with the Karnataka government to provide a Health Information Help Line Services in the state through 104 BSNL telephone number. This helpline service, called “Arogya Vani” works towards providing basic medical information, advice, counseling without visiting a doctor, pharmacist or a health center. Piramal Swasthya in association with National Rural Health Mission (NRHM), Assam has set up a call centre for pregnant women in Assam. This project focuses towards reducing the Maternity Mortality Rate (MMR) and Infant Mortality Rate (IMR) through this initiative. India’s first HIV AIDS Counselling Helpline Service – 1097, was launched by Remote Health Advisory Services

National Aids Control Organisation and implemented by Piramal Swasthya. One such project which

Community Outreach Program

Piramla Swasthya took up was in the Araku region of Andhra Pradesh. With the aim of reducing Maternal Mortality Rate (MMR) and Infant Mortality Rate

Reaching out to Remote Communities

(IMR), the organisation started working in the region which is populated by various indigenous tribes.

Reach of Piramal Swasthya and its projects across different parts of the country (Source: www.piramalswasthya.org)

Graduation Project

A telemedicine centre and nutrition hub work as curative and preventive approaches, respectively, for tackling the issue of IMR and MMR.

Vineet Gedam | Graphic Design | M. Des 2015

1.3

Background There is an upsurge in collective efforts in India to improve neonatal and maternal health in line with the UNâ&#x20AC;&#x2122;s Sustainable Development Goals.

Despite the remarkable global progress

neonatal and maternal health in line

made in maternal and newborn survival

with the UNâ&#x20AC;&#x2122;s Sustainable Development

over the last decade, 4.6 million babies

Goals. However, major challenges remain,

still die in their first year of lifeâ&#x20AC;&#x201D;nearly

especially around ensuring that small and

three million in the first 28 days. India

isolated populations, women and children

loses more children under age 5 each year

in particular, in vulnerable locations can

than any other country. Countrywide,

access the healthcare they need.

more than half of these deaths occur in the neonatal period, most often because

To solve these challenges successfully,

babies are born prematurely, suffer

we need urgent and more coordinated

from birth asphyxia, or have neonatal

collaborative efforts that address the

infections. The maternal mortality for

complex socio-economic factors leading to

India continues to be high, with 167

ill health in children and women in India.

maternal deaths per 100,000 live births.

Neonates born to vulnerable populations,

Unavailability and delays in obstetric care

such as the urban and rural poor, and

coupled with poor quality of service in

traditionally marginalized and excluded

government hospitals have contributed

communities, such as Adivasis and Dalits,

to maternal deaths as well. Deaths due to

have a higher probability of being excluded

complications like anemia and obstructed

from health services and are at high risk of

labour are preventable with provision for

morbidity and mortality.

proper care and timely treatment. The good news is that there is an upsurge in collective efforts in India to improve

Swasthya: Visual Communication for Community Health

Introduction

With the main aim of reducing infant,

to 63 (SRS 2002) but the aim of universal

In 2007 a Joint Review Mission (JRM),

child and maternal mortality rates, the

immunization was far from reach. Polio

under the Ministry of Health and Family

Reproductive and Child Health (RCH)

though reduced has not met the eradication

Welfare, reviewed the progress of RCH-II

Programme was launched in October

target. Not enough attention was paid to

and found with a number of key concern

1997 by the government of India. The

awareness of diarrhoea management and

areas. The JRM found that child health

programme in its first phase (RCH-I)

Acute Respiratory Infection danger signs

was being limited to immunization and

worked on improving the implementation

hence resulting in a rise of case incidents.

other aspects were being ignored. Proper

and management of policy by using a

guidelines for implementation needed

participatory planning approach and

The child health programme is now in its

to be put in place for the states. There

strengthening institutions to maximum

second phase (RCH-II) and some of its

need to be more training programmes to

utilization of the project resources.

aims include expanding services to the

meet the need for qualified personnel.

RCH-I had a number of successful and

entire sector of Family Welfare beyond

Many innovative techniques and methods

unsuccessful outcomes. Base line statistics

RCH scope, holding States accountable by

that are being implemented need to be

were recorded in 1998-99 and compared to

involving them in the development of the

evaluated before expansion takes place.

2002-03. Percentage of women receiving

programme and decentralization for better

any Antenatal Care (ANC) rose by about 12

services. Some of the initiatives under

% to reach 77.2%. But use of government

RCH-II include the Janani Suraksha Yojana

health facilities has declined. Use of

(JSY), Janani Shishu Suraksha Karyakram

contraceptives increased by 3.3 % to 52.0

(JSSK) and Rashtriya Bal Swasthya

%, while family planning due to spacing

Karyakram (RBSK).

method rose by 3.3% to 10.7 %. Use of permanent methods did not change. Infant mortality came down from 71(SRS 1997)

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Swasthya: Visual Communication for Community Health

Introduction

This section begins with a study of the projects in the tribal region of Araku and talks about the demographics of this region. Details of the research done by the earlier design team of Therefore Design are discussed along with the discussions had with clients. Further, the process of redefining the brief is shown and what follows are the various tools and

inspiration

methods used for research, right from secondary research to field research to stakeholder mapping.

The Projects in Araku Demographics of the Region Research by Therefore Design Talks with the Client Framing the Design Challenge Recruiting Tools Secondary Research Expert Views Field Research Stakeholder Mapping Extremes and Mainstreams Analogous Inspiration

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Vineet Gedam | Graphic Design | M. Des 2015

2.1

The Projects in Araku

The tribal communities of Araku and most other parts of India have been going through a huge cultural change due to the influence of urbanization and mass media.

Piramal Swasthya is known for starting

Nationâ&#x20AC;&#x2122;s Millennium Development

projects which have been adopted

Goals for India also include this issue.

throughout the nation. It aims to

Considering the same, Piramal Swasthya

strengthen the health facilities and

chose this region for running a system

services in the country by coming up with

which might give a comprehensive solution

innovative and efficient systems which

for the problem of increased IMR and MMR.

could be implemented by the government throughout. For doing this, the

The tribal communities of Araku and

organisation starts with pilot projects in

most other parts of India have been going

smaller areas, such as regions like Araku.

through a huge cultural change due to the

The pilot is implemented in these regions,

influence of urbanization and mass media.

developed and improved before proposing

In these times, the divide between the

these systems to the government.

younger and older generation of tribes is ever increasing which in turn is leading to a

Swasthya: Visual Communication for Community Health

The projects running in Araku are similarly

loss of knowledge, traditions and values of

being developed. The issue of high IMR

the tribes. Depletion of natural resources

(Infant Mortality Rate) and MMR (Maternal

is adding to the problems as this leads to

Mortality Ratio) in India has always been

decreasing amounts of nutritious foods

of importance, to the extent that United

leading to an unbalanced diet.

Inspiration

Piramal decided to understand the root causes of this issue and accordingly design solutions to counter the problems. It was planned that the issue of IMR and MMR would be tackled by taking two approaches: first, a Curative approach and second, a Preventive Approach. The curative approach would help control cases which needed immediate action and the preventive approach would imbibe a culture which would help improve the lifestyle of the people thereby creating an environment of lesser vulnerability. The curative approach took the aid of technology to achieve its goal of tackling complications and was given the form of a Telemedicine Centre. The preventive approach, on the other hand, took the form of a Community Nutrition Hub, as nutrition was seen as the most important trigger to improving the health of the communities. ANMs interacting with women outside the Telemedicine Centre

Graduation Project

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The Telemedicine Centre in the Araku valley

Swasthya: Visual Communication for Community Health

Inspiration

181 habitations, Araku Valley

3 Teams of healthcare professionals and riders on two-wheelers

Driver and Jeep

The Telemedicine Centre Project (named Project Asara) is located in the main village of the region namely Araku. Started in 2010, Project Asara is a unique model ending preventable deaths in extremely remote, hilly and difficult to access terrain of the Araku valley. The model aims to provide access to specialist consultation in remotest of the areas where there is no or

Telemedicine Center in Araku (Head Nurse & Lab Technician)

limited availability of Healthcare resources. The project has now been expanded to Paderu and Chintapalle mandals. The expansion aims to cover the 2.5 lakh-plus population, including women, children and adolescents in 1179 hard-to-reach habitations across the entire tribal belt of Vishakhapatnam district, starting with

Experienced Gynaecologist in Hyderabad

Paderu and Chintapalle.

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The Telehealth Centre jeep in front of the Community Health Centre near Araku

The general nurse connects to gynaecologist in Hyderabad through a video call and the doctors consult the patients in this manner.

The staff at the Telemedicine Centre

about the day and time when TMC’s

consists of a head nurse, a technician, a

pick-up jeep would arrive. The women

supervisor and a coordinator. Apart from

are expected to show up at the assigned

these, three teams help in the functioning

pick up points from where they are taken

of the centre. Each of these teams consists

to the TMC for consultation. At the TMC,

of one ANM (Auxiliary Nurse Midwife)

the general nurse does a basic check up

and a bike rider or ‘pilot’. These three

while updating the records of each of these

teams travel to remote villages everyday

women. The technician takes samples

for a health check up of women from

from the women for various tests. The

different communities. On reaching the

general nurse connects to gynaecologists

villages, the ANMs call the women of

in Hyderabad through a video call and

the community and on check-up, tell

the doctors consult the patients in this

them about their next visit to the TMC

manner. After all the women have been

(Telemedicine Centre). They are informed

done with their consultation, they are

Swasthya: Visual Communication for Community Health

Inspiration

The general nurse connecting a patient to the doctor in Hyderabad through a video call

all dropped back to their respective

cover most of the communities on a two-

communities. The supervisor keeps track

wheeler, but for remote villages where

of all the cases as well as gives the three

accessibility is limited, they need to

teams information about the villages to

reach the communities on foot. Most of

be visited and details of critical cases. The

the TMC staff belongs to the same tribal

antenatal cases are supposed to visit the

communities and hence their interaction

TMC at least four times during pregnancy.

with the villagers is efficient.

Critical cases, however, are called often

The signage at the Telemedicine Centre

or else referred to the Community Health Centre. The teams of the rider and ANM

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The 8 Fold Path (Source: Piramal Swasthya) To address malnutrition, Piramal Swasthya initiated Gosthani Project that spearheaded the attack against malnutrition with its 8-fold path.

PHASE 1

The Community Nutrition Hub project,

PHASE 2

also know as the Gosthani Project (named

Livelihood Income Generation

PHASE 3

after the local river Gosthani), was being

Community Nutrition Hub

set up when this design project started. The Piramal team had identified that the root cause of Infant and Maternal Mortality lies not just in childâ&#x20AC;&#x2122;s undernutrition

Digital Nutrition Monitoring

Nutritional Gardens

but also in high maternal undernutrition. This is mainly due to lack of knowledge on nutrition and intense manual labour. Piramal Swasthya has planned the functioning of this project in an 8 fold path

Health Services and Treatment

Integrating the WASH services Community based nutrient dense food products

Community Engagement & Awareness Programs

which would be laid out in three phases and currently, the first phase is in motion. This phase covers setting up a Nutrition hub and nutrition garden, providing health services and treatment, and spreading awareness regarding better nutrition. The nutrition hub will also provide food-processing equipments to the villagers. The villagers can bring their raw foods to the hub and process them using these equipments.

Swasthya: Visual Communication for Community Health

Inspiration

Nutrient dense food and easy-to-prepare

The various services provided at the

foods are prepared in the Nutritional hubs

Nutrition hub will include:

using local foods. The availability of easy-toprepare, nutrient dense food will not only

Nutritional Assessment: Every mother

address the malnutrition but also reduce the

and child will be assessed for their

cooking time so that the pregnant women

nutritional status

can take care of self and the children. Nutritional gardens will be managed by

Awareness would be created on how to

the families of pregnant women and young

improve the nutritional status with locally

mothers. The fresh produce from these

available foods

gardens will be used at the household level, and excess vegetables and fruits

Demonstration of easy to prepare nutrient

will be brought to the nutritional hub and

dense foods to improve the nutritional

preserved and processed into easy-to-

status will be conducted in the nutrition

prepare healthy foods.

hub. The nutrition hub is equipped with kitchen appliances and small scale food processing unit

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The Nutrition Hub in Nandivalasa village near Araku

Swasthya: Visual Communication for Community Health

Inspiration

The project is sustainable as local foods

Initially the Nutritional Hub will focus on

like Ragi, Jackfruit, etc. are included in the

creating food security and improve the

programmes. Also, the engagement of local

nutritional status of tribal people. In the

people in running the community Nutrition

second phase, income generation activity

Hub helps in creating impact.

will be included in which nutrient dense foods will be prepared by the community

The area where cooking workshops would be conducted in the Nutrition Hub

It will function in coordination with the

members and they will be sold in the

Integrated tribal development agency

local market. Making foods available at

(ITDA), and Integrated Child Development

affordable price will contribute to the food

Services (ICDS). These are the two main

and nutritional security and value chain

government institutions that will be

will be created to increase the market

involved in the program. Services like

beyond Araku valley to increase the income.

WASH, Livelihood generation, and

Availability of nutritious health products in

nutritional gardens will be developed in

the local market not only generates revenue

partnership with other NGOs who have

but also improves the nutritional status of

experience and expertise in implementing

the community.

the program.

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2.2

Demographics of the Region

Araku Valley is an Agency area located

Population

in the Dumbriguda Mandal (Tehsil) of Visakhapatnam district, Andhra Pradesh.

The Araku village has population of 2279

It is a valley in the Eastern Ghats inhabited

of which 1086 are males while 1193 are

by different tribes. It is located in the

females as per Population Census 2011. In

Eastern Ghat about 114 kilometres (71 mi)

Araku village, population of children with

from Visakhapatnam, close to the border

age 0-6 yr is 261 which makes up 11.45 %

of the Odisha state. The Anantagiri and

of total population of village. Population

Sunkarimetta Reserved Forest which are

density of the village is 101 persons per sq.

part of Araku Valley, are rich in biodiversity

km. Average Sex Ratio of Araku village is

and are mined for bauxite.

1099 which is higher than Andhra Pradesh state average of 993. Child Sex Ratio for Araku as per census is 878, lower than Andhra Pradesh average of 939.

Swasthya: Visual Communication for Community Health

Inspiration

Map of Andhra Pradesh with Vishakhapatnam district Source: http://d-maps.com

Population Growth

Workers profile

Population of the village has increased

In Araku Valley, out of the total population,

by 7.8% in last 10 years. In 2001 census

29,750 were engaged in work activities.

total population here were 2115. Female

65.3% of workers describe their work as

population growth rate of the village

Main Work (Employment or Earning more

is 8.6% which is 1.7% higher than male

than 6 Months) while 34.7% were involved

population growth rate of 6.9%. Child

in Marginal activity providing livelihood

population has decreased by 7.1% in the

for less than 6 months. Of 29,750 workers

village since last census.

engaged in Main Work, 9,449 were cultivators (owner or co-owner) while 5,567 were Agricultural labourer.

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Health

Literacy

There is a high prevalence of protein,

Araku village has lower literacy rate

iron, vitamin A, and iodine deficiency and

compared to Andhra Pradesh. In 2011,

malnutrition. People face illnesses caused

literacy rate of Araku village was 59.81 %

by unsanitary living conditions. Problems

compared to 67.02 % of Andhra Pradesh. In

due to improper water drainage systems

Araku, Male literacy stands at 72.02% while

also lead to water and mosquito-borne

female literacy rate was 49.02 %. Overall

diseases like malaria, typhoid and diarrhea.

literacy rate in Araku has increased by 10%.

Moreover, the areaâ&#x20AC;&#x2122;s MMR is 800 and IMR is 150. These ratios are roughly three times Indiaâ&#x20AC;&#x2122;s national averages. The district of Visakhapatnam consists of 24 Primary Health Centres and 6 Community Health Centres. The last resort of the villagers are these Community Health Centres (CHCs) which they have to visit in cases of complicated health problems. Children in the village Lamtam Padu, near Araku

Swasthya: Visual Communication for Community Health

Inspiration

Settlements in the Araku Valley

The Principal Hill tribes living in the

that they exchange information of their

Agency are Bhagatha, Kondadora, Khond,

welfare and at times they use these places

Kondakapu, Valmiki, Kammara, Gadaba,

to fix up alliances. The shandy points

Kotias, Porja and Nookadora. They speak

are also benefiting the tribals for their

Telugu and of few speak tribal dialects

natural interest. Agriculture is the main

like Gadaba and Kotiya. The Bhagata and

occupation of the Tribals. They cultivate

Valmiki are more advanced in all walks

both wet and dry crops. Their income is

of life than the other tribes. Half of the

supplemented by collection and sale of

District area is covered by forests and a

Minor Forest Produce. Araku Valley has

considerable portion of reserve Forest.

very little infrastructure, including poor

The area is rich in Forest Produces. The

road connectivity and a lack of electricity

Scheduled Tribes who are scattered in the

and running water. Most tribal families

hilly region usually assemble at the weekly

generate a meager average income of 1500

shandies (markets). It is at these places

INR/month through agricultural activities (ITDA, AP). Health problems in the region are greatly influenced by these factors. Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

2.3

Research By Therefore Design A majority of the tribes visited by the team followed Christianity which is prevalent in these regions due to the influence of missionaries.

Before the commencement of this

The Field Research spanned over a time

graduation project, the Therefore Design

period of three days which covered the

Team had conducted a research study

following sites:

for the project by visiting the field. The team with the help of the Piramal Swasthya staff visited various tribal communities in and around Araku valley. A majority of the tribes visited by the team followed Christianity which is prevalent

• • •

in these regions due to the influence of missionaries. The design team also interacted with the staff at Asara, the Telemedicine project at Araku. During this visit, the second project by Piramal Swasthya in the region, namely Project Gosthani (Nutrition Hub), was in the construction phase and the necessary infrastructure was being put in place. The team used observation and interviews as methods for the research study.

Swasthya: Visual Communication for Community Health

Inspiration

•

Telemedicine Centre (Project Asara), Araku Site for Nutrition Hub (Project Gosthani), Nandivalasa Three habitations around Araku, namely Nandivalasa, Borriguda and Urumulu Piramal Swasthya Headquarters, Hyderabad

The team drew various insights from their observations and interviews. They observed that the Telemedicine Centre is functionally well equipped. That said, the space appears clinical and possibly intimidating for the patients. This was identified as an opportunity to make the patientsâ&#x20AC;&#x2122; experience more comfortable and also provide information. In regards to the Nutrition Hub, they observed that essential elements to facilitate training and utility for women from the communities had been planned. The team proposed that communication material and peripheral tools / objects could help to strengthen the impact of the hub. They noticed that the advantage for the nutrition hub is that there is a ration store right opposite it. The prices of the grains, cereals and other products such as oil gave them a good A team from Therefore Design along with the Piramal Swasthya staff on the field visit in Araku

Graduation Project

insight into possible reasons for the way the diet of the locals is skewed.

Vineet Gedam | Graphic Design | M. Des 2015

During interviews with the women they

boxes, plastic boxes, trunks and nylon

it comes to general problems, whereas

observed that women belong to varied

woven sacks. Most homes have access to

health related problems are primarily

educational backgrounds and levels

electricity â&#x20AC;&#x201C; however usage and application

addressed by the traditional healer. As

of literacy. The younger women in the

might be limited. Cooking space is a corner

far as employment is concerned, NRGS

community are more self aware and

of the home with a mud chulaah fueled by

scheme and working as farm hands are the

independent. Their dressing styles vary

wood. Diet consists mainly of rice and thin

two major sources of employment. In this

quite a lot; though they drape saris in their

dal made using tamarind and ragi porridge.

community, Christianity is the dominant

traditional fashion, regular draped sari and

Other pulses that are locally grown are also

religion and hence the community mainly

salwar kameez are also commonly worn.

part of the diet but are not mentioned as

celebrates Christian festivals. Sunday mass

Discussions with the experts and the team

part of the staple.

has become an important community

on ground helped them to get a better

event. The team also talked to a village

context and improve their understanding

They talked to different women and men

headman who gave information regarding

of the communities and people of Araku.

from these communities and recorded

the lifestyle of the people, the community

their lifestyle. The women told them about

as a whole and their views and beliefs.

The team visited the homes of the villages

their routine, work, income and how they

The headman stressed on Work being the

and found out that metal / aluminum pots

spend it. They also talked about special

most important aspect of their lives. He

play a very important role in the home for

events, traditions and festivals that they

also gave his views on the difference in

storage and for cooking. The kitchens are

celebrate. Questions were also asked to

lifestyles of towns and villages and his

central to the home and occupy a place of

find out the positions of different villagers

reasons for preferring the tribal way of life.

priority. Homes have a mix of materials

in terms of power and respect. The village

â&#x20AC;&#x201C; woven baskets, metal pots, small steel

headmen holds considerable power when

Swasthya: Visual Communication for Community Health

Inspiration

While interviewing these people, the team

On interviewing the Piramal Swasthya

also observed and analysed their living

team, it was found that the Piramal staff

spaces and how they interacted with them.

finds it difficult to get the pregnant

While there is no alter place in the home

women to come forward voluntarily to

there are a lot of posters / leaflets etc that

the ANMs. According to the Piramal

have probably been distributed by the

staff, women have now started coming

Church. All this communication material

to the Telemedicine center but still do so

is proudly displayed within and outside the

reluctantly. They informed that the Daiâ&#x20AC;&#x2122;s

home. The churches are well appointed

in the communities were trained but no

building furnished with speakers,

follow up training has happened with them

instruments, chairs, plates, false ceiling

and hence they are / may not be equipped

and tube lights etc. Most communities each

appropriately to manage the deliveries

have a church of their own in their vicinity.

at home. Regarding nutrition, it was

Interaction with the Telemedicine Centre staff at Araku

understood that the people of the village had the knowledge of what is nutritious and what isnâ&#x20AC;&#x2122;t. However this knowledge is being lost and the new generation is not carrying forward old practices and the new practices being adopted are not in their best interests.

Graduation Project

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Men from one of the tribal communities of Araku

Depleting forest

Loss of Identity

Changes in surrounding environment and exposure to media

Changing religious status of communities at large

The design team complied certain broad

and traditions associated with the forest

insights garnered from this preliminary

that the older generations have, are

study. They concluded that the tribal

not relevant today. Growing number of

communities are facing problems due

educated youngsters and level of literacy

to a loss of their age old characteristics.

has given rise to a population that wants

Forces like depletion of forests, changes

to live and work in a more urban setting.

in surrounding environment, exposure

Exposure to society and media is driving

to media and changing religious status of

new habits, behaviors and aspirations

communities at large are leading this loss

among the tribals.

of identity. As forest resources become more scarce â&#x20AC;&#x201C; they are saved for more special occasions and hence impact the daily diet of the people. Age old knowledge

Swasthya: Visual Communication for Community Health

Inspiration

Through Christianity, an adoption of new cultural / social identity and traditions within the community has made the communities to break away from old customs, rituals, legacy and folklore. In this changing context, age old traditions hold less value for the people and hence,

In this changing context, age old traditions hold less value for the people and hence, they are not able to discern the difference the impact of adopting these new behaviors is making.

they are not able to discern the difference the impact of adopting these new behaviors is making. Hence, there is low awareness of impact of bad lifestyle and nutrition choices. Keeping these insights in mind, the design team started asking questions which might give a starting point for interventions to be designed.

The sticker on a motor-bike showing a cross. Most of the communities practice Christianity in the region.

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Children playing in one of the villages near Araku

Keeping these insights in mind, the design

Other important questions, specifically in

team started asking questions which might

the context of the telemedicine centre and

give a starting point for interventions to be

the nutrition hub, were also asked.

designed. What is the experience we want to provide at the What would be the motivators to affect

Telemedicine center and the Nutrition Hub?

behaviour change? What is the communication at each important Who would the influencers be?

touch point in both the centers?

How can we involve the influencers to help us in

What do the women carry back with them that

the project?

will help to remind them of what they learnt and help to inspire them to change their behaviors?

How do we achieve sustained behavior change for maximum number of people?

Swasthya: Visual Communication for Community Health

Inspiration

Women being interviewed by the Therefore Design team

The team listed various challenges to be

habits by creating awareness before hand

tackled in terms of designing solutions

on the adverse effects of packaged food.

and initiating behaviour change within the communities. For the Telemedicine

After this preliminary study, the insights

centre, these challenges included getting

and opportunities were presented to the

women to come forward willingly about

client. Also, post this study, we (Anupama,

their pregnancy, take proper care and

Ojal and myself) joined the team as

medication and understand the problems

consultants to Piramal Swasthya. This

they have. Creating a conducive and

study acted as a good starting point for

supportive family environment for the

our research and helped us get a basic

pregnant woman would also be important.

understanding before diving into the

The challenges for Nutrition hub would be

design process.

This study acted as a good starting point for our research and helped us get a basic understanding before diving into the design process.

to modify eating habits of the people to inculcate a more healthy diet and reduce the impact of mass media on their eating

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2.4

Talks with the Client

In this process, we also got important information from the staff regarding the distinct characteristics and behaviours of the tribal population.

In the initial few weeks, the design team

The person we were in constant touch with

had several conference calls with the

was Suneetha Sapur, the nutritionist who

Piramal staff in order to understand the

had been working with the communities

functioning of the projects, the problems

and developing the nutrition hub. She

faced by the staff and the communication

gave information regarding the tribal

requirements of the client. In this process,

communities, their behaviours and the

we also got important information from the

progress and plans of the upcoming

staff regarding the distinct characteristics

projects. According to her, the women

and behaviours of the tribal population.

start acting on their health problems only

At this point in the project, we had not

when complications occur. There is a need

visited the field and so had quite limited

for a proper communication strategy in

understanding of the people and the

order to make the people understand the

environment. And so, these initial talks

‘what’, ‘why’ and ‘how’ of the issues at

with the clients were extremely helpful in

hand. Talking about the nutrition hub,

visualizing the scenario in Araku.

the Piramal staff informed that the main target group for hub are pregnant women, mothers, adolescents and infants till the age of five years. The processing of foods at the nutrition hub would begin with the introduction of a method to modify the

Swasthya: Visual Communication for Community Health

Inspiration

staple food of the region, Ragi. The staff

own child. These tools of measurement

barriers for better health. Certain myths

had planned to demonstrate and teach the

need to be done in a way to make it

such as â&#x20AC;&#x2DC;eating eggs produce bald childrenâ&#x20AC;&#x2122;

women, this method of processing Ragi so

interesting and easy for the women to use.

directly affect the nutrition of the mothers.

that later the women can themselves do

The tools can be somehow integrated with

The nutrition hub will also give options

it using their own Ragi. This method was

the environment of the nutrition hub and

of preserving foods and so people would

designed mainly to increase the nutrient-

the surroundings around. The Piramal

not have to depend on seasonal fruits for

density of these foods. The clients talked

staff also plan to make the other villagers

certain nutrients. The team told us that

about the possibility of communicating

aware about the nutrition garden, so that

another factor affecting the diet of the

this information and other details to the

they also contribute in taking care of the

people was mass media like the TV. Earlier

women through kits which can be carried

garden. The design of the nutrition garden

the only pass-time for the communities

home. These kits could contain simple

will be inspired from the Mandala style of

was chatting after work, but now many

instructions on the method of processing

making gardens which will include a variety

households have a dish-TV connection

and using ragi. Another aspect of the

of nutritious plants. The Piramal team

which then helps them spend evenings

functioning of the hub includes assessment

told us that apart from the challenges of

watching movies or sports. Food products

and tracking the growth of infants. This

spreading awareness in these regions, we

promoted on TV channels are mostly

would be done by tracking the height,

also need to take into consideration, the

packaged foods which are not a healthy

weight and mid-arm circumference of the

age old myths and beliefs that the tribals

option and hence pose a threat to their diet.

children. They plan to also teach these

have regarding pregnancy, health and

methods of assessment to the women so

nutrition. Some beliefs might actually be

that they can assess the growth of their

beneficial for them, but some are acting as

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

The weekly market in the Araku valley is known as ‘Shandy’

Swasthya: Visual Communication for Community Health

Inspiration

Women performing the traditional Dhimsa dance of Araku

The weekly market (called â&#x20AC;&#x2DC;Shandyâ&#x20AC;&#x2122;) is

of the people. The team at Piramal

also be displayed in an interesting fashion

the place where most people buy food and

suggested various solutions for both, the

in or around the hub.

other products. People in the shandy sell

Telemedicine centre and the Nutrition hub.

and buy various farm produce, packaged

The TMC has a TV installed in it, which

During subsequent calls with the Piramal

foods, groceries and other items. These

could be used to display information for the

team, we were given a brief for creating

items also include alcohol which is

women who come for a checkup. On exit,

certain communication material for the

consumed in heavy quantities by men

something like a booklet could be given

nutrition hub. This material would cover

and women alike. Since ages, the tribal

to the women for taking home. The ANMs

three important aspects of the first phase,

communities had been preparing alcohol

could also carry certain material for their

namely, food processing, nutritional

naturally by fermenting rice, but nowadays,

visits to the villages. The nutrition hub

assessment and food intake information

cheap and quick alcohol is available in the

could have posters or charts for explaining

for mother and child. The target audience

shandy which is mostly adulterated. Like

the various processes for preparing,

for this material would be pregnant

alcohol, other foods are also adulterated

processing and preserving local foods. The

women, mothers and infants till five years

which again hampers the nutrition

nutrition assessment information could

of age.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

2.5

Framing the Design Challenge

Elements like poor accessibility, importance of traditional healers and presence of cultural practices and beliefs were some of the constraints that needed to be considered while designing.

After understanding the challenges faced

constraints and nature of the environment

by the staff at the Telemedicine centre and

where the design intervention would be

the objectives of the nutrition hub, the

implemented. These constraints were then

task of framing a proper design challenge

listed in order to help refine our design

or question was taken up. For this, the

problem. Elements like poor accessibility,

different problems to be solved were

importance of traditional healers and

listed. Looking at these problems, the

presence of cultural practices and beliefs

most important and relevant problem was

were some of the constraints that needed

used to frame a design question. The next

to be considered while designing.

step was to identify the ultimate impact that the design team was trying to achieve

It was seen whether the initial challenge

by solving this design problem. Before

drives towards ultimate impact, allows

finalizing the design question, a set of

for a variety of solutions, and takes

possible solutions to the design problem

into account context. Keeping all this

were thought and put down as options.

information in mind, the design problem was modified. The final design challenge

Swasthya: Visual Communication for Community Health

From the knowledge gained through

stressed on integrating good healthcare

talks with the Piramal staff and the study

practices in the community rather than

done by the Therefore Design team,

just orienting women to take proper care

we had a rough picture of the context,

during pregnancy.

Inspiration

What’s the Problem we are trying to solve?

Make women take

Make Piramal

Make women

Making women

proper prenatal and

staff’s work easy

cooperate with

follow instructions

postnatal care

and efficient

Piramal’s staff and

and take medicines

engage in their

regularly

projects

Design Question

How can we make women to take proper prenatal and postnatal care?

Ultimate Impact we are trying to achieve

Women are actively taking steps to ensure proper health and nutrition during and after pregnancy and are aware of the issues

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Possible Solutions

Spreading

Showing Benefits of

Showing

Sensitizing people

awareness

better Health and

disadvantages of

around the Mother

regarding Health

Nutrition

improper care

and child

and Nutrition

Context and

Limited

Presence of

Constraints

Accessibility

traditions and

packaged foods and

cultural practices

TV/phones

Traditional healers

Pregnancy perceived

given more

as normal

Depleting Natural Resources Illiteracy

importance

Myths around around foods

Revised Design

How can we integrate good maternal care and child care practices in the tribal community and culture?

Question

Swasthya: Visual Communication for Community Health

Inspiration

Apart from this design challenge, the team

What to Eat

also had to work on a list of communication

Showcasing the process of processing Ragi

requirements given by the Piramal staff

and its benefits

which were to become a part of the

Showcasing the process of solar dryer and

Nutrition hub project.

its benefits Balanced diet - how to improve current diet

Based on discussions with them, the information was clubbed in the following

When and How Much to Eat

broad categories:

Measures of food for better nutrition of pregnant women, mother & child

Nutrition Assessment What to Eat When and How Much to Eat These categories contained information on which the deliverables would be built: Nutrition Assessment Height, Weight, Mid-arm assessment for Nutrition Assessment

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

2.6

Recruiting Tools

By planning ahead, and tracking who we talk to, we could be sure to have the right balance of experts and laymen, women and men, people of different ethnicities and classes.

Before we started talking to the people we

As we started to determine who we

would be designing for, it was important

wanted to talk to, a variety of factors were

to have a strategy around whom to talk

considered: age, gender, ethnicity, class,

to, what to ask them, and what pieces of

social position. Initially, the people were

information are needed to be gathered

divided based on gender and then further

By planning ahead, and tracking who we

into categories such as literacy, age, power

talk to, we could be sure to have the right

status and government workers.

balance of experts and laymen, women and men, people of different ethnicities and classes, as well as a full range of behaviors, beliefs, and perspectives.

Swasthya: Visual Communication for Community Health

Inspiration

Glimpses of mind maps for figuring out the kind of people to be interviewed

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

2.7

Secondary Research Secondary Research, whether done online, by reading books, or by crunching numbers, could help one ask the right questions.

Talking with people about their challenges,

secondary research. The study was initiated

ambitions, and constraints is of utmost

by exploring the most recent news in the

importance in order to inform our design

field. An effort was made to find the recent

process. But as we move through the

innovations which could be technological,

research phase, there are moments where

behavioral, or cultural. Existing solutions

more context, history, or data is needed

in similar regions were looked at. It was

that is difficult to gather from an interview.

analyzed as to which solutions worked and

Secondary Research, whether done

which ones didnâ&#x20AC;&#x2122;t, as well as any that felt

online, by reading books, or by crunching

similar to what we might design.

numbers, could help one ask the right questions. The studies done fell broadly into the The secondary research initially started in

following categories:

a quite divergent manner in the sense that various themes related to the project were

Similar Case Studies

explored simultaneously. But eventually,

Other Case Studies

the research was streamlined and divided

Tribal culture and behavior

into broad themes in order to organize

Communication strategy and tools

better and make the most out of the

Swasthya: Visual Communication for Community Health

Inspiration

Avantha Foundation We started looking at projects taken up by NGOs which shared with this project Training of Aanganwadi Workers, Accredited Social Health Activists and Auxiliary Nurse Midwives on care and growth monitoring of children by Avantha Foundation

the aim of tackling the problem of IMR and MMR. One such organisation is the Avantha Foundation, based in Pune, which came into existence with the

‘Saksham’, as their new initiative is

Demonstrations in the field are key

objective of improving the quality of life

called, focuses on improving child

to Avantha Foundation’s approach to

of communities across the country by

nutrition indicators by promoting critical

building skills of community members.

addressing issues of national concern

nutrition service delivery. Education and

It has integrated field demonstrations as

through pioneering development

empowerment of mothers, strengthening

an important constituent of counseling

initiatives. The foundation currently

capabilities of frontline nutrition

for growth monitoring. This is planned to

addresses the following three critical areas

workers, engaging local communities,

educate mothers and family members and

of need, in locations like Madhya Pradesh,

and promoting convergence in services

to build their skills for adopting effective

Rajasthan and Maharashtra:

are their key project approaches. One of

child care practices. Demonstrations

their interventions include using mobile

are held on hand washing practices,

technology to support frontline Nutrition

breastfeeding, cooking low cost high

Workers . Generating child-specific

nutrition recipes using locally available

longitudinal nutrition status, a key tool

resources, making oral rehydration

to effectively manage nutrition service

solution to address diarrhoea in children,

delivery, is enabled by a specially designed

and on proper use of nutrition supplements

mobile application.

distributed through Anganwadi centres.

· Improving child nutrition in indigenous and tribal communities.

· Treatment, care and support to people living with HIV.

· Building capacities to improve governance in small towns.

Source: www.avanthafoundation.org/

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

A community health worker educating women in a village in Rae Bareli district

Sure Start - An initiative by PATH Sure Start applied several innovative communication tools through accredited social health activists, Village Health and Sanitation Committees, and mothers’ groups.

PATH is an international nonprofit

behaviors at the village level.

organization that transforms global

Sure Start focused on behavior change

health through innovation. They take an

communication based on the individual

entrepreneurial approach to developing

needs of each woman and family. This

and delivering high-impact, low-cost

communication was intended to increase

solutions, from lifesaving vaccines and

demand for needed health services. Various

devices to collaborative programs with

stakeholders and beneficiaries—such as

communities. PATH’s Sure Start project

the pregnant woman’s mother-in-law,

catalyzed community action to increase

her husband, mothers’ groups, and the

access to services that improve maternal

Village Health and Sanitation Committee

and newborn health care in seven districts

(VHSC)— were engaged to increase

of Uttar Pradesh. Sure Start applied several

community understanding of maternal

innovative communication tools through

and neonatal health. The intervention was

accredited social health activists, Village

intended to challenge deeply entrenched

Health and Sanitation Committees, and

myths about harmful practices and

mothers’ groups. All three types of change

behaviors related to pregnancy, childbirth,

agents played a significant role in changing

and newborn care.

Swasthya: Visual Communication for Community Health

Inspiration

A daily wage laborer from Mudhadhia village, Basti district holding the letter from the â&#x20AC;&#x2DC;Chitthi Mere Papa Ke Naamâ&#x20AC;&#x2122; campaign

Sure Start used low-cost, interactive tools

The Chitthi Mere Papa Ke Naam campaign

to communicate with target beneficiaries.

reached out to more than 211,200 fathers-

These tools were effective in raising

to-be to sensitize them to issues related

awareness of health issues and bringing

to maternal and newborn health as well as

about desired behavior changes. ASHAs

encourage their proactive support during

used the tools during home visits and

and after pregnancy. The centerpiece of

mothersâ&#x20AC;&#x2122; group meetings. An interpersonal

the campaign was a letter from the unborn

communication toolkit developed by

baby to its father urging him to ensure

the Sure Start team contains 16 tools

necessary care and support for the well-

on maternal and newborn health. The

being of both the child and the mother.

accompanying usage booklet helped

Sure Start also held sensitization meetings

frontline health workers use appropriate

for men. Although the meetings were

communication materials during home

informal, they were organized to reinforce

visits and group meetings to dispel myths

male involvement and to promote

and promote healthy behaviors. Various

sharing of experiences and difficulties.

participatory tools and exercises were

These meetings also provided a space to

used to deliver messages about birth

understand the myths and misconceptions

preparedness, recognition of danger signs,

of male involvement.

The centerpiece of the campaign was a letter from the unborn baby to its father urging him to ensure necessary care and support for the well-being of both the child and the mother.

immediate and exclusive breastfeeding, newborn care, and emergency transport.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Hoardings in the media campaign ‘Pehla Ek Ghanta’ (the first one hour) which spread messages about the critical importance of the first hour after delivery.

The campaign also featured games, street plays, mothers’ meetings, flip books, film screenings, and jingles intermingling core behavioral messages.

Sure Start used creative methods to

messages. It included messages on birth

disseminate important information

preparedness, danger sign recognition,

about maternal and newborn health to

cord care, thermal care of the newborn, and

communities. The project undertook

immediate and exclusive breastfeeding.

an innovative media campaign—Pehla Ek Ghanta (the first one hour) —which

These interactive and entertaining

included setting up five hoardings

methods were designed specifically to

(billboards) in each of the seven districts

attract men, pregnant women, nursing

and outfitting 750 rickshaws with

mothers, and mothers-in-law. The

messages about the critical importance of

campaign reached an estimated 37,000

the first hour after delivery. The campaign

pregnant women.

also featured games, street plays, mothers’ meetings, flip books, film screenings, and jingles intermingling core behavioral

Swasthya: Visual Communication for Community Health

Inspiration

Mobile Kunji: An audio-visual â&#x20AC;&#x2DC;job-aidâ&#x20AC;&#x2122; for community health workers

The cards are colour-coded so that the 40 sheets are easily navigable for health workers who typically spend on average 10â&#x20AC;&#x201C;15 minutes on a visit.

on the front of the card above a mobile

The project addresses both practical and

Created by the organisation Anaya and

shortcode. Dialing this code takes the

more systematic problems the health

BBC Media Action, Mobile Kunji is an

health worker through to an audio

workers face. The need for something

audio-visual job aid for community health

recording of Dr Anita or her assistant, the

that could be carried easily on home

workers working in maternal care in rural

authority figures created to to convey short

visits, for example, alongside the need

India. So far the project has been launched

messages of important information to

for a substantial amount of accurate and

in Bihar, Odisha and Uttar Pradesh. A

the families. These authority figures were

standardised information, and the the need

deck of 40 cards go, quite literally, hand-

created to build trust in the families who

for a tool which values and empowers the

in-hand with pre-recorded audio clips

often lack access to larger professional

health worker role rather than replaces

accessible from a basic mobile phone. The

health care institutions. In Bihar, for

it. Mobile Kunji demonstrates a well-

cards contain information on the crucial

example, the ratio of doctors to patients

executed process of understanding a need

early stages of pre and post-natal health

is 1:3,500 (the national average in 2013

and addressing it with considered form and

care, breaking down a vast subject into

was 1:1,700). On the back of the card the

function, a strong example of how a piece

eight important behaviours and over 100

key content is summarised along with a

of visual communication can support and

points which encourage attitude change.

lightly written couplet also repeated in the

enhance interpersonal communication, not

Each point is visualised as an illustration

accompanying recording.

replace it.

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Amitabh Bachchan at a special event hosted by UNICEF to celebrate the contribution of community mobilisers, frontline workers and Bachchan in making India polio free.

The Polio Immunisation Campaign Sure Start applied several innovative communication tools through accredited social health activists, Village Health and Sanitation Committees, and mothers’ groups.

mothers were not willing to pursue the With the global initiative of eradication

dosage for their young. When everything

of polio in 1988 following World Health

else did not get the required results, the

Assembly resolution in 1988, Pulse Polio

campaign managers decided to bring

Immunization programme was launched

Bachchan in his film avatar that he’s most

in India in 1995. The Pulse Polio Initiative

remembered for — the angry young man

was started with an objective of achieving

(though that was many decades ago).

hundred per cent coverage under Oral Polio

Instead of pleading they decided to get

Vaccine. It aimed to immunize children

annoyed with them. The campaign with

through improved social mobilization,

“great annoyance” worked. Bachchan

plan mop-up operations in areas where

recalls a UN representative telling him that

poliovirus has almost disappeared and

when they decided to study the reason for

maintain high level of morale among the

the latest campaign’s success, one rural

public. The trick lied in recruiting locals,

woman told the team that Amitabh was

who would know who’s turned up this time

very upset, hence she decided to give polio

and who has not. This move worked even

drops to her child.

in smaller villages where births would not get registered in time, particularly if the childbirth happened at home and not in any healthcare facility. The project faced many issues, for instance, in rural India,

Swasthya: Visual Communication for Community Health

Inspiration

A rally during The Sparsh Leprosy Awareness Campaign in a town in Meghalaya

Media and advocacy has been one of the

Branding: Branding of all polio information,

high priority areas or where rumours and

key components of the communication

education and communication (IEC)

community concerns need to be addressed.

strategy for polio eradication in India,

material with bright yellow, pink and

constantly evolving and adapting to the

blue, consistently in every state has

Advocacy with Political Leaders & Others:

changing needs and the challenges facing

given a distinct and unique identity to the

Rotary leads political advocacy at the

the programme. The aim has been to

programme. Polio posters and banners

highest level, engaging with state heads

build an atmosphere conducive for polio

are easily recognized by the community

and top level bureaucrats. The engagement

immunization. The media strategy has

in any part of the country. Logos and

of top politicians has helped send out

complemented other efforts to reinforce

taglines for the programme have evolved

a clear message of strong government

key programme messages and bring

with the changing programme needs. The

ownership of the programme. UNICEF

about long-term behavior change in the

first tagline being â&#x20AC;&#x2DC;do boond zindagi kiâ&#x20AC;&#x2122;,

and partners WHO and CORE advocate

community to accept polio immunization.

(two drops for life) to advocate with the

with programme managers, religious

community the importance of the two

leaders and institutions, community

drops of polio.

leaders, elected representatives, medical

Brand Ambassador: In 2002, UNICEF approached the most popular Bollywood

associations, medical practitioners, and

star Amitabh Bachchan to be the

Partnership with Media: Media is a critical

small and big businesses like construction

ambassador for the polio programme in

partner for the programme. Media reports

companies, brass factory owners,

India. Since then the top celebrity has

are tracked and analyzed at the national,

managers of brick kilns etc. This has

been the face of the polio programme.

state, district and block levels. Advocacy

helped build strong community ownership

His appeal to the masses through TV and

meetings, briefings and field trips are

of the programme.

radio spots, beamed across the country

ongoing to share with the media the

ahead of each polio round, helped garner

challenges, initiatives and programme

community support to the polio booths.

updates. These initiatives are intense in

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

A Study of Utilization of Communication Channels and Information Seeking Behaviour by the Tribals for Improving their Health Care Practices By T. Mathiyazhagan (Professor and Head, Department of Communication), Deoki Nandan (Director), M.P.Meshram (Research Officer), Ramesh Chand and Lakhan Lal Meena (Assistant Research Officer, National Institute of Health and Family Welfare, New Delhi)

The findings of the study revealed that tribals tend to believe in interpersonal communication as compared to other modes of communication.

The objectives of this research was to

of two channels. Illiteracy is a prominent

to study the utilization of different

issue among tribals. Hence, reaching them

communication channels by the tribals for

with health care messages through printed

getting information on various health and

materials will be of less use. However, in

family welfare programmes; and

this study, an attempt was made to see how

to understand their information seeking

far the printed materials are popular in the

behaviour with reference to health care

tribal localities. In spite of high illiteracy

practices. The study was conducted in

in the tribal area, tribals still consider

Mandla, one of the tribal dominated

posters (57.8%) as one of the sources for

districts of Madhya Pradesh, in 2005.

getting information on health and family

Mandla district is situated in south-

welfare. The other sources like banners

eastern part of Makal Hilly ranges of

accounted for 30.6 per cent and hoardings

Madhya Pradesh in central India. The

and billboards have been ranked very low,

study conducted quantitative analyses on

5.6 per cent and 5.0 per cent, respectively.

utilization of channels like Interpersonal

The findings suggest that to educate the

Communication (IPC), Mass media ,

tribal people we may use posters as one of

traditional media, as well as combination

the potential sources of information.

Swasthya: Visual Communication for Community Health

Inspiration

The findings of the study revealed that

of emotions, ideas and dreams. Because of these reasons, the tribals in the study

(i) tribals tend to believe in interpersonal

area may have preferred traditional media

communication as compared to other

as one of the combinations of media along

modes of communication

with interpersonal communication.

(ii) availability of electronic media viz.

The study concludes that the availability

radio and television with the tribals is

of electronic media such as radio and

limited, however, their accessibility to

television is very limited with the tribals.

these media is somewhat better;

The study further concludes that the tribals tend to believe in interpersonal

(iii) IPC (Interpersonal Communication)

communication as well as in traditional

followed by traditional media is the choice

media of communication. Therefore,

of combination of channels preferred by

the authors suggest that a combination

the tribals; and

of interpersonal communication and

The authors suggest that a combination of interpersonal communication and traditional media may be adopted to deliver health care messages to the tribals in Mandla District of Madhya Pradesh.

traditional media may be adopted to (iv) tribals prefer to watch television or

deliver health care messages to the tribals

listen to radio only in the evening hours

in Mandla District of Madhya Pradesh.

but information seeking behaviour among

This is in line with National Population

them from various sources is casual.

Policy (2000) which also emphasis on communicating clear and focussed

The traditional folk media are personal

health care messages to the people in the

forms of communication of entertainment.

remotest corners of the country in local

These forms of art are a part of the way

dialects through local artists, singers,

of life of the community and provide

folk-dance groups, comedians, actors,

acceptable means of bringing development

drummers, popular film stars, etc.

issues into the community on its own. They are themes-carriers by nature, not simply as vehicles of communication but as games of recreating and sharing a common world

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

Healthcareseeking Behaviour among the Tribal People of Bangladesh: Can the Current Health System Really Meet Their Needs?

interviews, and participant observations, were used involving 218 men, women,

Syed Azizur Rahman, Centre for Applied

adolescent boys, and girls belonging

Research in Cancer Control, BC Cancer Agency

to nine different tribal communities in

and University of British Columbia, Vancouver,

six districts. Data were transcribed and analyzed using the narrative analysis

Tara Kielmann,Barbara McPake,Institute of

approach

International Health and Development, Queen Margaret University, Edinburgh, UK

The following four main findings emerged from the study, suggesting that the

Gender and age play a role in making decisions in households in relation to health matters and treatmentseeking

Charles Normand, Health Policy and

tribal communities may differ from the

Management, School of Medicine, University of

predominant Bengali population in their

Dublin, Trinity College, Ireland

health needs and priorities:

Despite the wealth of studies on health

(a) Traditional healers are still very popular

and healthcareseeking behaviour among

among the tribal population in Bangladesh;

the Bengali population in Bangladesh,

(b) Perceptions of the quality and manner

relatively few studies have focused

of treatment and communication can

specifically on the tribal groups in the

override costs when it comes to provider

country. This study aimed at exploring the

preference;

context, reasons, and choices in patterns

of healthcareseeking behaviour of the hill

decisions in households in relation to

tribal population of Bangladesh to present

health matters and treatmentseeking;

the obstacles and challenges faced in

(d) Distinct differences exist among the

accessing healthcare provision in the tribal

tribal people concerning their knowledge

areas. Participatory tools and techniques,

on health, awareness, and treatment

including focus group discussions, in depth

seeking behaviour.

Swasthya: Visual Communication for Community Health

Inspiration

Regional communication strategy for the prevention and control of birth defects A publication from the WHO Regional Office for South-East Asia This publication talks about Birth defects and how it is an urgent public health priority. It further informs on interventions that can be integrated into existing and emerging programmes. It talks about the power of communication in prevention of birth defect and gives strategic actions in order to plan and implement communication activities for behaviour change. An enabling environment for a new intervention is crucial to support behaviour change and encourage individuals and communities to

mobilisation, when supported by behaviour change communication, influence people’s perceptions, beliefs, and attitudes and can lead to changes in social norms towards prevention and management of birth defects. For changes in behaviour to occur, incentives and “triggers” need to be identified and used appropriately. The text gives essential factors for efficective communication (7 C’s of effective communication): Command attention, Cater to the heart and head, Clarity, Communicate a benefit, Create trust, Consistent message, Call for action.

sustain such behaviours. Public campaigns should focus on alleviating the stigma related to birth defects and sensitively address cultural and religious issues such as myths and misconceptions around birth defects. This is achieved through community mobilization and media campaigns. Communication initiated for a specific programme may also influence related programmes, simply because audiences, issues and techniques overlap significantly. Advocacy and community

Graduation Project

Vineet Gedam | Graphic Design | M. Des 2015

It is important to use culturally acceptable communication channels and optimize multichannel opportunities.

Based on understanding of audience

Community channels help spread

segments and development of evidence-

information and messages through

based and persuasive messages, it is

existing social networks, such as the family

important to identify the appropriate

or community groups (e.g. meetings,

channel/ medium of communication to

motherâ&#x20AC;&#x2122;s groups, faith-based groups).

deliver the identified message/s to the

These channels are effective when dealing

target audience. It is important to use

with community norms. They optimize

culturally acceptable communication

participation and present opportunities

channels and optimize multi-channel

for audience members to reinforce one

opportunities. Various communication

anotherâ&#x20AC;&#x2122;s behaviour.

channels may be used in a phased manner to reinforce one another and maximize the

Mass media reach large audiences. They

impact on audiences.

are particularly effective for agendasetting and contribute to the establishment

Interpersonal communication channels

of new social norms.

focus on either one-to-one or one-togroup communication. One-to-one

Information and communication

channels include peer to peer, spouse to

technology (ICT) covers short messaging

spouse, health clinic worker to client,

services (SMS) (i.e. text messaging) via

and opinion-maker to community. An

mobile phone to keep health workers

example of one-to-group communication

apprised of the latest developments in

is a community- based outreach

obstetric care and counseling.

worker meeting with a womenâ&#x20AC;&#x2122;s group. Interpersonal channels use both verbal and nonverbal communication (e.g. charades, role-plays and skits).

Swasthya: Visual Communication for Community Health

Inspiration

Simply communicating a persuasive message does not lead to the desired behaviour change. The message, and the audience, must pass through a series of steps to result in the desired effect on the target audience.

Get the audience tuned in (exposure) Help maintain audience interest in the message Get audience to think about the message

the message must receive due attention from the target audience.

the message has to be repeated for the audience to register, remember and recollect it. words and pictures in the message should encourage the audience to reflect on what has been communicated

Help audience to acquire and practice the desired behaviour

for example, reminding pregnant women to take folic acid tablet,

Facilitate attitude change in the audience

the audience should feel convinced that it is in their best interest

Help the audience store the message in memory

regularly.

to adopt the desired behaviour if a message has been powerful enough and the audience has been carried through these stages, then the message will be stored in their long-term memory, well after the campaign is over.

Retrieval of the message from memory when relevant Support audience to act on the message (behaviour)

audience is able to retrieve the persuasive message from past experience and apply it in the future for example, the health worker actually provides tablets of folic acid, after explaining the reason and benefits, and the woman actually consumes tablet.

Audience integrates the behaviour into lifestyle

for example, community members quit using tobacco or seek deaddiction for drug users. Women planning pregnancies take folic acid regularly.

Audience recruits others to adopt the healthy behaviour

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audience spreads the message and influences others to adopt healthy behaviour

Vineet Gedam | Graphic Design | M. Des 2015

The ‘HIC-DARM’ analysis presented in

A – Individuals and communities act

another strategy by WHO, Communication

on their new behaviour (for example,

for behavioural impact (COMBI), explains

take folic acid supplementation, access

processes that may take place from the

treatment, encourage pregnant women

time audiences hear about birth defects to

to go for antenatal care); and await

the time they adopt the behaviour as part

reinforcement

of their routine.

R – reinforcement that their action was a good one (support from health-care

H – Individuals and communities hear

providers, health workers, opinion leaders

about birth defects from various sources

and community groups) and if all is well,

(providers, health workers, community

they go on to the maintenance stage

officials and opinion leaders); therefore

M – maintain their behaviour (continue

it is important for programme managers

supplementation, check-ups, spread

to provide correct information and clarify

the word about birth defects prevention,

doubts and misconceptions among these

encourage community members to seek

groups.

treatment and care for birth defects).

I – Individuals and communities are

This model also helps programme

informed about the causes of birth

managers to address the question of

defects and the advantages of prevention,

what is to be done in situations where

treatment, care and rehabilitation from

communities have been exposed to

various sources (relatives, community,

campaigns, but large-scale adoption of

media and providers).

safe behaviours (e.g. regularly taking folic

C – After receiving information, they

acid tablets during pregnancy, immunizing

become convinced that birth defects are a

children against rubella) have not taken

serious, but preventable health issue that

place to the desired extent.

require early diagnosis and treatment. D – Individuals and communities decide to do something about their conviction such as taking action

Swasthya: Visual Communication for Community Health

Inspiration

The five-pointed star of integrated

Public advocacy and mobilizing

communication action

decision-makers and administrative structures

A successful behavioural and social communication intervention calls for a judicious, integrated mix of five communication action areas, illustrated

Point-of-service promotion

Community mobilization

in the five-point star in the Figure. These actions will be integrated into a strategic communication plan around your behavioural goals. The communication action plan calls for engaging people at all

Promotional materials and advertising

Personal selling (mobilizing local networks and advocates)

levels of society through a wide array of media and in a variety of settings, such as their homes, clinics, at work, in church, in civic groups, in school and at community

The 5 communication action areas

events. In doing so, one should broadly outline the proposed communication actions for achieving the objectives in terms of the five communication action areas.

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Lok Biradri Prakalp for tribal development by Dr. Prakash Amte

Lok Biradri Prakalp in the Gadchiroli district of Maharashtra.

Swasthya: Visual Communication for Community Health

Dr Prakash Amte and his wife Dr

When Dr. Prakash Amte and his wife Dr.

Mandakini Amte have been working for

Mandakini Amte, started the hospital,

tribal population in the remote areas of

they faced lot of challenges - they didn’t

Maharashtra and innocent animals for

know the language, adivasis had lots

decades. In 1973, they started Lok Biradri

of superstitions and didn’t trust them

Prakalp for tribal development and worked

initially and there was a lack of resources

extensively for upliftment of rural tribes

(such as motorable roads and availability

Madias and Gonds in Gadchiroli district.

of electricity in this inaccessible region)

Amtes’ are accredited for introducing

to succeed. To gain the trust of adivasis,

medical treatment and working towards

Dr. Prakash Amte and Dr. Mandakini

eradication of superstitions in the

Amte first learnt their local language.

community. They started providing

In the initial days, they treated patients

medical aid to people there and taking

and performed basic operations in the

care of their health despite all barriers

open to gain the people’s trust. Today,

like language, fear in the minds of locals,

the hospital serves around 1000 villages

geography, terrain and others. Currently,

(adivasi and non-adivasis) in a 250 km

Lok Biradri Prakalp has three main

radius. The hospital does not charge for

projects- orphanage for wild animals, a

doctor consultation or procedures, lab tests

hospital and residential school for tribal

or medications. People here live together.

community and vocational and livelihood

In many ways, their mindsets are more

skills training.

open than the ones in mainstream parts

Inspiration

Dr Amte inspecting a child admitted to his hospital with kidney ailment, Hemalkasa, Gadchiroli district

of India. According to Dr. Amte, in many

the key to their development. They need

ways, the tribals are more civilised than

to be educated and connected to the world

the so-called civilised population of the

outside. Initially they used to be hostile,

country. Women have better status in their

but with passage of time and our work

society. Many times, women here look

here, their approach has changed. They are

more empowered than other places. People

now more open to â&#x20AC;&#x2DC;civilisedâ&#x20AC;&#x2122; people.

are free to choose their partners. Widow re-marriages are not looked down upon; nor are pregnancies before marriage. All

According to Dr. Amte, in many ways, the tribals are more civilised than the so-called civilised population of the country. Women have better status in their society. Many times, women here look more empowered than other places.

problems of the village will be sorted in the village itself with discussions. There is a lot that needs to be learned from them. Dr. Prakash Amte says that education is

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Games and Tools for Empowerment by Thoughtshop Foundation but very effective technique helped them

Their experiences with working children on the streets of Delhi taught them that the communication process had to be learner centred – a ‘partnership’.

Thoughtshop Foundation is a Social

maintain the dignity of characters, and

Communication Organisation based in

therefore connect with men and women.

Kolkata. It is dedicated to creating new and

It was interesting to hear people point

effective ways of dealing with social issues,

out to images. The focus was on change –

with the aim to educate, motivate and

encouraging every individual to commit to

initiate change. The organisation develops

even a small change; to believe that small

communication design for the social sector,

efforts lead to big changes. There was also

not just to provide information, raise

a continuous effort to find techniques that

awareness and change behaviours, but also

would challenge people’s beliefs, make

to help spark off a dialogue that leads to a

them rethink attitudes that had been

process of self reflection, empowerment

accepted without question for generations.

and transformation, for individuals and society. The organisation has worked on a

Their solutions range from games

variety of different projects ranging from

and models to films, audio tools and

developing card games for educating street

multimedia. Training of trainers, especially

children of Delhi to gender sensitization

grass-root facilitators or peer educators

kits for adolescent boys and girls from rural

are integral processes. More recently

areas, to designing teaching aids for health

their work could be better described as

workers for disseminating information on

programme design: Creating sustainable,

reproductive health to rural adolescent.

replicable models for development.

Their experiences with working children

They have discovered the synergy

on the streets of Delhi taught them that

between developing communications

the communication process had to be

and community building. According to

learner centred – a ‘partnership’ – they

them, effective communication improves

had as much to learn from the children

the quality of life and relationships

as they had to offer the kids. According to

between people. It increases empathy,

thm, one of the thumb rules of creating

reduces judgment and the barriers of

an image was this – the viewer must be

misunderstanding that separate us from

able to imagine himself or herself as being

each other.

the character in the image. This simple

Swasthya: Visual Communication for Community Health

Inspiration

One of the thumb rules of creating an image was this â&#x20AC;&#x201C; the viewer must be able to imagine himself or herself as being the character in the image.

Clockwise from top-left: (i) The Champa kit, a teaching aid for health workers disseminating information on reproductive health to rural adolescent (ii) Family Spacing Board Game. Part of the Shankar Kit which addresses adolescent boys and young men (iii) Children discuss cards from a Thoughtshop Toolkit (iv) Character illustrations from the Understanding Gender and Violence against Women Toolkit. (v) Illustrations for the We Can Campaign to End Violence Against Women

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Various existing communication on health and hygiene awareness

Swasthya: Visual Communication for Community Health

Inspiration

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2.8

Expert Views Though the crux of the Inspiration (research) phase is talking with the people one is designing for, one can gain valuable perspective by talking to experts.

Experts can fill in quickly on a topic, and

specially helpful in preparing for the

give key insights into relevant history,

research to be done during the field visit.

context, and innovations. Though the crux of the Inspiration (research) phase is

Dr. Rani Bang, founder of SEARCH,

talking with the people one is designing

an organisation that works for social

for, one can gain valuable perspective

upliftment of vulnerable tribal

by talking to experts. Experts can often

communities in Maharashtra, published

give a systems-level view of the project

a book on her experience with the

area, inform about recent innovationsâ&#x20AC;&#x201D;

communities. Her views also helped

successes and failuresâ&#x20AC;&#x201D;and offer the

tremendously in understanding contexts

perspectives of organizations like banks,

similar to this project.

governments, or NGOs. Lakshmi Murthy, Founder of Vikalp Design, Therefore Design arranged multiple

has given extremely useful insights on

meetings with Prasanna Hulikavi, Former

developing visual communication material

Deputy Director of Symbiosis institute of

for the rural audiences. These observations

Media and Communication, Pune and a

and learnings influenced some important

Research and communication expert. She

decisions during the field research.

gave useful insights on all occasions and helped shape the design of the research study. Her knowledge and expertise was

Swasthya: Visual Communication for Community Health

Inspiration

Prasanna Hulikavi, Former Deputy Director of Symbiosis Institute of Media and Communication, Pune

Prasanna talked about the importance

phones or radio. Concept of a community

of peer-to-peer communication (eg.

radio could be explored where messages

children to family). Simple messages

are sent out regularly (daily, weekly,

could be disseminated through children or

monthly). Audio messages given out in

adolescents for better reach. Local healers

local languages could be impactful.

Identifying local heroes and harnessing their influence to drive a campaign is powerful.

and priests usually have the power to influence and this can be used efficiently

Designing experiential activities for the

to spread important messages. Local

people at meeting points could help people

songs and art forms are excellent tools to

think on the issues. It is important to

attract audience and communicate good

conduct a media-audit which would help

practices. The places where these kinds

in choosing channels for disseminating

of communication would be given are also

messages Identifying local heroes and

important. Places like markets, fairs and

harnessing their influence to drive a

religious venues are good environments

campaign is also powerful. Simple but

as people collect in large numbers here.

consistent messages would help the

Congregation points like these should be

audience remember the messages better.

identified and accordingly communication

An understanding of the way health

can be designed. A survey of the shops and

workers communicate with the community

the weekly markets could also be helpful in

helps in finding gaps and integrating our

gaining insights on the communities. The

designs in the system. It is important to

power of technology could be harnessed

identify the emotional hooks of the people

in strengthening the design. Example of

in order to trigger behaviour change in the

this could be something like using smart

tribal community.

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Dr. Abhay Bang and Rani Bang at SEARCH, Gadchiroli

“..more than anything else, it is the nightmarish experience they go through at the Gadchiroli civil hospital that drives women to seek the services of quacks.”

Rani Bang and her husband, Abhay Bang,

In the book, the distressing tale

both qualified doctors, have dedicated

of the women in Gadchiroli is told

themselves completely to the social and

graphically — how they are impacted by

educational upliftment of the tribal people

economic deprivation, illiteracy, social

of Gadchiroli district in Maharashtra, by

discrimination, exploitation, and rampant

providing effective medical and public

alcoholism. In the process, the failures,

health services to them. On her return to

deficiencies, and shortcomings of the

India from the USA, Rani and her husband

government’s health policies are brought

set up a grassroots health organization

into focus. For instance, it is revealed that

SEARCH (Society for Education, Action &

92 per cent of women in the region had

Research in Community Health) in 1986.

no access to treatment for gynaecological

Rani Bang, the primary author of the

disorders, a crucial area of health concern

book, ‘Putting Women First: Women and

for women. Another significant finding

Health in a Rural Community’, along with

is that, more than anything else, it is the

her husband Abhay Bang set up SEARCH

nightmarish experience they go through

to cater especially to the medical needs

at the Gadchiroli civil hospital that drives

of the major tribal groups in the region

women to seek the services of quacks.

— Raj Gond, Madiya Gond, and Pradhan. This settlement, which adjoins the Dhandakaranya forests, is said to go back to the pre-historic era.

Swasthya: Visual Communication for Community Health

Inspiration

Women in the premises of SEARCH in Gadchiroli, Maharashtra

She stresses on the idea that it is important

games and songs, in spreading awareness

to understand the beliefs of the community

amongst the people.

rather than ridicule them. Rani Bang also talks about the plight of women who are

For a community health care initiative to

forced to miss a whole day at work (and

succeed, it needs to be based on a proper

consequently a dayâ&#x20AC;&#x2122;s pay) if they decide to

understanding of the notions that prevail

visit the doctor. This is another reason why

among the people about male and female

the tribals tend to visit their traditional

relationships, sexuality, fertility, child

healers first. If the healer canâ&#x20AC;&#x2122;t help, only

bearing, motherhood, and fatherhood,

then they visit the doctor. As a case study,

infidelity, and so on. That infertility and

she talks about the alcohol problem in

infidelity are social issues that go beyond

the community by saying that the need

medicine, renders them difficult to

for alcohol de-addiction services made

discuss or explain without oneâ&#x20AC;&#x2122;s own value

impact when the problem was translated

judgment creeping in.

She stresses on the idea that it is important to understand the beliefs of the community rather than ridicule them.

in economic terms and what it does to the family. She also talks about the importance of informal methods of education, like

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Lakshmi Murthy, Vikalp Design

They (urban designers) need to assume the role of a facilitator and act as a catalyst in encouraging people’s own visual expression, finding a common visual language and producing visuals that are responsive to the needs of the audience.

Lakshmi Murthy, founder of Vikalp Design,

vernacular knowledge to draw, displaying a

has been working with the rural population

keen unlettered intelligence.

in Rajasthan & Gujarat for over 30 years as a communication designer, to develop an

Urban designers need to re-examine their

effective framework for communication.

role in communication when working with

And in doing so, she has uncovered a way

non-literate and rural groups. They need to

of seeing, and consequently a new way of

assume the role of a facilitator and act as a

conversing with her audiences.

catalyst in encouraging people’s own visual expression, finding a common visual language

“In distinguishing between the urban and the

and producing visuals that are responsive to the

rural audience, the latter is wrongfully regarded

needs of the audience.

as visually illiterate. The rural audience has a sharper perception of their environment and

A participatory process of self-expression holds

are keener to infer from indexical traces that

one answer. Encouraging people to draw has

the urban individual would neglect. In fact it is

been looked upon as an empowering process

the city-bred individual who may be ‘illiterate’

that leads to inclusion of notions otherwise

in the rural environment, lacking their visual

difficult to express.” - Lakshmi Murthy

knowledge. While an urban designer will draw in proportion and orientation of what they see as ‘known’, a villager would rely on

Swasthya: Visual Communication for Community Health

Inspiration

The target audience is the source

seeks to leverage existing knowledge and

from which all media originates and

language—gently questioning and guiding

ends. Encouraging to people draw

and eventually co-creating a solution. The

gives to the ordinary villager and the

process brings one of the key principles

marginalized, a means for expression.

of design—empathy into action, and goes

In urban mainstream art institutions,

beyond merely sensitizing a designer

communicators are taught to draw what

to enabling him/her with the building

one sees; however, rural people draw what

blocks of a design intervention. The other

one knows. Visual language is often similar

key benefit of this process can be the

among other noneducated women. Yet, the

emergence of a natural ownership. World-

assumption cannot be made. Field testing

over, well meaning design interventions

is still indispensable to comprehension and

often break down with users/communities

effective implementation.

not being able to sustain a connection with

When a diagram of the uterus is field tested, most women say that it is a drawing of a flower. For women pregnancy is easily understood when drawn as a black round mass and the uterus as an inverted ‘U’. Women whose visual perception differs from the urban must be involved in designing their own communication materials. The creative process has enormous potential to be empowering. (Source: vikalpdesign.com)

it (design intervention). But this new way Lakshmi puts forth a new role of the

of building together, breaks down barriers

communication designer when working

and roots the foundation of an idea in the

in a new social and cultural environment.

user community.

She proposes a shift, from creator to a facilitator—wherein the process of design

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Message is not received

SENDER

Message is received but not understood

ENCODE (urban context)

Message is understood but not accepted

Message is understood but action is not taken

DECODE (rural context)

MESSAGE

RECEIVER

FEEDBACK Source: vikalpdesign.com

Why Communication Fails There is a blatant disconnect between the sender of visual messages – who are typically urban, educated professionals – and the receiver of the message – who are often rural, illiterate villagers – in development programs.

Design and communication has

between the sender of visual messages

traditionally been viewed only as an

– who are typically urban, educated

extension of a development program, and

professionals – and the receiver of the

when visual communication is employed,

message – who are often rural, illiterate

designers, artists, communication

villagers – in development programs.

planners, and program managers neglect the needs of their audience. Designers

There is a need for group, age, gender-

create one-size-fits-all messages,

specific communication material for a

and communication managers follow

rural context.

professional communication strategies. However, there is a blatant disconnect

Swasthya: Visual Communication for Community Health

Inspiration

During discussions, women who are often silent are able to communicate through drawings. Opening new avenues

The above element from the

of communication can be part of a wider

picture dictionary, created

process of re-valuing and redefining

using drawings of rural people, was integrated in the illustrations that intended to

women’s experiences and roles in the Source: vikalpdesign.com

community. In workshops where women are encouraged to express themselves

say “Do not drink” and

through drawing, issues and concerns

“Do not do drugs”

subtly surface which otherwise would remain hidden i.e. domestic abuse, heavy workloads, gender inequality, social exclusion, etc. The actualization of these issues through pictures can also be the beginning of discussions.

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2.9

Field Research The research consisting of structured interviews, focus groups, observation, card sorting and drawing activities, helped us to get to know the tribal communities from close proximity and understand their lifestyle and the environment they lived in.

The field research was carried out by

Writing Research Objectives

employing various methods of research. Referring to views, thoughts and ideas

The preparation for the field research

from experts helped greatly in planning

began with formalizing the primary

before going to the field. To get clarity

research question. This research question

on what we wanted to get out of the field

would be the basis of all the questions to be

visit, we listed down our objectives for

asked through various research methods

the research which came from forming a

that would be followed on the field. The

primary design question. Based on these

primary research question was broken

objectives, the rest of the field research

down to its elements and each element

was planned. The research consisting

was also defined so that clarity could be

of structured interviews, focus groups,

achieved in designing further research.

observation, card sorting and drawing activities, helped us to get to know the

The following question was decided as the

tribal communities from close proximity

primary research question:

and understand their lifestyle and the environment they lived in.

â&#x20AC;&#x153;What is the most effective method of communicating with the Target Audience?â&#x20AC;?

Swasthya: Visual Communication for Community Health

Inspiration

The communication reaches the maximum number of our Target Group The information is conveyed appropriately It is understood and absorbed by them

Most Effective

Primary Research Question

And it results in the desired action and behavioural changes

“What is the most effective method of communicating with the Target Audience ?”

Method of communicating

The mediums being employed to carry out our objectives Verbal and non-verbal communication

The following five research objectives

Perceptions ( colours, forms, positive and negative associations, aesthetic sensibilities etc.)

were derived from the primary research question: To understand their visual and aesthetic

To understand ways of non-verbal

sensibilities

communication

Imagery, Forms, Colours, Artforms,

Understanding communication through

Symbolism

Gestures, Social Gatherings, Physical Environments

expanded in the form of a set of questions. These questions were further divided according to the method of research to be

To understand perceptions Existing knowledge and the positive and

To carry out the Media Audit

negative associations they make.

Understanding existing mediums of communication, Reach and Effectivity of

To understand their history and culture

Each of these research objectives was

various mediums.

employed to answer them. Most questions fell into the category of ‘Interviews’, while others were to be addressed using methods such as card sorting, drawing or observation.

Traditions, Customs, Folk-lore, Myths, bed-time stories and their Origin, Source and Inspiration.

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Interview with a local healer (Left); Telemedicine Centre (Middle); Interviews with pregnant women (Above)

Interviews The questions listed down in the

The interviews were conducted over

previous stage were organised into a

a period of three days in around six

questionnaire that were to be asked to the

villages near Araku. During the visit, the

community during interviews. Two kinds

Telemedicine centre in Araku and Nutrition

of questionnaire were created based on

hub in Nandivalasa village were also visited

the people to be interviewed. First one

and their functioning was observed. Most

was designed for interviews of common

of the people interviewed were women,

women (mothers, pregnant women) and

and it was found that they opened up more

men (fathers, farmers, etc.). The other

when interviewed in groups.

was designed for interviews of people who had a special position or designation in the

The first few interviews were conducted

community like that of village-headmen,

at the Telemedicine centre, where a few

Dais, Ashas, Teachers or traditional

pregnant women had come for their

healers. Apart from these structured

routine checkup. These initial interviews

interviews, the staff of Piramal on the field

helped us test the questionnaire which we

was also interviewed in an unstructured

had prepared and this led to changes in it.

fashion. We, as a team of three, conducted

Some of the questions or activities to be

all interviews along with a team from the

done with the interviewees did not work

Piramal staff acting as translators for us.

out and so had to be changed or eliminated.

Swasthya: Visual Communication for Community Health

Inspiration

Most of the people interviewed were women, and it was found that they opened up more when interviewed in groups.

Interviews with women in Nandivalasa village (Left) Poster of the Polio campaign in a village near Araku

After a couple of interviews we got the

known as â&#x20AC;&#x2DC;Shandyâ&#x20AC;&#x2122; are an important part

understand their tribal language. So, the

flow of how the process should be done

of the their lives. These places, act not just

teacher has to translate the lessons before

and went on from village to village with

as a source of foods and groceries, but also

teaching it to students. She expressed her

the Piramal staff. The women talked

act as meeting points for village headmen

desire for an urban life, but she said she

about their daily routine, family members

and the people, where they discuss matters

doesnâ&#x20AC;&#x2122;t want to move to the city. Instead,

and work. For most women, the routine

of the villages. Talking about the people

she wants the city to come to the villages.

consists of activities like collecting water

they respected the most, many women

and wood, preparing food, working in the

mentioned the village headmen and the

fields, and pounding rice or ragi. The staple

mother-in-law.

diet of the people primarily consists of Ragi which consumed in the form of a porridge.

A talk with a primary school teacher,

Foods like Ragi, rice, pumpkin, jackfruit

who is also a mother, revealed the plight

and corn are grown locally in their fields.

of teachers working in tribal areas. She

However, for other food items, the people

complained that the books from which she

visit the weekly markets. These markets,

teaches are in Telugu, but the children only

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When it came to pregnancy, most women

After work, men usually discuss issues with

told that their routine wasn’t affected by

the headmen, play sports like kabaddi or

pregnancy. They continued with the same

cricket and watch TV. According to men,

work and food. Only when it rained, they

pregnant women are asked to stay home,

stop working. Some women did complain

away from work so that they get rest.

that they feel strained, but told that they

This was in contrast to what women said

had no other option. Women with younger

when interviewed separately. Women had

children often send them to Anganwadi

mentioned that they have to work even

as it provides lunch and so they don’t

during pregnancy. Some men said that they

have to cook extra meals during the day.

like producing commercial crops like coffee

For women, the common meeting points

because it brings money. When asked

included places where they collect water

about how they get important information,

and wood as well as fields and special

they said that two Messengers or Ward

occasions like naming ceremonies and

Members are sent to other villages who go

festivals. The famous Dhimsa dance of

door to door giving messages. Men, like

the tribals of Araku is mostly done only by

women are also concerned when it comes

women on almost every special occasion

to education of children. They celebrate

from festivals to weddings. When asked

when the child performs well at school and

about dreams and aspirations, women

some men even said that schools shouldn’t

talked about a good house and better

have holidays.

education for children. Men were also interviewed separately and different observations were collected from these talks. Their routine differed from that of the women in the way that they don’t have to cook or do the household Interviews with women in different villages

work. They work in the fields or get work through NREGA. Many people practise community farming where a couple of households share land, labour and output.

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Inspiration

Village headmen and Sarpanchs were also

go from home to home preaching, though

interviewed to get their perspective and

sometimes he also solves disputes in the

concerns for the community. The role

church. Gifts are given to people and saris

of these leaders is to make sure they get

are donated to widows during Christmas.

funds from government for development works and pensions. They also help settle

A discussion with a traditional healer was

disputes in the community. Most of the

enlightening as well. The healer was the

times, disputes are solved within the

last one in his village as his children are

community with the help of headmen

not interested in learning the skills and

without approaching the police. Water

knowledge. He said he treats all kinds of

management is a major problem in

illnesses, but if he canâ&#x20AC;&#x2122;t then tells people

most communities so village headmen

to go to the doctor. City-dwellers and the

aim to renovate all check dams, bore-

NGO Nature Foundation come to him for

wells, storage tanks and pipes for proper

knowledge on medicine. He often attends

supply of drinking water. Weekly markets

meetings organised by Nature Foundation

help headmen to discuss and spread

where he exchanges information on health

information to their villages.

and medicine with them. He tells people to

People, ward members and headmen

prefer home delivery for pregnant women

from different villages gather and drink

and checks pregnant women personally

in the weekly market. One religious

only after her fifth or seventh month.

leader was interviewed who was a Pastor

According to him, the routine and food

in a Christian village. Most communities

should be the same during pregnancy. He

follow Christianity and it has become an

dreams of good water and road facility and

important part of their lives. Calendars and

Upper Primary school for his village.

posters from the church are often stuck on Glimpses of interviews with men from the villages who held different positions like that of a village headman and a local healer (Guru)

walls of home. The job of the pastor is to

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The Piramal staff on the field which helped

the mainstream. He said he dreamt of

us reach different communities and also

compulsory education and secure jobs for

in translation during interviews were

his people. Talking about the TMC, he said

also interviewed in order to understand

that the women were reluctant initially,

the interaction and relationship between

but then the staff counseled and convinced

the community and them. As mentioned

them with the help of other educated

earlier, this staff consists of a head nurse, a

tribals. The ANMs and drivers also talked

technician, a supervisor and a coordinator.

about their tribes and their culture. The

Apart from these, three teams which travel

ANMs said that antenatal cases are not

to different communities consist of ANMs

always cooperative when it comes to

(Auxiliary Nurse Midwives) and bike riders

check-up and following instructions.

or ‘pilots’. Each of this staff member

Patients don’t like their blood being taken

was interviewed and a new perspective

and it’s an unpleasant event during their

was revealed. All of these staff members,

work. Women don’t want to miss a day’s

except for the coordinator, belong to the

work, so they are reluctant to visit the

same communities for which Piramal

TMC. One ANM said she likes her job as

Swasthya works.

she loves working for her community. The pilots (drivers), apart from helping ANMs

The supervisor, who informs the teams

travel to different villages, ensure safety of

about the sites to visit and keeps track of

the nurse as well as mobilize other villagers

critical cases, talked about his journey till

specially, men. They said that by the time

Piramal Swasthya and future plans as well.

the nurse checks women in the village,

He told us about his tribe and how different

they talk to the men and tell them about

events like marriages and festivals are

taking proper care of the women.

celebrated. He talked about how the tribal people are devoid of job and education opportunities and how this is preventing them from developing and entering Interview with the TMC-coordinator (Top) An ANM collecting blood samples of women (Above)

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Inspiration

Interview with school teachers at Sarubeda village

The field research was an extremely crucial

should be briefed on the kind of questions

part of the design process and many

to be asked and how to ask them. They

lessons were learned during this stage.

have to be warned to not lead the audience

Proper planning prior to researching in

in any way by asking the questions in a

the field is necessary for a smooth study.

different manner. Usually, in cases like

An open mind and observant eyes are a

these, each interview takes a little longer

must-have for visits like these, which are

to finish and so the overall schedule should

often largely different from the usual urban

be planned accordingly. The design of the

settings. While interviewing people, it is

questions also makes a lot of difference

imperative to plan in such a way so that

as the kind of audience in these regions

they talk freely and are not uncomfortable

is often simple and practical in their

in any way. One should be sensitive while

thoughts and so asking questions which

talking to women and preferably female

are somewhat abstract might confuse

interviewers and translators should be

them and one might get an unsatisfactory

employed for these tasks. When the

response. Attention to details and the

audience to be interviewed speaks and

behaviours of the people and reflecting

understands a different language, the

on the reason for such behaviours is

interviewer has to be extremely careful

important in getting valuable insights from

while taking help from translators. Before

field visits.

starting with interviews, the translators

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Card Sorting Activity In order to understand the visual perceptions and associations of the people in the community, a card sorting activity was planned. Pictures of different art forms from within and around the state of Andhra Pradesh were selected and printed on cards. The idea was to test whether the people have been exposed to such art forms and whether they are able to understand the content and the visuals. The intention was also to explore the possibility of reviving such art forms if at all they had existed in or near these tribal regions. The content of these pictures had topics such as Gods and Goddess, life or events in villages, forest animals, festivals, etc. A set cards of solid colours was also prepared in order to inquire about the associations the people had with those colours.

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Cards with different art forms that were used during card-sorting activities in the field

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The Cheriyal painting card and Warli painting card were chosen by most women

Useful insights were gathered from this activity. The women preferred visuals which showed relatable elements or contents. A familiarity with the elements or details in the visuals made more impact than aesthetically attractive images. Also, visual references from nearby Women participating in the card-sorting activity

The card activity was conducted with

women was the fact that they could relate

groups of women and with some individual

to the activities and surroundings shown

women as well. The women were shown

in the picture. Responses like “Rice is

all the cards and asked to select one or

tastier when pounded at home” and “Lots

multiple pictures which they liked or

of trees shown in the picture are good for

preferred and the reason why they chose

the village” were interesting to listen to.

those. A pattern could be seen in the

Some women also selected the picture

responses of the women. Two particular

which showed the God Jagganath in the

pictures were chosen by most women. One

Pattachitra style. These women gave the

showed women pounding rice in a village,

reason that since it’s a picture of God they

rendered in the Cheriyal painting style of

like it. This showed that they could identify

Andhra Pradesh and the other was a picture

the images of Gods from Orissa, which

of a village which showed houses, trees and

is logical as the region is closer to Orissa

people in the Warli style of painting. The

state’s border.

or neighbouring regions gathered the attention of people, but this was only occasionally evident. The activity helped us gain insights which couldn’t be gathered from the usual format of asking questions. And apart from giving us hints on the visual perceptions of the people, it also showed us how nature and traditional methods of food-processing still hold prime importance in the minds of the tribal people.

reason for choosing these pictures for most

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Drawing Activity Considering Lakshmi Murthyâ&#x20AC;&#x2122;s views on the importance of the participatory process of self-expression and the empowering process of drawing, a drawing activity was planned for the field visit. It was planned that the people would be asked to draw on themes like their home, family, routine, notions of good/bad, etc. But due to time constraint only limited themes were explored and the activity was conducted only with women and school-children. The challenge was also to make people (specially adults) draw without hesitation and the fear of being judged. For both the groups (women and children), in order to break the ice, they were asked to draw their home and then whatever that made them happy. Women initially needed some persuasion but children were more than excited to put pencils (and colours) to paper. Many sketches by the children suggested the usual template-drawings of a house and mountains which are often taught in Indian schools, but some drawings revealed interesting aspect of their lives.

Children and women from different villages drawing on themes like home, friends and family. Swasthya: Visual Communication for Community Health

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Water and its sources were recurring elements in most drawings. This connected with the observations in interviews where women talked about water-collection sites being meeting points for them and when men talked about improving the water supply facilities in their villages. Taps, reservoirs and hand-pumps are shown with pots for collection of water. Fields are shown connected to the main storage tanks through pipes or canals. Clearly, water is not only an issue that they face but it also binds them as a community as it makes them socialize with each other during visits to water collection sites. Drawings showing water sources and systems

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Homes drawn by the children were somewhat similar to the ones usually taught to draw in schools but certain elements made them specific to the region. Most homes were shown with Rangolis outside them. Almost all of the houses had stairs leading up to the door. This was evident even in the actual houses seen during the field visit. All the houses are always shown accompanied by a tree and some potted plants with flowers. It is evident that a certain visual language has been imbibed in the children through the teachings in Drawings of houses along with Rangolis

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Another recurring theme in the drawings was hills and mountains. Since the region is amidst hills and the overall terrain is also hilly, children and women frequently drew them. Along with these, farms and field were also repeated. In doing so, the villagers have created patterns in most pictures. Patterns as decorative elements are also seen in the Rangoli made by them. Drawings showing fields and patterns with the background of hills

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In a way, repeating motifs could be used to instill familiarity in the aesthetics of the visuals to be designed.

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2.10

Stakeholder Mapping This helped in thinking about the connections these peripheral groups had with our topic and which of these could be regarded as fans and skeptics of the project.

The people or groups that are directly

Relationships were explored among the

involved in or reached by the project were

stakeholders and it was seen as to how

written down at this stage. These groups

each of them is dependent on the other.

were taken down on Post-its and put

This process was helpful in knowing which

together on a board so as to visualize the

groups influence the main audience and

audience. Then, people or groups were

how they interact with them. It was also

added who are peripherally relevant, or are

seen how the Piramal staff and the tribals

associated with the direct audience.

are dependent on each other. Role of

This helped in thinking about the

Peripheral groups like those associated

connections these peripheral groups had

with the government, such as the staff

with our topic and which of these could

from Primary Health Centres, Anganwadi

be regarded as fans and skeptics of the

and Schools, was analyzed with respect to

project. These Post-its were arranged

the tribal population. In a way, this was

into a map of the people involved in the

an efficient method in quickly grasping

challenge. This map was helpful later for

the overall situation of the people

reference while moving through the other

being influenced by the project and the

stages of the design process.

connections between them.

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A map of the stakeholders in connection with the project

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2.11

Extremes and Mainstreams Designing a solution that will work for

An idea that suits an extreme user will nearly certainly work for the majority of others. And without understanding what people on the far reaches of the solution need, one will never arrive at answers that can work for everyone.

everyone means talking to both extreme users and those squarely in the middle of your target audience. While interviewing people in the field, this was kept in mind, and accordingly efforts were made to meet a wide variety of individuals and communities. An idea that suits an extreme user will nearly certainly work for the majority of others. And without understanding what people on the far reaches of the solution need, one will never arrive at answers that can work for everyone in the community. A focus group interview with the people of a remote village Lamtampadu

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The Remote Village

Youngsters and Elders

The team while surveying the field got

Another case of extremes was observed

the chance to visit a remote village in the

from the divide between two generations

region which has poor accessibility. This

in the communities. The younger and older

is a village where vehicles cannot reach

generations can be said to be two different

because of absence of roads or pathways

extremes in the community whose needs

and one can reach there only after an hour

and perceptions regarding life is different.

long trek. Such conditions heavily affect

The young are exposed to new media and

most aspects of the lives of the villagers.

technology and have adapted modern

A visit to this village gave unexpected

clothing (Jeans, Night-gowns, Synthetic

revelations. Though accessibility is poor,

Bright Saris). They have different tastes as

the village is well equipped with electricity

compared to elders. Boys in the community

and comparatively more number of people

have started following hairstyles

have dish TVs installed in their homes.

influenced from urban cultures and girls

Youngsters in the village widely use

are moving away from wearing Traditional

smart phones and social media. A mixed

Jewelery (Nose-rings) to simple minimal

group of men, women, and children was

jewelery. The elders wear Traditional

interviewed and it was found out that

Clothes and Jewelery and are less exposed

water shortage and accessibility were the

to new media. Both elders and youngsters

two main problems they faced. For going

demand for development of village but

to the hospital, the people need to walk

refuse to move to towns or cities.

down to the nearest village and take an autorickshaw from there.

There is a need for a Solution which incorporates traditional elements but also appeals to

In this extreme case of a remote village, there

youngsters in the community and helps young

is need for a solution which is less affected by

people to reconnect with their roots to build a

improper roads or difficult terrain and doesnâ&#x20AC;&#x2122;t

sense of community in them.

require the users to travel frequently or travel Top: Children playing in the remote village Lamtampadu Above: Women from the older and younger generation

long distances.

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2.12

Analogous Inspiration Analogous settings can help you isolate elements of an experience, interaction, or product, and then apply them to whatever design challenge you’re working on.

This method, suggested in the Human-

The process began by listing the distinct

centred design process of Ideo.org, talks

activities, behaviors, and emotions that

about drawing parallels from a completely

we were looking to research. For each of

different context to apply it in your own

these, a setting or situation was written

project. It tells to shift your focus to a new

down where we might observe this activity,

context in order to get a fresh perspective

behavior, or emotion. For example, if the

on your research. As an example, visiting

activity is “use a device at the same time

an Apple store might feel odd when one

every day,” parallel situations might be

is designing for those living in difficult

how people use alarm clocks.

circumstances, but this may unlock the key to a memorable customer experience

Activities or behaviours to be researched

or a compelling way to arrange products.

were decided by looking at the way the

Analogous settings can help you isolate

tribals might experience the services

elements of an experience, interaction, or

provided by the Telemedicine centre and

product, and then apply them to whatever

Nutrition hub. It was also seen as to how a

design challenge you’re working on.

solution could be used to spread awareness and change perceptions regarding pregnancy and health. Both the TMC and Nutrition hub involve keeping track of certain things. For example, Piramal plans

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Activities or Behaviours

Parallel Situations

Keeping Track

Giving special importance/attention

Sharing ideologies or stories

Calendars for Keeping track

Festivals

Using Merchandise (Bags,

of expenses/payments (Milk, Groceries, Salary)

stickers) Special Days (Mother’s Day, Teacher’s Day)

Audio/visuals on TV/Radio

Diary for recording events Social Media Putting Reminders on phones

to train women in nutrition-assessment of

An important function of the solution

their own child. The TMC also encourages

would be to share the ideology of good

women to ensure timely visits for check-

maternal and child care amongst the

up. Activities like these require the persons

community. Parallels were drawn to

to keep track or record of their data. Thus,

situations where an individual or group

parallels were drawn from other contexts

shares its ideas regarding an issue and the

which involve record-keeping.

way they do it.

Similarly, in order to change the

This was an interesting activity as it gave

perceptions regarding pregnancy and

a chance to make unexpected connections

elevate the importance of the life-event,

between two different contexts and spark

the activity of “giving special importance”

off creativity. These connections helped

was probed into, by looking at situations

greatly further in the design process where

where an event or person is celebrated.

brainstorming for solutions was to be done.

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In the Ideation section, it is shared as to how sense was made of the vast amount of collected data. It is discussed as to how insights were drawn in an organized manner and how brainstorming led to the generation of several ideas for the solution. The section also describes the way in which the content for communication was structured. Lastly, concepts

ideation

for the various solutions are shown along with their iterations at each stage.

Inspiring Stories Finding Themes Creating Insight Statements How Might We Questions Creating Frameworks Brainstorming Context, Content and Communication Concepts

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3.1

Inspiring Stories Many inspiring stories took our attention during this phase as they had the potential to provide useful insights and inform our design decisions.

After the research phase, all the data

wheat seeds in a pot and keep it for 12 days

was collated and organized. This sorting

for the sapling to emerge. After the sapling

was followed by extraction of important

grows to a certain height, it is considered

and inspiring data from the collection.

as a sign that the harvest would be good.

Important data from field visit, secondary

These sapling are then exchanged with

research and expertsâ&#x20AC;&#x2122; opinions was put

neighbours and new friendships are built.

together on a board with post-its. This

This is an efficient way to know whether

helped in taking an overall view of all

the harvest would be good and also to keep

the data and make connections. Many

harmony amongst the community.

inspiring stories took our attention during this phase. They had the potential to

Other stories were instances when the

provide useful insights and inform our

villagers gave unique responses to some

design decisions.

of the questions. The headman of a village believed that a healthy person should be

Facing page: Highlights from interviews

Some stories were unique as they were

light and a heavy person is considered

connected to the regionâ&#x20AC;&#x2122;s rich culture.

unhealthy. A woman when asked about

Festivals form an important part of their

her most priced possession told that it is

culture and most festivals revolve around

alcohol. Many such instances were put

farming, hunting and the nature. In one

together and along with data from other

such festival, the people sow corn and

sources in order to look for patterns.

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3.2

Finding Themes Many inspiring stories took our attention during this phase as they had the potential to provide useful insights and inform our design decisions.

Key take-aways from different stages of

The information was finally divided into

the research phase were put together.

the following seven categories or themes:

Highlights from the words of the experts, important case studies and information from the secondary research, and interesting observations and responses from the field visit, all were combined on a board and then connections were looked for. Interestingly, many relationships emerged out among varied sources of information. Patterns and relationships were found out and an effort was made to categorize these bits of information. These categories would later be utilized to extract insights from the data.

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Ideation

• • • • • • •

Visual Perceptions And Preferences Interpersonal Communication And Recreation Dreams And Aspirations Attitude Towards Maternal Care Traditional Healer Beliefs And Perceptions Local Social Networks And Communication Channels

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Visual Perception

Interpersonal Communication & Recreation

Dreams & Aspirations

Attitude towards Pregnancy

Traditional Healer

Beliefs & Myths

Social Networks

Grouping of insights obtained from different research methods into categories

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3.3

Creating Insight Statements Insight statements were valuable as they helped in giving shape and form to subsequent brainstorms.

A critical piece of the ideation phase is

The themes found out in the previous stage

plucking the insights that will drive the

were put on a board and for each theme,

design out of the huge body of information

insights were written by rephrasing the

gathered. After hearing from different

themes as a short statement. The original

people, and identified key themes from

design challenge statement was also

the research, the next step in the synthesis

referred to in this process to check if the

process was to create insight statements,

insights relate to it. The ones that didnâ&#x20AC;&#x2122;t

concise sentences that will point the way

relate were eliminated.

forward. Insight statements were valuable as they helped in giving shape and form to subsequent brainstorms.

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Theme 1

Interpersonal Communication And Recreation

Theme 2

Visual Perceptions And Preferences

Insights

Tribal people prefer interpersonal

Insights

Women prefer pictures which show

communications than other channels

environments and activities similar to their own

Women open up more and enjoy interacting more in groups which are

Though women prefer the colour Green as

devoid of men

it represents the nature around them, they aspire for bright colours when it comes to

Festivals and events also incorporate

their clothing

interpersonal communication and interaction with peers

A preference for decorations with patterns is (flowers, rangoli) is seen Water sources (Taps, reservoirs, pipelines, etc.) and Hills are recurring elements in childrenâ&#x20AC;&#x2122;s drawings Women, though not fully exposed to regional art forms, are able to identify the content

Women tend to interact openly among groups containing only women

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Theme 3

Dreams And Aspirations

Theme 4

Attitude Towards Maternal Care

Insights

Development of villages in terms of roads/

Insights

Pregnancy is treated as a regular normal

transport and water facilities is demanded

phase and so no change in routine or

by most people

nutrition is observed

Education of children is given importance

Work and earning is given more

to by parents

importance than maternal care

Government jobs, opportunities and

Antenatal cases donâ&#x20AC;&#x2122;t seek regular medical

security is sought by youths

care and attention Medical Equipements (like needles) are intimidating to women Men are ignorant about maternal care

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Theme 5

Traditional Healer

Theme 6

Beliefs And Perceptions

Insights

The healer is always the first preference of

Insights

They eat food only to kill hunger

the tribal people They don’t prefer the urban environment He checks the women personally only after

because of lack of open spaces, lack of

the fifth month of pregnancy

cleanliness and the idea of sharing toilets

He acts as a medium of information

Consumption of certain foods is restricted

exchange between NGOs and villagers

due to beliefs regarding there side effects Fruits are consumed only during their seasons A light weight person is considered healthy, while heavy person is considered unhealthy

The traditional healer (centre), also known as ‘Guru’, is the first preference for most villagers in need of medical care

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Theme 7

Local Social Networks And Communication Channels

Insights

Important messages travel through messengers (sometimes accompanied by a drum beater) who go village to village, home to home Information exchange also happens at congregation points like Weekly market, Water sources, wood collection places, farms, churches and festivals Information dissemination at upper level happens through village headmen

The weekly market acts as a congregation point for exchange of information among communities

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3.4

‘How Might We’ questions The ‘How Might We’ format was chosen because it suggests that a solution is possible and also because these questions offer the chance to answer them in a variety of ways.

Insight statements were transformed into

The process was started by looking at the

opportunities for design by reframing them

insight statements that were created. The

as “How Might We” questions. By Finding

goal was to find opportunities for design.

Themes and Creating Insight Statements,

After taking a look at the How Might We

problem areas were identified that pose

questions and it was seen if it allows for

challenges to the target group. Now, an

a variety of solutions. If it doesn’t, the

effort was made to reframe the insight

questions were broadened. These How

statements as How Might We questions to

Might We should generate a number of

turn those challenges into opportunities

possible answers and would become a

for design. The ‘How Might We’ format

starting point for the brainstorms. Also,

was chosen because it suggests that a

it was tried to make sure that the How

solution is possible and also because these

Might We’s aren’t too broad. It was a tricky

questions offer the chance to answer them

process but a good How Might We should

in a variety of ways. A properly framed

give both a narrow enough frame to let

How Might We doesn’t suggest a particular

us know where to start the brainstorm,

solution, but gives the perfect frame for

but also enough breadth to give room to

innovative thinking.

explore wild ideas.

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Interpersonal Communications And Recreation

How might we create a solution which triggers interpersonal communication? How might we design a system which works well in groups of women?

Visual Perceptions And Preferences

How might we integrate our solution in their festivals or events?

Visual Perceptions And Preferences

How might we use regional art forms in our communication material?

How might we include the local environment and activities in our communication material? How might we make our communication visually attractive or attention-catching for the women?

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Ideation

How might we build stories or communications around water sources and hills?

Dreams And Aspirations

How might we connect development and education to our messages and communication?

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Attitude Towards Maternal Care

How might we change the perception of pregnancy and elevate its importance? How might we convey the importance of antenatal care to the people?

Traditional Healer

How might we include the healer in the process of giving information to villagers?

Beliefs and Perceptions

How might we sensitively address popular beliefs and perception in our communications?

How might we make the experience of check-ups more pleasant for women? How might we sensitize men about maternal care so that they are supportive towards pregnant women?

How might we create awareness regarding importance of nutritious foods while addressing beliefs on food? How might we make our solutions more usable in open spaces?

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3.5

Creating Frameworks The most clear and simple systems to identify were those of the Telemedicine centre and the Nutrition hub. A journey map helped visualize the process in each of these cases from beginning to end.

A framework is a visual representation of

Apart from visualizing the process and

a system and a great way to make sense

tracking each point of contact, the journey

of data. They can be used to highlight key

maps were also extremely useful when

relationships and develop a strategy. As

it came to finding out opportunities for

Inspiring Stories from the research were

design interventions. Suitable points in

listed, it was seen if things could fit into a

the journey were highlighted to mark an

larger system. The most clear and simple

opportunity which would later help inform

systems to identify were those of the

the design solution.

Telemedicine centre and the Nutrition hub. A journey map helped visualize the process

At this stage, the area of work was

in each of these cases from beginning to

divided into two parts, namely, the

end. These journey maps informed about

Telemedicine Centre (part I) and

the relationship and interaction happening

Nutrition Hub (part II). For the Nutrition

between the Piramal staff and the tribal

Hub, the client had already given a brief

people. Each point of contact between

which was in connection with one of the

Piramal and the community was tracked,

opportunities identified through this

right from the first time they interact till

mapping. Part I, i.e. the Telemedicine

the time when they separate.

centre process, worked on developing a solution through analysis by the designer.

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part 1

Telemedicine Centre

Indicates Opportunities

Journey Map

ANM collects urine/blood Samples ANM checks/does tests ANM interacts with women

ANM & Pilot leave TMC

After 1-3 days, women come to pick-up point

Pilot interacts, gives information to man and others

ANM & Pilot reach Village

Pilot gathers women

ANM tells women to come to pick-up point on particular day

Explaination with teaching aids Communication material shared with men, others

Communication displayed at pickup point

Driver picks women from pick-up point

Communication material for carrying home

Women exit TMC Women dropped back to Pick-up points

Communication in the waiting area (walls, etc.)

Online connection with doctors in Hyderabad High risk cases referred to CHC Medicines given

General nurse checks women

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Women are dropped at TMC

Women wait in waiting area

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part 2

Nutrition Hub

Volunteers from the Nutrition Hub leave for villages

Indicates Opportunities

Journey Map

Volunteers collect women and other villagers

Volunteers give information on Nutrition hub to the villagers

Educational Aids and Communication on Nutrition

Communication material to carry home along with food

Volunteers call the women to the hub on a certain day

Women assess their childrenâ&#x20AC;&#x2122;s height, weight, etc.

Training Aids and material for education

Women are given workshops on processing food, cooking, feeding

Women reach Nutrition Hub

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Women use the equipments (solar dryer, mill) in the hub for processing their foods

Nutrition Assessment tools for women

Ideation

Women exit the hub along with their processed foods

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Glimpses of the relational maps made to visualize how different entities were connected with each other

A relational map is another example of a framework used to see how different ideas relate to one another. This type of framework can organize some of the things learned during the inspiration phase, visualize how things connect, and help in finding patterns. This process was started by putting one idea at the center and then mapping how other ideas and insights play off of it. Two relational maps were formed, one which tried to visualize how different groups of people in the project were connected and related to each other. The other map looked at different aspects of the community, its beliefs and characteristics, and how each of these connected to the other. Graduation Project

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3.6

Brainstorms Each of the How Might We was written one by one and possible solutions or answers were thought of.

Brainstorms tap into a broad body of knowledge and creativity. These sessions were done for multiple stages of the ideation process, but the major part was done during answering the How Might We questions. Each of the How Might We was written one by one and possible solutions or answers were thought of. There were many overlaps of answers as well, which was helpful as it gave rise to a common solution which would address multiple design problems. This part of the process was a divergent one, so several different ideas were thought of.

Brainstorming sessions based on the â&#x20AC;&#x2DC;How might Weâ&#x20AC;&#x2122; questions

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Physical Games

How might we create a solution which triggers interpersonal communication?

Board Games

Games

Card Games Competitions Question-answer sessions

Debates

Common Activity

Discussions

Poetry Collecting water / wood

Making or Building something

Learning new skills or art forms

Drama

Story-telling Dance

Drawing

Music Information along with Gifts in Christmas

Communication near Handpumps or taps

Relatibility

Reference to their daily life

Seed festival: Exchanging information along with saplings

Showing festivals in our communication material

Dhimsa Dance

How might we integrate our solution with their festivals or events?

How might we design a system which works well for groups of women?

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Glimpses of the brainstorming sessions

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3.7

Context, Content and Communication Paying attention to these aspects not only makes the design efficient and strong, but also helps clarify the actual problem to be addressed.

For any communication design to work as expected, three main aspects of the design need to be properly framed which should be in sync with each other. Paying attention to these aspects not only makes the design efficient and strong, but also helps clarify the actual problem to be addressed. In order to define the context of the solution, all the communication points in the scenario were looked at and listed down. For each of these communication points, it was also seen as to which section of the community represented the target audience for that communication. Hence, a list of scenarios was formed, each of which denoted a context for which a separate communication and content would be found out.

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Figuring out the contexts by defining the communication points

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Content Antenatal Care, Anemia (Symptoms, Prevention, Cure), Maternal Health, Child Health and Care

Communication Points

Context

Audience

Proper Nutrition, Growth Assessment, Food processing and preservation

ANM’s and Pilot’s visit to villages

TMC’s waiting area

Women’s exit from the TMC

Nutrition Hub’s Volunteer visiting the villages

Nutrition Hub’s premises and exit from the hub

Women, Men, Children

Pregnant women, mothers

Pregnant Women, Mothers

Pregnant Women, Mothers, Family members

Pregnant Women, Mothers, Adolescent girls, children, Family members

Teaching Aids, Picture books, Charts, Flip book, Games, Activities

Posters, Charts, Activities

Calendars, Schedules, Booklets or cards to take home

Picture books, Charts, Flip book, Games, Activities

Growth assessment tools, Informative Charts, Paintings on walls, Activities, Booklets, Posters

Communication

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Content Development for Part I (Telemedicine Centre) Also, it was observed that the interaction of Piramal with Antenatal cases was the first point of contact between the two stakeholders (Piramal and tribals).

Telemedicine centre, being a curative

A common thread found through research

project, stressed on issues related to the

and inferences was the problem of

health of pregnant women, mothers and

Antenatal cases. From expertsâ&#x20AC;&#x2122; views and

children. Consequently, the content for

interviews with the ANMs, it was noticed

the TMC mainly consisted of information

that in a context like this, Antenatal cases

on common facts and precautions related

were the ones who were least likely to take

to diseases associated with pregnancy and

actions for prevention of complications.

motherhood. This information needed to

Also, it was observed that the interaction of

be conveyed at different communication

Piramal with Antenatal cases was the first

points in relation to the TMC in order

point of contact between the two groups

to educated people on these issues and

(Piramal and tribals).

initiate behaviour change. As seen in the previous figure, there were several points of communication, a vast content and different options for the kind of communication to be used. It was to be narrowed down as to which part of this information needed to be addressed first. To make this decision, a number of factors were looked into.

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Antenatal Care Messages

Aim Making women take proper care during pregnancy

Since, the content needed to address the antenatal cases, it was decided that

Desired Actions

certain important messages related to care

Women going for minimum 4

during pregnancy would be selected to be

Antenatal check -ups to TMC

delivered by the ANMs during their visits

Women taking proper nutrition during pregnancy

to the villages. These messages would be simple and easy to understand so that they are remembered easily by the women. The

Women taking precautions to avoid

most common issue during pregnancy

anemia and other complications

is Anemia which can be easily avoided if proper care is taken. It was decided that

Why will women take the desired actions?

simple messages to prevent anemia would

They will take the desired actions if

be given. Basic doâ&#x20AC;&#x2122;s and dontâ&#x20AC;&#x2122;s during

they know the importance and benefits

pregnancy given with logical reasoning

of proper ANC (Antenatal Care) and

could help in spreading awareness

the dangers and problems of improper

regarding antenatal care. The simplicity

Antenatal Care.

of this solution would also help in testing

Various existing material for spreading awareness on Anaemia

the basic attributes of the communication material like the ability of tribal women to understand the visuals.

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Ideal positive situation Structuring the Content

Structure Explorations

In order to communicate the messages of proper ANC to the women, it was

Problems

explored as to what should be the flow

Comparison with present existing conditions

of information in the communication. Various structures for the content were explored to see which one would help in

Solutions and Ideal situations

creating maximum impact and would be easily understood by the target audience.

Solutions, Actions to be taken to achieve ideal situation

It started with a basic simple structure of introducing the problem and comparing it with an ideal case, followed by showing

Desired actions

the desired action to be taken. After

Questions addressed on existing conditions

several variations and iterations of this structure and referring to ones used in existing case studies, one format was

Positive Results

chosen. This format was taken ahead to build the final communication material. It was kept in mind that the tribal people

Logical explanation and busting of myths

are simple people who tend to go with logical reasoning rather than emotional or abstract concepts. The communication to be developed needed to consider this aspect of the peopleâ&#x20AC;&#x2122;s mind.

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Action to be taken to achieve ideal condition

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Final Structure

Introduction to Problem

Logical explanation of reason behind the problem

Anemia Symptoms Disadvantages

Reduction in Hemoglobin or Iron in blood

Triggers and Incentives According to a study in secondary research, it was found out that identifying the hooks, triggers and incentives for the community

Defining the solution

Iron Tablets Nutritious Food Proper rest

helps in making a communication which initiates sustained behaviour change. These triggers and incentives could be identified while conducting field research

How the solution works

Increasing Hemoglobin Nutrition for baby Energy through foods

by asking the right questions in interviews. For this community, most of the times it was found out that the triggers were proper education for children and development. A

Tangible benefits

Smooth pregnancy Development of child for better education Better health

good home and work also constituted the peopleâ&#x20AC;&#x2122;s desires or aims. These triggers were to be used in the communication for persuasion by showing the audience the incentives of taking a desired action. This

Actions to be taken for solving the problem

Eating Nutritious food Resting Visiting doctor

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information on triggers and incentives should be well integrated with the communication to make in rich.

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Content Development for Part II (Nutrition Hub) The content for the deliverables to be used

Ragi Processing

in the Nutrition hub was specified by the client. The communication to be used in

The communication for Ragi processing

the nutrition hub was divided into three

had to be a step-by-step process of

parts:

transforming Ragi and highlighting the benefits of certain important steps in the

•

Process of transforming Ragi into a

process. This content had been provided

nutrient-dense food

by the nutritionist from Piramal and had

•

Ways to improve diet

to be represented in a way which is easy to

•

Solar Dryer Food products

understand for the audience in the hub. Since Ragi is an essential part of the community’s diet, it was planned that instead of introducing new foods and diets, the existing diet would be improved and built upon. The process consisted of four important parts namely, Sprouting, Drying, Grinding and Mixing with the meal. The basic process was first put in a flow and then developed to include further details and benefits of the steps.

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Ideation

Since Ragi is an essential part of the community’s diet, it was planned that instead of introducing new foods and diets, the existing diet would be improved and built upon.

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Basic Flow for Ragi Processing Procedure

Normal Ragi

Sprouting of Ragi

Solar Drying of Ragi

Milling Ragi with Dal

Feeding the Baby

Placing grains in a cloth and leaving it covered for 24h

Collecting sprouts and placing in Solar dryer

Milling dried sprouts with Dal

Repeat

Adding one teaspoon to every feed

Storing the flour in an air tight container

Detailed Flow for Ragi Processing Procedure

Getting Ragi to Nutrition Hub

Soaking Ragi in water for 24 hours

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One of the pieces of information provided by the client for the design of material for â&#x20AC;&#x2DC;Ways to improve Dietâ&#x20AC;&#x2122; and Solar Dryer foods

Ways to improve Diet

Solar Dryer Food Products

Brochure and Identity for Nutrition Hub

When the women visit the nutrition hub,

In order to imbibe the culture of preserving

The client, apart from giving brief for the

they will be assessing their childâ&#x20AC;&#x2122;s growth,

nutritious foods so that they are available

communication material for Ragi process,

using the equipments available there for

for consumption for the whole year, a

Improving diet, and Solar Dryer, also

processing their raw food and attending

system of drying foods was introduced

required a brochure and a visual identity

workshops on cooking and improving their

in the nutrition hub. A solar dryer was

designed for the Nutrition hub project.

diet. Workshops would form an important

installed and the Piramal staff wanted to

The brochure would be presented to

part of the nutrition hub programme and

introduce its usage to the tribal people.

the organisations that would help fund

would need material and activities to be

They wanted to inform the people that

the projects and the audience for the

designed. The client specifically wanted the

different dried foods could be produced

identity would be all the stakeholders in

studio to design a system to educate the

from raw foods using the solar drier. The

connection with the Nutrition Hub project.

women regarding a better diet. Since there

client provided a list of items that could

This project, named as Gosthani Project,

would be workshops conducted in the hub,

be produced and the task was to pictorially

already had an identity which was to be

it was proposed that an activity be designed

show these products along with a solar

redesigned in order to align it with all the

to be integrated within a workshop. The

drier. The initial idea was also to show the

new visual communication material to be

idea was to first show the existing diet of

benefits of each of these products, but later

designed. The content for the brochure was

the people and then show them how they

the idea was dropped on account of making

already provided which contained basic

could improve it.

the communication simple.

information regarding nutrition hub.

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Developing an Illustration Style and Visual Language Each of the communication tools needed various elements to be illustrated in a distinct style. An overall visual language was to be created which would help create consistency across the deliverables and increase the recall value of the visuals. The main inputs for creating the visuals came from the field research results. During the car sorting activity, majority of the people selected the picture of women pounding rice which was rendered in the Cheriyal scroll painting style. This picture had elements shown in flat colours with an outline, as well as patterns and decorations. These painting also have distinct borders on the edge and usually show a flat perspective. The colours are warm and earthy, and the backgrounds are minimal and flat. To further simplify this style, reference was taken from paintings of Jamini Roy and simple illustrations found in educational material produced by the National Rural Health Mission for Ashas. A combination of these different styles was tried out and various options were made before finalizing one.

HUMAN FIGURE REFERENCE

RENDERING STYLE REFERENCE

Various references for developing an illustration style

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Illustration Explorations

Taking reference from the pictures shown in the previous page, illustration options were explored with human figures, specifically those of women and children as these would be used predominantly in the communication material to be developed. Given that the women had a preference for pictures with flat colours and flat perspectives, human figures were explored with flat colours and mostly with a front or profile view. The colours explored were earthy and subdued so that the pictures would blend in with the environment of the people and not stand out in a stark way. Since the chosen references had outlines in the illustrations, options were explored which had outlines of uniform and nonuniform thicknesses. In order to make the characters relatable, they were shown wearing sari and jewelery in the local style.

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Illustration Explorations

The exploration highlighted with a circle was chosen and refined. This exploration was chosen as it achieved a balance between realistic human figures and those in the paintings chosen by the women. The line thickness in this style, apart from being non-uniform, had a rough organic quality which made it look closer to the paintings. Also, the human features in this style are simple but well defined. This style helped give a distinct, simple and identifiable quality to the illustrations which facilitated in creating consistency throughout the communication material. Selected illustration style

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The skin colour in the human figures was earlier kept warm and yellow as seen in the visuals of Cheriyal paintings and those of Jamini Roy, but it was observed that this might give a feeling of diseases (like jaundice) and hence needed to be changed. This colour was then made closer to the colour of actual skin but still a little warmth was retained in it. A distinct style of representing the features of the humans, especially the eyes, helped in creating consistency among the illustrations. In the earlier iterations, the women were shown wearing triple-noserings which is the traditional jewelery of the region. But on revisiting the field research, it was observed that only the

Final Illustration Style

older women wore these nose-rings, while the younger generation wore simple jewelery. Since majority of our target group would belong to the younger generation, it was decided that the illustrations would show women with simple jewelery so that they can relate to them better.

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Examples of borders in traditional paintings and existing material

One of the insights also informed us that women showed inclination towards patterns and decorations in visuals. Most of their own drawings included decorations like flowers and Rangolis. Keeping this in mind, the possibility of using decorative borders throughout the visuals was explored which might help attract their attention while also create consistency in the visual material. Different kinds of borders were looked at from traditional art forms and existing material. Finally, a border style was chosen which was simple and neutral, as the region did not have

Final border style used in all the material

specific elements when it came to borders and decorations.

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3.8

Concepts Antenatal Care Communication (Telemedicine Centre) The points of communication for each of these solutions were different, hence the nature of the design would also differ.

The content for each of the solutions was

For the design of the communication

put in place and the details of the design

material to be used by the ANMs during

were now to be decided. The points of

their visits to the village, several existing

communication for each of these solutions

solutions were first analyzed. In scenarios

were different, hence the nature of the

like these, a number of different solutions

design would also differ. Though, for

or material was being used, varying from

almost all of them, the audience primarily

flip charts to posters to card games and

remained the same, which was women.

board games. These solutions aimed at

For building the concept, the context of

making the communication interactive

the solution was studied and accordingly

and interesting for the audience. The

options were being generated to choose

organisation Thoughtshop Foundation

from. A selected option would then be

designs and produces various educational

developed further by making iterations of

material, often in the form of special kits

the same in order to refine it. Feedback

which contain a set of activities to be

from the guide and mentors at various

conducted using tools such as Flip charts,

stages of the iterations as well as basic

card games, board games and charts. A

testing of the product, as and when

case study of these kits was helpful in

possible, led to a final concept for all the

understanding the design of such tools.

different solutions.

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Flip charts and Usersâ&#x20AC;&#x2122; Manual for the kits developed by Thoughtshop Foundation for education on Adolescent Reproductive health Source: thoughtshopfoundation.org

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ANM interacting with the women in villages

Before starting to build concepts it was

Scenario during ANMâ&#x20AC;&#x2122;s visit to a village:

important to completely understand the

An ANM collecting blood samples of women to check haemoglobin levels

context and situation. For doing this, the

1. ANM and Pilot reach the village

actual scenario was described in detail and

2. ANM and Pilot call the women by going

it was analysed as to what all attributes are necessary for the design to fit in such a scenario. After writing and understanding the scenario, a list of attributes or requirements for the solution was written down in order to achieve further clarity on the nature of the design.

home to home or asking other villagers to call them 3. ANM tells women to bring urine samples and check for pregnancy 4. ANM does a Hemoglobin test and other tests to check if women are anemic 5. ANM writes details in her records 6. ANM tells the women the day and time of pick up by the TMC-jeep for a visit to the TMC 7. Meanwhile, the Pilot was talking to other villagers - men, children, etc. 8. ANM and Pilot leave for other village

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Material developed by Sesame Workshop India for educating children on nutrition, health and hygiene

Need for a solution which:

Requirements for the Physical Structure of the Solution:

1. Communicates at the point of contact of ANM and women in the villages 2. Triggers Interpersonal Communication 3. Works well in groups of 5-6 women 4. Doesnâ&#x20AC;&#x2122;t take much time as ANMs need to visit other villages 5. Assists and guides the ANM in conducting the sessions

1. Around 12 to 14 pictures to be displayed in each frame 2. Large enough to be viewed by a group of 5-6 women 3. Easy to carry and handle for ANM 4. Frames to be viewed one at a time 5. Preferably a single compact tool

6. Helps in navigating easily from one topic to another

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Activity book developed by Sesame Workshop India for educating children

Various books and flip charts were studied

complete dialogue between the characters.

from different sources. Looking at the

While the other part had just the main

design requirements for the solution, a flip

message highlighted. Few flip charts,

chart seemed like the most appropriate

produced under the National Rural Health

tool in such a scenario. However, before

Mission in partnership with various

finalizing the concept of a simple flip chart,

organisations, were also analysed. These

the designs of various existing flip charts

flip charts usually didnâ&#x20AC;&#x2122;t have elaborate

were analyzed and alternatives for the

illustrations, instead, only the essential

same design requirements were explored.

elements were shown in the picture.

Most flip charts by the Thoughtshop

The back side of these charts had more

foundation told stories where a central

divisions for information: Main message,

characters journey was being shown. The

points for discussion, and questions asking

front part had a detailed illustration of a

the contents of the picture (to test their

scene which was explained in the form of a

understanding of the visual).

dialogue between various characters in the story. The back side of the chart, which is for the ANMâ&#x20AC;&#x2122;s reference, had information divided into two parts. One part had the

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A flip chart developed by Thoughtshop Foundation for adolescent girls Source: www.thoughtshopfoundation.org

A flip chart developed by National Rural Health Mission in association with other organizations for awareness on Antenatal Care Source: www.nihfw.org

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Exploring concepts for the structure and form of the communication material

The structure and the system of the solution was explored by trying different formats. One concept was to show two different scenarios (positive and negative) simultaneously for comparison and then the reasons that led up to these scenarios. This tool could be in the form of a set of cards or a single accordion fold card which would unfold to show different frames. Another option could be showing individual picture cards of different scenarios and then initiating a discussion on the reasons behind these situation. Other formats and variations of tools were explored in the form of rough sketches and paper models. On analysis, it was realized that the basic model of a flip chart was the most suitable in this scenario as it fulfilled the various design requirements.

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On analysis, it was realized that the basic model of a flip chart was the most suitable in this scenario as it fulfilled the various design requirements.

Various ideas and alternatives for the structure of a flip chart

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The next step was to design the visual content for the tool. Following the content-structure designed in the previous section, a flow of visuals was needed to be made. For this, rough story board sketches were made. As seen in the flip charts by Thoughtshop foundation, often the use of stories and characters is done for such material. Including defined characters helps the audience remember and relate to the story. A decision was to be made as to how many characters should the story have. Options were tried by initially keeping a single character and then keeping two characters. A horizontal format was chosen for the material as it gave scope for making visuals which can compare two scenes by arranging them besides each other.

Rough sketches and thumbnails for the illustrations for the flip chart

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The material needed to guide the ANM while conducting sessions. In order to make this happen, the back side of the pictures, which would face the ANM, would give information on what to say. Apart from the thumbnail of the visual facing the audience, this layout had to have the main message as a highlight and details of the same in an elaborate manner as well. Options were explored where this information also included a set of questions to be asked to the women before or after the session in order to test their understanding of the visuals and Layout explorations for the pages containing messages to be given by the ANM

the messages given by the ANM. These questions would also helps as triggers for discussions and efficient interpersonal communication. Different hierarchy and placement of the elements was tried to achieve a suitable solution.

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Iteration 1 The frames shown here belong to the first

show this information, which was named

iteration in the process of developing the

in a manner similar to the way women

flip chart. Simple illustrations in isolation

are usually named in the Araku region.

were shown in the visuals. No background

This was done so that the audience could

was included in the visuals with the aim

relate to the character and her problems.

of not distracting the viewer with any

The character of an ANM was also shown

other information. Only the action shown

in a few slides to build trust and create a

was to be emphasized on. The whole

respectable but friendly perception of the

information was divided into two flip

ANM. A border was used in all the frames

charts. The first chart gave information on

as one of the insights informed about

the problems and risks during pregnancy

the preference of women for decorative

and the second chart talked about the

elements in visuals

Glimpses of the first iteration

solutions and benefits of proper antenatal care. Both these charts were colour coded

The layout of the back pages was designed

in order to differentiate them. Red colour

to a three-column grid with a 14 point

(which is associated with blood) will

size serif font for the body and 18 point

help identify the situations which are

for the titles. On testing the prints of

helpful and positive in â&#x20AC;&#x2DC;increasing bloodâ&#x20AC;&#x2122;

these layouts, it was found out that these

(increasing haemoglobin). Green would

specifications for the type were large for

suggest the problems and the existing

it to be read from the required distance.

conditions. The flip charts needed to be

The highlighted main message was set

used in succession where initially the

in a 24 point sans-serif font in a colour

women would be informed about the risks,

corresponding to the overall colour of the

followed by the solutions to prevent these

flip chart.

risks. A single central character was used to

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Guide’s Feedback Dividing the information into two flip

to bring attention to a certain element

charts might make it difficult for the ANM

in the picture, the eyes of the character

to handle and carry them together. First

pointing in the direction of the element

showing the dont’s or negatives and then

easily help in doing so. The back side page

later showing the do’s might lead to break

layout could be designed in such a way so

in continuity and also difficult for women

that the ANM can identify the sequence

to compare the two situations together.

and number of slides for navigating with

Putting the do’s and dont’s together will

ease. Hierarchy in the typography also

make the communication easy and the

needed to be improved accordingly.

borders could be used to differentiate the two scenarios. Including indicators of a Glimpses of the first iteration

married women in the illustration is an important detail. Details of the anatomy and postures should be improved. In order

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Iteration 2 This iteration included the changes given in the guideâ&#x20AC;&#x2122;s feedback on the first

Corrected sleeping posture and other illustrations

iteration. The whole information was included in a single flip chart. The color coding was retained and details were improved upon. The flow was such adjusted so that the negative and positive actions were shown one after the other and also compared in a common slide. The postures were also corrected, for example in the picture of the sleeping pregnant woman, it is usually advised by doctors to sleep only in a particular manner. This information was checked and accordingly changes were made in the illustration. Details like patterns on the sari were also added. The ANMâ&#x20AC;&#x2122;s page (back page) was redesigned in a way to show the sequence of the slides and highlight the main message and the current slide. The detailed messages and questions were reduced in size and set in a sans-serif multi-script typeface Hind Guntur which can be set in Telugu script later after translation.

Page facing the ANM Swasthya: Visual Communication for Community Health

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The reduction of iron or hemoglobin in blood was informed by saying that there is a reduction in blood because concepts of iron and hemoglobin in body would be difficult to convey

Guide’s Feedback Illustration which gave information

pictures of women who are being compared

regarding symptoms of anemia needed to

looking at their overall being. Also, the

be revised for correct postures and view.

ANM character needed to be modified

The pictures showing the telemedicine

in order to make look belonging to the

centre needed to give an indication of

context. A context could be given to all the

the doctor or nurse being present there.

pictures by suggesting a background or

This could be done by showing a vehicle

environment for each of the characters.

or open windows. The picture showing

Two different characters could help in

the reduction in ‘blood’ (hemoglobin)

easy comparison. For the ANM’s page,

suggested a silhouettes of pregnant women

the hierarchy of the messages could be

with tint of red colour. The possibility

increased by possibly increasing its size

of this illustration working in the given

or changing the colour. Expressions of the

context would be quite low, so it would

characters and consistency in the style of

be better to simplify it by just showing

illustrations should be checked.

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Pages facing the women

Iteration 3 According to the previous feedback, indications of the backgrounds were added to each of the frames. These backgrounds also supported the main subject in a subtle manner like the healthy women is shown outside the home to show that she is active while the unhealthy women is shown sitting indoors. The illustration for blood reduction was simplified with just two women being shown together to compare their health. The ANMâ&#x20AC;&#x2122;s character was also improved upon and her interaction with the woman was also shown in a proper way. Two different characters were shown in this iteration and they were given specific distinct names for easy comparison. The messages section in the ANMâ&#x20AC;&#x2122;s page was was highlighted by increasing the size and giving it a colour.

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Modified illustrations according to the feedback

Guideâ&#x20AC;&#x2122;s Feedback The houses depicted in the backgrounds

in the exact manner like an actual one.

could be made with proper details. The

Colour coding done in the chart is doubtful

vehicle shown in front of the TMC could

as Red might not suggest positive or safe

be made more consistent with the style of

actions. A better option would be to drop

the rest of the illustrations. The picture

colour coding and represent the frames in

with the baby could look complete if the

a neutral manner. The second character is

details of the hands are made properly.

always shown in a plain sari which might

Jewellery is an important aspect of the

not work as the young women seldom wear

tribal woman and it should not be missed

such saris in the region.

in any illustrations. These details make a lot of difference. Same goes for the details and form of the sari which should be made

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Iteration 4 The changes made in the final iteration included dropping the colour coding of the frames. All the frames were given a neutral colour (green). Other details like the jewelery, saris and houses were improved.

Page facing the women

Few changes were also made in the ANMâ&#x20AC;&#x2122;s page. A gray background was given to the main message in these pages and all the thumbnails were given a grayscale. This was done as the highlighted thumbnail was already higher up in hierarchy because of its size, so it did not need colours to stand out. Before preparing the final prototype which was to be tested in the field, few refinements were done in the illustrations.

Page facing the ANM

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Pages facing the women

Pages facing the ANM

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Prototype Iteration 1 The first prototype of the flip chart was made by simply binding pages in a centrestaple format in the form of a normal book. It had to held by the ANM directly which resulted in partial concealing of parts of the illustration. Also, the structure could not be placed on a surface or hung on the wall. Though the product was cheap, it had issues in handling. The paper used for this prototype was a 70 gsm paper, which could be replaced in the final product by a thicker heavier paper for stiffness, but that wonâ&#x20AC;&#x2122;t solve the problem of hands covering the pictures while holding the chart. First prototype for the structure of the flip chart

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The centre-staple bound flip chart prototype had several issues regarding handling

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Prototype Iteration 2 The second prototype followed the usual structure of a flip chart or a table calendar. This structure is sturdy and easy to handle. The ANM can easily insert one hand inside the cavity of the structure and use the other hand to point out or explain. The problem of illustrations getting covered by the hand was solved in this iteration as well as the usage of both the hands to hold is also avoided. The size of the pages was decided on the regular A4 size dimensions as it is easily available for printing, so that changes or additions can be made efficiently in the future. Also, this size if comfortable for holding as well as makes the content visible for a small group of 5-6 people. The structure also makes it easy to place the chart on a surface like a table for conducting a one-toone session. Final Dimensions of the Flip chart

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The structure of this flip chart facilitated better handling as the cavity would also act as a holder. This solved the issue of hands covering the content.

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Communication at Nutrition Hub

Ragi Process Chart : In order to increase the nutrient-density of the regionâ&#x20AC;&#x2122;s

The communication to be used in the

staple food Ragi, a process was designed

nutrition hub was divided into three parts:

to transform it. This process had to be communicated and taught to the women

Process of transforming Ragi into a

who would visit the hub so that they could

nutrient-dense food (Ragi Processing)

feed this nutrient-dense food to their child and family members. A chart on this

Ways to improve diet

subject was to be designed and put up in the hub.

Solar Dryer Food products Ways to improve diet : Workshops on I worked on the above three solutions while

diet and nutrition were to be conducted

my two team members worked on the

in the hub. For this, the client needed a

other solutions which included the Food-

way to communicate the importance of a

intake charts and Nutrition Assessment

good diet to the women. The existing diet

charts which were also to be put up in the

of the people lacks a variety of nutrients

Nutrition Hub.

and hence addition of different food items

The Nutrition hub building

could help them gain important nutrients. When we started working on these

An activity was to be designed to inform

solutions, the client sent us information

the women on this issue.

on the location where these charts or solutions could be placed in the hub. The

Solar Dryer Food products : Among the

dimensions and placement of the charts

various equipments installed in the hub,

The following few sections talk about

was planned accordingly. It was decided

is the Solar dryer which is a sustainable

the concept development of these three

that since the solutions would have to be

and efficient tool in processing foods. The

communication needs of the clients which

tested, they would be initially printed on

client needed to convey the versatility of

were later implemented in the Nutrition

flex, mounted on a frame and then put up

the Dryer and the indicate the variety of

Hub at Araku.

on the walls of the hub.

foods that can be produced with the help of this equipment. Thus, a chart was to be designed to communicate this at the hub.

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Plan of the Nutrition Hub, along with dimensions and placement of various charts on the walls

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The Ragi Process Chart As the content and its flow was locked for the ragi process chart, the next step was to develop visuals for the same. Each step in the process was written and various options for visually depicting that step were explored. Each illustration which would go into a step was created in the illustration style decided earlier. The overall layout of the chart was also explored. Different visual flows were tried for the process to be visible properly. At the same time it was seen as to not make the process too cluttered or complicated to read. Visual metaphors were also used at places which were derived from the people associations with growth and development. While designing visuals, it was to be decided at various points whether to use

Illustration explorations for the Ragi process chart

pictures of actual food or make illustrations at that step.

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Illustration explorations for the Ragi process chart

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Layout explorations for the Ragi process chart

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Showing growth and development As mentioned earlier, the aspects of growth and development were depicted using metaphors. These metaphors had been derived from the responses and insights gained during the interviews and field research. In most cases, it was observed that for the people, the concept of growth was related to the growth of crops and plants. This was because agriculture is an important aspects of their lives as it is also visible in their festivals and culture. Keeping this in mind, the illustrations showing the growth of a child were accompanied by a growing sapling so that people can easily connect the two ideas. Proper growth and prosperity of crops leads to a happier life as does the growth of their child.

Illustration iterations for the showing better growth of the children

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The layout of the chart was locked at this stage of the process and improvements in the details of the chart were being done. The layout was a linear flow of information with emphasis on the important stages of the process. The benefits at these important stages were separately highlighted. The issues of hierarchy of various elements had to be constantly dealt with. Many a time it so happened that the benefits-section or the arrows were taking more attention than the main process itself. At times like these, the form and colour had to be adjusted so that proper hierarchy is achieved.

Iterations for the selected Layout for the Ragi process chart

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The design of the Ragi process chart went through several changes and improvements at various stages. Feedback from mentors and guide led to further improvements in the design. At this stage, changes like the forms and visual weights of various elements was looked at. The form of the element which depicted the Benefits was explored several times so that it maintained a certain position in the hierarchy of the overall design. The form in some of the first few designs resembled the form of a gas cylinder which was an important issue to address. The final form of the benefits-elements was decided on that of a circle as it is most simple shape to understand and it went in synchronization

Explorations for the forms used in the chart

with the other elements on the chart.

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The design of the element which depicted the flow and direction of the process also went through several changes. Initially, the use of solid arrows created the issue of higher visual weight and hence had to be lightened in some way. Different combinations of colour were tried on various elements to create uniformity in the design. Also, the overall colour palette had to be kept uniform and similar to the one decided earlier while locking the illustration style.

Iterations for denoting flow and arrows in the chart

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Placement and Dimensions of the Ragi Process Chart inside the Hub. After printing on a flex, the chart was to be mounted on a frame to put up on the wall.

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Size of the chart compared to human scale

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â&#x20AC;&#x2DC;Ways of Improving Dietâ&#x20AC;&#x2122; Activity The client needed a way to communicate the importance of a good diet to the women for which workshops were to be conducted. The design team decided to develop an activity to inform the women on this theme of good diet. The concept for this activity was derived from the idea of a food pyramid but was changed to accommodate to the context. Eventually, the concept changed even more to make it suitable for an activity. The idea was to install a pyramid shelf in the nutrition hub, on which models of different food items would be kept for displaying. These models would be arranged in such a way, so as to inform the people regarding a better diet for a healthy life. The walls behind each compartment of the shelf would be given a certain colour so as to relate to the kind of food kept there.

Reference of a food pyramid for the balanced diet activity

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Existing Diet

Nutritious foods 1

Nutritious foods 2

Each shelf in the structure denoted a different kind of food item with a different colour code

The Activity (Initial version) 1. The women would be asked about their

3. Women are explained about

existing diet and food models of this

complementary foods and additives to

existing meal would be kept on the top

be consumed along with this meal and

red shelf.

their benefits. Models of these items

2. Women would then be told about the modifications needed to be done in this

are arranged these on the third bottom shelf

meal and the benefits of doing this. Food models of the modified meal are then kept in the middle shelf.

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Iteration 1 The initial concept was to show the processing of foods, the equipments used in making them and the foods which are finally prepared. These foods would then be compared with the existing diet of the people. Illustrations of the ragi process and solar dryer were arranged on one side of the compartment which would contain foods prepared using these methods. The other side of the same compartment would show positive images of healthy children. Foods of the existing diet would be kept in the smallest compartment to indicate that it is not as nutrient-dense as the foods prepared in the hub.

The first iteration compared the existing diet with the foods produced using solar dryer and ragi process Swasthya: Visual Communication for Community Health

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Iteration 2 The first iteration only included children in the illustration, however, the foods prepared in the nutrition hub are also for the women. To rectify this, illustrations of women were arranged on one side of the compartments to indicate that the foods also affect and improve the health of women. The issue with these versions of the design was that the existing meal was denoted by a red colour which might indicate danger. The idea was not to indicate that the existing meal is dangerous, but it is not enough for proper nutrition. These feedbacks came out after discussions with the mentors and eventually changes were made. The second iteration replaced the illustrations of the equipments with those of women and children

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Iteration 3 The colour denoting the existing meal was changed to a brown. An illustration of a happy woman was added to the shelf which initially had the illustration of a girl, so that one whole side shows pictures of only women. The flow of the activity was also changed accordingly. In order to make the food models, it was decided that instead of three-dimensional model, cards with pictures of foods would be used. This would help in saving cost and the process of producing such cards would also be simpler. The cards needed to stand on a surface and be visible from a certain distance. Different cardboard-models for these cards were explored to find out which structure would be the most stable and cost-effective.

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Initially, circular shaped cards were tried but it was later realized that these would require die-cutting so a simpler square shaped card was finalized

Prototypes of the food-cards to be used in the pyramid shelf

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Iteration 4 At this stage it was realized that keeping the existing meal at the top shelf might give more importance to these foods because of their placement relative to the other shelves. This had to be avoided and instead it was to be shown that the ‘Modified meal’ and ‘Additional food’ items hold more importance. Keeping this in mind, the complete pyramid shelf was inverted to change the hierarchy and importance of the different food items. Accordingly, the illustrations and details of the activity were modified.

The final iteration had the pyramid inverted in order to correct the hierarchies of the food items

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It was proposed that the pyramid shelf could be installed in the area where cooking workshops would be conducted in the hub.

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The Solar Dryer Chart The content for the Solar dryer chart was comparatively simpler and straight forward. Different solar dried food items needed to be shown along with a solar dryer. The benefits of consuming these food items was also needed to be shown. Like the process of the Ragi chart, this began by exploring different layouts and visual structures for showing the flow of the chart.

One of the initial explorations for the layout for the Solar dryer chart

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Layout explorations for the chart

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In order to show the food items, photographs of the foods were used instead of making illustrations for representing them. This decision was made because illustrations had the possibility of misleading the audience when it came to certain food items as clarity is difficult to achieve in visually representing those

Location of the Solar dryer chart on the outer wall of the Nutrition Hub, along with the proposed dimensions

foods. For showing the benefits of solar dried foods, ‘before’ and ‘after’ scenes of a woman and a child were shown to depict how consumption of Solar dried foods is beneficial for health. These benefits were, however, removed from the chart on account of simplifying the information and reducing clutter.

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Size of the chart (4 x 6 feet) compared to human scale

These iterations had the benefits of solar dried foods included in the form of scenes showing women and children which were dropped in the final concept

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4 This section lays out the final concepts selected after all the iterations and feedback on each of them. These

deliverables

concepts are then turned into prototypes to be tested for improvement. It is discussed as to what all needs to be tested in these concepts.

Final concepts Prototypes to test

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4.1

Final Concepts Paying attention to these aspects not only makes the design efficient and strong, but also helps clarify the actual problem to be addressed.

After several iterations of all the solutions,

conducted for the ANMs and the staff or

the final ideas were locked down and were

volunteers of Piramal Swasthya in order

being made ready to be tested in the real

to explain them the functioning of these

scenario. All the final concepts and the

designs and how they can make full use of

decisions behind the designs were made

this material. Each of these concepts have

based on the basic understanding of the

their own different purpose and function

context and the people. These decisions

but together they are supposed to be a part

were, in no way, ultimate, as only testing

of a common system which is aimed at

in the field would give assurance on

awareness and behaviour change regarding

the proper functionality of a solution.

maternal and child health.

A training session would have to be

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Glimpses of the final concepts

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Antenatal Care Flip-chart According to guideâ&#x20AC;&#x2122;s last feedback, certain changes were made in the final iteration. The colour coding was dropped and all the frames were given a neutral colour (green). Other details like the jewelery, saris and houses were improved. The expressions of the women in the illustrations were improved and the interaction of the foreground and the background was also reviewed and revised. Few changes were also made in the ANMâ&#x20AC;&#x2122;s page. Overall, the design was ready to take a physical form and the next step would be to create a prototype for testing in the field. Cover page for the flip chart

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Pages from the Flip chart

Pages facing the audience

Pages facing the ANM

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Pages from the Flip chart

Pages facing the audience

Pages facing the ANM

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Pages from the Flip chart

Pages facing the audience

Pages facing the ANM

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Pages from the Flip chart

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Pages facing the audience

Pages facing the ANM

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Ragi Process Chart Colours and forms of the elements in the Ragi process chart were adjusted such that the visuals appeared in harmony with each other. The elements which were initially visually heavy were later modified to look neutral. The design of the arrows was made such that it took less attention but did the function of guiding the eye in the proper direction. A hand gesture was introduced in the benefits-section to indicate a ‘positive sign’ or ‘good’. Testing of the design and orientation of the audience to learn signs like these might help in building an understanding of the communication. The final design was translated to Telegu as most volunteers and audience only know Telugu and the local languages. Translation was done with the help of the Piramal staff in Hyderabad, but due to time and technical constraints, typefaces for the text

Above: Final chart for the Ragi process in English Facing page: Final chart in Telugu

could not be explored, though the available typeface with the Piramal team was simple, neutral and legible enough for the charts.

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‘Ways to Improve Diet’ Activity The final concept for this activity was obtained by inverting the whole shelf. This decision was made keeping in mind the common understanding that things at the top have the highest priority. The food model cards were also finalized. A simple square card board with a picture of the food stuck on it was to be used. The structure of this card was also quite simple to build. This particular solution was proposed to the client but a decision to test it or take it forward wasn’t made. Making a rough prototype of the shelf and testing the activity with a group of women would be the next step for this design.

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Solar Dryer Chart The final Solar dryer chart was a simple flow chart showing food products and their corresponding solar dried food product. The purpose of the chart was finally to just show the variety of products which can be prepared using this simple device. The chart showed the versatility of the solar dryer and how it is a boon for the villagers. This chart was also translated to Telugu and set in the same typeface as the one used in the Ragi process chart.

Above: Final chart for the Solar Dryer in English Facing page: Final chart in Telugu

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Brochure and Visual Identity for Gosthani Project (Nutrition Hub) The brochure for the Nutrition hub was to be used in the inauguration of the hub. The content informed about the concept, aim and functioning of the hub. Certain info-graphics were also to be designed to be included in the brochure. The Nutrition Hub already had a visual identity but the client wanted to redesign it to make it consistent with the communication material designed by the studio. Three concepts were presented to the client, of which one was designed by me. The identity once designed was applied on various collaterals. The details of both the brochure and the identity can be found in the appendix.

Brochure for the Gosthani project

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Spreads of the Gosthani project brochure

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4.2

Prototypes to Test Checking what the audience understands from the visuals and then accordingly modifying them would strengthen the communication design.

All the solutions were to be given physical

For the Antenatal Flip chart, the physical

forms to be tested in the field. The initial

structure of the prototype was satisfactory

few prototypes were rapid prototypes made

in the basic testing phase. However, each

using low quality material for basic testing.

and every visual in the chart needs testing

But the prototypes to be made for the field

so as to understand which aspects of the

were to be made using actual materials.

illustration work for the audience and

The selection of materials was important

which donâ&#x20AC;&#x2122;t. The material used for making

given that the usage of these tools would

the prototype were selected keeping in

be over a long period of time. Testing the

mind its usage. A 170 gsm paper was

visuals is of utmost importance as they

used for the pages and the structure was

form the basis of the whole communication

made using a 1.5 mm thick cardboard. The

strategy. Checking what the audience

pages were bound to the structure using

understands from the visuals and then

spiral binding which would be replaced

accordingly modifying them would

by a wire-o binding in the final product.

strengthen the communication design.

The final dimensions of the product are mentioned in the â&#x20AC;&#x2DC;Conceptsâ&#x20AC;&#x2122; section. These specifications for the prototype are also recommended for the final product.

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Glimpses of the final prototype of the Flip chart to be tested in the field

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Charts in the Nutrition Hub The Ragi process chart and the solar dryer chart were to be tested for their visuals. The Piramal staff would have to be oriented to the charts first and then they could explain them to the women. These charts are not self-explanatory and there is bound to be a learning curve for the audience. But still, testing all the aspects of the chart would help improve its visual design. Since all the charts were to be first tested, they were printed on a flex and mounted on a wooden frame. These were then hung on the walls of the hub. Apart from the Ragi process and Solar dryer chart, other charts on ‘Food Intake’ and ‘Nutrition Assessment’ were also designed by the rest of the design team. These were also printed in the same manner and put up in the Nutrition hub. Prototypes of the Ragi Process chart and the Solar Dryer chart put up on the walls of the Nutrition hub in Araku

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Glimpses of the charts designed by the other designers in the team put up on the walls of the Nutrition Hub

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Food Pyramid activity The complete activity would have to be acted out from beginning to end with people in order to understand if it works properly. Prototypes of the shelf, pictures and food-cards will have to be made and installed on a wall. An interactive session with the tribal people after training of the Piramal staff regarding the activity will help in getting feedback for improving the overall design.

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5 This document would be incomplete without suggesting a way ahead for the project as well as reflecting on the experiences gained by working on

epilogue

such a project. The six months put in this project created highly valuable lessons on different areas of work as well as on life in general.

Conclusion Retrospect References

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5.1

Conclusion The studies done and concepts developed in this project are a starting point for the design of a communication strategy which needs further development.

The project began with the plan of

a push to our learning curve on the issues

researching on field to understand the

to be addressed. These studies informed

communities and context, arriving at

about things which worked and the ones

insights and designing solutions to

which didn’t. Views from experts gave new

help the client achieve their objective

perspectives on the process of designing

of communicating key messages to

for rural audiences. Innovative methods

the communities and initiating behaviour

of research and tips on working on field

change in them. Initially, the context

were some of the inputs which can be

was not completely clear as all of our

credited to these experts. These views were

understanding was built only on secondary

especially helpful in understanding the

information and also because of the fact

nuances of tribal communities and their

that the systems designed by Piramal

behaviour patterns. The interesting part

Swasthya were new for us. The research

about absorbing Dr. Rani Bang’s thoughts

done by Therefore Design’s earlier team

on tribal communities was the amount of

acted as a good starting point to get an idea

similarities found between the people in

about the project. The overall system in

this project and the ones she worked for.

the project was quite vast, hence framing a design challenge helped streamline our

Field research, which was the most

objectives. Secondary research in the form

crucial part of the research process, led

of case studies and research papers gave

to unexpected discoveries and various

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learnings. This phase gave a direct contact

Journey maps were useful tools for not only

system which is defined around the

with the target audience and with the

identifying gaps in the systems, but also

community. Such a communication would

environment they live in. Nature and

for strengthening our own understanding

then be able to imbibe the required ideals

characteristics of different groups of

of the project through the study of each

in the culture and psyche of the tribal

people were different but certain common

step involved. The analysis of the context,

community. The time period required

elements united them as a community.

content and communication further

to make this behaviour change would

helped focus on the attributes necessary

also be considerably long and hence the

Hierarchies and systems were identified

for the design to work. The generation

communication strategy will also need to

in their age old practices. The shift and

of concepts and subsequent iterations of

be put in action for a prolonged duration.

difference in cultures between the older

the concepts helped in producing a refined

Over the course of this time, the design and

and newer generations, about which the

product at the end. As mentioned earlier,

structure of the communication system

studies and experts talked about, could

the prototypes of each of the solutions

would inevitably change at various steps,

be actually seen during the field visit.

would be tested further in order to improve

because of the continuous reshaping of

This transformation of cultures could be

the designs.

culture and ideas happening with the

attributed to the influence from the urban

passage of time.

ideas of development. Analysis of the

The studies done and concepts developed

collected data and drawing of insights from

in this project are a starting point for the

the same helped refine and organize our

design of a communication strategy which

understanding of the whole scenario. This

needs further development. There is a

also informed the next steps of coming up

need for a multi-pronged communication

with several ideas for the design solutions.

to be planted at various points in this

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5.2

Retrospect There were many failures and mistakes which led to the learning of invaluable lessons.

This project has marked the beginning of my career as a practicing designer and

Learnings on Processes and Industry

in this process, several observations and learnings took place for me. Looking

The module ‘Learning From the Field’ in

back at the time during the course of this

the fourth semester at NID had introduced

project, the journey was not a straight and

me to field research and design for a rural

simple one. This was my first internship

context. In this course, I had learned that

ever and my first experience of working

one needs to have an open and unbiased

in a professional studio. There were many

mind while studying these contexts.

failures and mistakes which led to the

While observing the lifestyle and other

learning of invaluable lessons. These

aspects of the rural audience, one must

lessons have been divided into two parts:

not just observe every detail of their

‘Learnings on Processes and Industry’ and

actions and environment, but also

‘Learnings as a Design Student’. Needless

question as to why an individual does

to say, being the first internship, these

what he does. Probing into the reason

enlightening experiences will stay with

behind their action can give useful insights

me for the rest of my life and help me take

while researching on field. A willingness

better decisions in future to hopefully

to step outside one’s comfort zone while

make me wiser designer.

working in such areas is also essential for efficient work. One must also be sensitive

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to issues such as gender and caste while

also helped me gain knowledge on how

hub initiative was also planned in such

conducting research. People in such setups

different organizations work. I got to

a manner so as to make slow and small

are usually particular about these issues

know how a non-profit organization

changes in the lifestyle of the people. A

so planning and design of the research

functions for bringing about change in the

smart move was to make small changes

should be done accordingly. Sketching on

existing systems of healthcare. Piramal

in their staple regular food (by making it

field is also an important and useful tool

Foundationâ&#x20AC;&#x2122;s other projects served as

nutrient-dense) rather than introducing

for enhancing oneâ&#x20AC;&#x2122;s observation skills.

examples on how a small initiative which

a completely new product which might

While drawing, one automatically develops

serves as test project in the beginning,

be difficult for them to accept. Through

a keen eye resulting in better absorption

ends up getting implemented nationwide.

Piramal, I also learned that technology,

of information. All these learnings from

Even through the projects in Araku, I

if used efficiently and smartly, can take

this course acted as a starting point for

learned how Piramal initiates a project in

the design of a system to a completely

me when I took up my graduation project.

a tribal region. By employing local people

advanced level.

Even during the time around my field visit

as volunteers and staff for their initiatives,

to Araku, I was referring to these learnings

the organization is able to build trust for

for preparing myself for the visits.

themselves in the minds of tribal people. Through their Telemedicine Centre project,

My time with Piramal Swasthya and

I realised that building a completely

Therefore Design added to my previous

functional system of healthcare takes

learnings on design for rural audience

time, effort and trust when it comes to

and on design processes in general. It

tribal regions. The design of the Nutrition

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Painting on the walls of the studio

While generating concepts, it is necessary to produce diverse options in the initial stages and then iterate on those options rather than sticking to a single concept right in the beginning of the ideation process.

Working at Therefore Design taught me

time is a crucial aspect and deadlines are

numerous lessons on design process,

to be respected as a number of people

graphic design, printing technology and

and agencies are connected with a single

communication skills. While working

project. Process-wise, I learned that

for Piramal Swasthya, we at Therefore

while preparing for field research,

design, often had to talk to the client on

it was important to form a clear and

our own which gave me the confidence to

concise list of objectives to be achieved

communicate efficiently. I learned that

through the research. All the observations

it was important to present your ideas

and insights should ultimately lead to

and concepts in a very clear way. The key

achieving and fulfilling of the research

to understanding the clientâ&#x20AC;&#x2122;s needs

objectives. While generating concepts, it

is clear and efficient communication.

is necessary to produce diverse options

Since the client was based in Hyderabad,

in the initial stages and then iterate on

while the studio was in Pune, a lot of

those options rather than sticking to a

the communication happened either on

single concept right in the beginning of

phone calls or mail. In situations like

the ideation process. Making of the Ragi

these, communication had to be clear

process chart and feedback on its iterations

and precise. For projects in the industry,

taught me a lot about understanding

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225

Details of the installation of the logo of the studio

and digesting the content thoroughly,

look consistent and pleasing. Thus, use

importance of a collaborative approach

creating suitable visuals and playing with

of InDesign is great in such situations.

to design. The overall experience of

hierarchies and visual weights in a layout.

Having said this, when one works in the

working in a studio for the first time

Apart from the Piramal project, I got the

design industry which in turn works for

brought several challenges for which I

opportunity to also work on a few different

non-design industries, it is important to

might not have been prepared initially, but

extra projects in the studio. These projects

learn how to make good presentations on

as I started giving attention to each and

belonged to various areas of design like

Powerpoint which is what the â&#x20AC;&#x2DC;non-designâ&#x20AC;&#x2122;

every detail of the working process, I found

branding, packaging design and publication

industries are comfortable with using.

that I could handle those challenges better.

design. I gained understanding on subjects like brand positioning and visual

An interesting and fun aspect of the studio

merchandise. Packaging design projects

were the group brainstorms that were

helped me understand how visual

conducted regularly for different projects.

hierarchy on the packet of a certain food

These sessions were efficient in the

product helps in drawing attention and

sense that different people gave different

communicating essential information.

perspectives and ideas on a single problem

I also gained the understanding that

at hand which not just accelerated the

though making a presentation on Keynote

design process, but also made the ideation

is quick and saves time, it doesnâ&#x20AC;&#x2122;t quite

richer. This made be understand the

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Learnings as a Design Student Being a life-long learner is what I wish

the apparent distance the greater the

an Engineering background, the field of

to remain and this project was a great

degree of creative thinking involved.”

design is comparatively new for me and

opportunity to gather loads of lessons as

thus working with seasoned designers in

a designer. All my mistakes during this

During the course of my internship, I learnt

the studio made me realize that I need to

project (which were a lot), made me

that one needs to ask more questions and

take extra efforts to learn more in order

learn important lessons, one of them

clarify even the tiniest of doubts. Asking

to reach their level of expertise. Working

being to make more mistakes, but not

questions to mentors, guides and clients

in a group, I learned that it is important

to repeat them. Another lesson learnt

helps get a clear understanding of the

to be proactive and to take initiative as it

was on creativity. After several attempts

tasks at hand so that efficient work is

helps in keeping the energy of the group

at failing to create innovative solutions

produced. I learnt that one needs to keep

on the higher side so that productivity

for one of the design problems, I realized

updating the client on each and every

is not hampered. Group members and

that creativity doesn’t come out of thin air.

development done on the designs and

fellow colleagues in a studio are a great

Absorbing from the resources around us

keep asking for feedbacks. This helps in

help when one is in the need of testing

is necessary before thinking of creating

identifying, early in the process, if one is

a design. Constantly gaining feedback

something new. Post this absorption of

going in the wrong or undesired direction.

from fellow designers helps in getting

information, the mind automatically starts

I also realized that while presenting drafts

new perspectives on a design solution

making connections. As described in ‘The

of a design, one must always present

behind which one has been working for a

Art of Creative Thinking’ by John Adair,

them in a clean and clear manner even

long time.

“You will be creative when you start seeing

if one is more comfortable generating

or making connections between ideas that

ideas by making dirty sketches which only

appear to others to be far apart: the wider

he or she can comprehend. Being from

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Notes on doubts during the process

During my feedback sessions with Tarun,

people. For example, absence of details

he told me to â&#x20AC;&#x153;Go for a walkâ&#x20AC;?. Good

which are indicators of a married woman,

Design does not come from sitting in

might cause the audience to question the

front of a laptop. Exploring the world

credibility of the communication. I also

around us is crucial for better problem

committed the mistake of applying a given

solving. During the design of the flip-

feedback to only those parts which have

chart, I had hardly thought about the

been pointed out. I need to understand and

life and worries of an ANM who plays

apply the feedback to all other similar parts

a crucial part in this communication

of the design.

system; rather I was more focused on the insights regarding the pregnant women.

During the internship, moving to a city

A designer should not only concentrate

which had numerous old friends working

on the primary target audience, but also

in different sectors of the industry made

think about all the other stakeholders

me realize that it is extremely important

and people who would be affected by

to keep in touch with friends as strong

and connected to the design. As far as

human relationships is all that matters

visuals were concerned, I learned that it

in the end.

is imperative to give attention to details of not just physical aspects like anatomy, but also to details which represent aspects like culture, beliefs and perceptions of

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5.3

References Web http://www.tribalhealth.org/ http://ashwini.org/new/ http://www.ruralhealthcarefoundation. com/what_we_do.php http://www.itdapaderu.com/ITDAProfile. aspx

https://piramalswasthya.org/ http://vikaspedia.in/health/nrhm/ national-health-programmes-1?b_ start:int=10 http://childlineindia.org.in/Reproductive-

http://www.vikalpdesign.com/ https://www.thoughtshopfoundation.org/ http://nhm.gov.in/nrhm-components/ rmnch-a/child-health-immunization/ child-health/schemes.html

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http://nhm.gov.in/

Epilogue

and-Child-Health-Programme.htm http://thecsrjournal.in/communitycivilisation-should-be-learnt-fromtribals-dr-prakash-amte/

229

http://projectrising.in/

http://searchforhealth.ngo/

https://www.avanthafoundation.org/

http://vikalpdesign.com/

http://the-anaemia-project.blogspot.

https://www.thebetterindia.com/101589/

in/2010/03/proposal_23.html

artisan-husband-wife-duo-legacycheriyal-paintings/

https://www.path.org/

Books Field Guide to Human-Centered Design by IDEO.org Putting Women First: Women and Health in a Rural Community by Dr. Rani Bang

https://fineartamerica.com/featured/ https://apps.searo.who.int

fetching-water-raghunath-chakraborty. html

https://www.thehindubusinessline. com/catalyst/finger-on-indias-pulse/

https://www.tallengestore.com/products/

article7818874.ece

mother-and-child-art-by-jamini-roy-artprints http://www.ehsconsult.biz/consult/ emergency-procedures-flip-charts/

https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3489951/

Arvind, Anupriya. Records for Life: Reevaluation and Re-design of a Healthcard Framework. National Institute of Design, 2014

medind.nic.in/hab/t07/i4/habt07i4p278. pdf

Graduation Projects

http://classroominthemiddle.com/nocopy-foldables/

Girdher, Tarun Deep. Visual aids on self governance: Communicating at the grass roots level. National Institute of Design, 1997

apps.searo.who.int/PDS_DOCS/B5175.pdf https://freedesignresources.net/squarethecsrjournal.in/community-civilisation-

magazine-free-mockup/

should-be-learnt-from-tribals-drprakash-amte/

https://www.flickr.com/photos/balu/ albums/72157663340181808

https://www.thebetterindia.com/78272/ family-planning-hush-hush-india-timeschange/

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Appendix

The client, apart from giving brief for the communication material for Ragi process,

Brochure Design for Gosthani Project (Nutrition Hub)

Improving diet, and Solar Dryer, also required a brochure and a visual identity

The client had the requirement of a

designed for the Nutrition hub project.

brochure to be designed which would

The brochure would be presented to

explain in brief about the Gosthani Project.

the organisations that would help fund

This brochure for the Nutrition hub was to

the projects and the audience for the

be used during the inauguration of the hub.

identity would be all the stakeholders

The content informed about the concept,

in connection with the Nutrition Hub

aim and functioning of the hub. Certain

project. The content for the brochure was

info-graphics were also to be designed to

already provided which contained basic

be included in the brochure. The design

information regarding nutrition hub. This

presented here was handed over to another

project, named as Gosthani Project, already

designer in the studio for changes since by

had an identity which was to be redesigned

the time the final feedback from the client

in order to align it with all the new visual

was received, my internship at the studio

communication material to be designed.

had already ended. The initial few drafts of the design for this brochure were designed by my team member, Ojal Khandpur.

Above: Cover page of the brochure for the Gosthani project (Nutrition Hub) Facing page: Spreads of the brochure

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Identity Design for Gosthani Project (Nutrition Hub) The Nutrition Hub already had a visual identity but the client wanted to redesign it to make it consistent with the communication material designed by the studio. The project was named after the local river Gosthani, which nourishes and replenishes the flora and fauna of the region. Three concepts were presented to the client, of which one was proposed by me. The identity shown on this page was designed by me. The identity, once designed, was applied on various collaterals. This identity was a built on the existing concept of the river Gosthani nourishing the life in the region. The elements from the older identity were simplified by rendering them in a style roughly inspired by the Rangoli drawn by women in the region.

Proposed alternative for the Identity Design and its applications designed by me

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Existing Identity

Proposed alternatives for the Identity Design and their application on the site; designed by team members Anupama Rao and Ojal Khandpur

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Colophon

Content

Production

Photographs for section openers were shot

This document was created using Adobe

by Balu Velacher, Nagarjun Kandukuru and

InDesign, Illustrator and Photoshop CC

Shankar Adisesh in Araku valley.

on a MacBook Pro bought in 2015. It is printed on a 100 gsm paper by Siddhi

All artwork and written content is originally created by the author, unless specified otherwise.

Typography The text of this document is set in Merriweather and Merriweather Sans designed by Eben Sorkin from Sorkin Type, a type design foundry based in Western Massachaussets, USA.

Printech, Ahmedabad.

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