Monday, June 6, 2011

Researching Healthcare in India - Rural India, Primary Healthcare Centers

I wrote this last year for another blog which never took off. Its a series of articles based on my personal experience on Researching Hospitals in India as a designer.

Hospitals are not an easy place to be, especially when you visit them with the intent of clinically observing what all goes on there, very objectively drawing conclusions, making connections and finally deciphering workable solutions for the very many opportunity areas which require attention in this very dynamic scene.

This is a series of articles based on my experiences in researching in hospitals for various products/ services.

The first in the series starts right at the bottom of the pyramid i.e in the villages. Most of the inferences drawn here are from my visit to a series of villages in Kutch as a part of one of my classroom projects while in NID.

At the village level, most often its only the government which reaches. There are very few private clinics or doctors, if at all any. It is at these levels that PHCs exist. Primary Health Centres (PHC) are the cornerstone of rural healthcare in India. Primary health centres and their sub-centres are supposed to meet the health care needs of rural population. Each primary health centre covers a population of 1,00,000 and is spread over about 100 villages. A Medical Officer, Block Extension Educator, one female Health Assistant, a compounder, a driver and laboratory technician look after the PHC. It is equipped with a jeep and necessary facilities to carry out small surgeries. However, not all PHCs, are equipped with all these, some manage with much less.

To be able to visit and do good amount of research at these centers isn't easy and requires a lot of perseverance. Also visiting a few would not exactly be very useful, one needs to visit many such centers to make any definite conclusions. Its a challenge not just for the researchers but also for the staff at the PHC, we visited one of the PHC where the doctor was a Bihari and couldn't understand the local language.

Some of the following tips may be useful:
  • Its very important to understand the local language, even if you cannot converse in it. If not you, then at least someone else in the group should be able to have conversations in the local language/ dialect. In any case, make sure you record all conversations for future references.
  • Often its not easy to get people to talk, especially when they anyway see you as outsiders. A good research would happen only if you are able to break the ice effectively, and do it as early as possible. Always have a strategy about this, and this shall be improvised to the place that you are visiting.
  • Once the ice is broken, people would talk and would be willing to listen to you as well as give feedback on what you ask. Its alright to have a questionnaire for this, but more effective would be some games that you can ask the stakeholders to get involved in. One of these could be role-playing, where everyone enacts out their roles and its an amazing time to observe and learn.
  • Be gender sensitive, males may not always be welcome at all places. An effective group is the one which has both male and female members. One of the most common visitors at a PHC are women, and one person who can give you a lot of information in an ANM (Auxiliary Nurse Midwife). The purpose of the visit could possibly be completely lost if no woman is there in the research team.
  • Just like any research, do have small gifts for everyone. Its would make sense that these are things that are not commonly available there. You might always need to go back to the same place again for validation of your concepts, and a rapport once built would go a long way in any further research as well.
  • Carrying a consent form is a good idea, and get it signed by the doctor  or the ANM. It always makes the process more official, apart from ensuring that the design ethics are also taken care of. Always explain what the document states before getting its signed, treat the people there as equals and make them participate in the whole process.
The next in the series (Rural India Primary Healthcare Centers Part II), will also include some quick case studies and some examples of how and what can go wrong while researching the Rural India.

p.s. Thanks to Muzayun for helping me with editing this.
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