Project Brief
This project was a part of Prabuddh Gram Yojna under which, our team was tasked with Research and Insights to point towards the underlying challenges and insights about rural health behavior and solutions for immediate effect and long-term directions.
This project has been carried out in collaboration with the Office of Principal Scientific Advisor to Government of India, Invest India Office, and Bharat Forge Ltd.
Research Flow
Secondary Research
Understanding Rural Healthcare scenario
Mapping Problem areas
Finding directions for research
Pilot Study
Visiting a similar sized Village to understand the context.
Primary Research
Visiting the Bhiura village to gather observations and data.
Analysis
Aggregating and analyzing data obtained from primary research.
Analysis
Analyzing Pilot Observation to create direction for Primary Research
Insight Generation
Integrating and disintegrating inferences to form insights
Design Direction
Leveraging the insights to create meaningful product and services
Prabuddh Gram Initiative
This project was a part of Prabuddh Gram Yojna under which, our team was tasked with Research and Insights to point towards the underlying challenges and insights about rural health behavior and solutions for immediate effect and long-term directions.
Rural Healthcare is one of the 9 focus areas of the Prabuddh Gram Initiative. It is the central pillar of the rural society and economy hence it is needed to be understood at a behavioral level to get deep insights that help to establish a robust and empathetic healthcare system.
Bhiura Village
Atrauliya Block, Azamgarh District
Bhiura is a peri-urban village, located on the Gorakhpur link expressway (under construction) - starting from the Poorvanchal expressway near Azamgarh and ending at the city bypass of Gorakhpur.
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Secondary Research
The research started with studying the information already available in secondary sources like newspaper articles, ground reports, official documents, etc. to understand the current scenario of rural healthcare.
Rural Healthcare Service
In India, on average, a government doctor attends to 11,082 people, more than 10 times what the WHO recommends (1:1000)
60%
PHCs in India have only one doctor while about 5% have none.
UP
Emerged the worst performers, with less than five percent PHCs following the norms.
Distribution of services as per population density
CHC: Community Health Center
PHC: Primary Health Center
SC: Sub Center
ANM: Auxiliary Nurse Midwife
ASHA: Accredited Social Health Activist
Distribution of Health Centers
Role of ANM
Role of ASHA
Rural Health Behaviors
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Covid-19 Vaccine Hesitancy: Believing vaccination leads to death.
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Rural people trust alternative unauthorized healthcare providers and feel they are immune to diseases.
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People deny, stigmatize Covid-19 Positivity, and are ignorant towards prevention & medication.
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See tangible as a treatment for diseases
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Lack of commitment to the healthcare process awareness towards health investment.
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Males make quick decisions on health compared to women.
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Vaccine-Preventable Diseases is placed in a less priority zone until it's too late.
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Unavailability of functioning healthcare centers nearby, travel long distances to get proper healthcare treatment.
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Low Doctors to Patient Ratio. (India is 1:1456 against the WHO recommendation of 1:1000)
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Shortage of Human resources.
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Health workers lack rural/cultural sensitivity.
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Healthcare providers are hesitant to work in rural areas
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Information flows through unorganized channels in Rural areas.
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Lack of information and awareness about Covid-19
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Word of mouth is, Key tool for Misinformation spreading.
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System and Technology are not designed to keep the Rural people in mind.
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Lack of a balanced diet: Low availability and Management of nutritious food.
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Labor-intensive work in harsh conditions.
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Insight:
Health Factors
Pilot Study
To familiarize ourselves with Rural Context
Samadha Village
Unnao District, Uttar Pradesh
Population Size: 1500 +
Total No. of Houses: 317
Total Literacy rate 56.8% Approx.
Population Size: 1500 +
Total No. of Houses: 317
Total Literacy rate 56.8% Approx.
Tools Used
Observational Study
Semi-Structured Interviews
Key Observations
Awareness
Healthcare
Economy
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Environment
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Primary Research
Bhiura Village
Population: 900+
Total Households 200+
Literacy: 59%
Sub Center: NA
Atrauliya CHC: 2KM
Tools Used
Contextual Inquiry
Probing Conversation
Sketching Exercise
Selfie with Trash
Observe Think Wonder Analysis
Artifact Analysis
Contextual Inquiry: CHC Atraulia Block
The Architectural layout to patients was confusing and visible modifications were seen based on requirements which were creating further problems and confusion.
Patients felt they were not diagnosed properly. It was observed that some doctors saw multiple patients during consultation. There was no significant medical record of the patients.
Contextual Inquiry: Vaccine Registration & Vaccination Process
The process of registration of a person for the first time vaccination is different than for the person coming for the second dose, this creates a basic heuristic error and people often get confused over the steps to be followed.
A patient has to stand in a queue for more than an hour to reach the registration desk, to eventually find out that some information is not correct or missing, This leads to line jumping as the wait time has increased for the patients standing behind.
Contextual Inquiry:
Pharmacy, CHC Atraulia Block
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The pharmacy at CHC is a small space of 6FT X 6FT approx. where patients receive subsidized/ free medicines provided by the State Government. The space was insufficient for the service processes which needs to be conducted.
Medicines were given loosely in hand and instructions of doses were given orally. Lack of empathy towards rural patients considering their anxiety and unawareness towards Rural Healthcare.
Sketching Exercise among kids (6-16 Y) of Bhiura Village
Topic: Health & Cleanliness
Probing conversations with Kids
Topic: Health & Cleanliness (Extension of Sketching Exercise)
Observe
School infrastructure with toilet, banyan tree and the school building was made where a man can be seen taking oxygen from the tree
Kids were fully aware of toilets and their significance, relationship with cleanliness and hygiene
Think
Kids are aware of the fact that trees are the major source of oxygen and its very important for a clean environment
Kids understand the importance of how small steps towards cleanliness can make country great
Kids understand importance of cleanliness and placement of dustbin in their house
Kids understand the importance of using toilets and associate it with clean village.
Wonder
Though kids believe in cleanliness still nobody takes initiative to keep the village clean?
Kids are aware of Dustbins and waste production, yet non of them use/ have a dustbin at home.
Many households lack proper toilets and kids also defecate in open. Why kids don't ask/ demand a toilet or discuss its importance with their parents?
Photography & Selfie Exercise with Youth (17-22)
Aim: To click pictures where Sanitation & Cleanliness were missing.
Straw is generally considered as waste so in any case of damage/ deformity, it might get disowned very easily by the residents.
No waste segregation & collection system or waste management system leading to accumulation of trach near households.
Seeing cow dung kept openly is an unsightly experience for the respondent, even though it's an indeginious practice in the village.
The respondents were aware of water pits as disease breeding grounds but collective responsibility was missing.
Artifact Analysis: Prescription & Medicines
None of the residents kept any government-provided medical prescription safe with them. There was a clear lack of trust and genuineness towards govt. funded medical facilities. Upon further probing, it was found that people tend to believe since Government facilities are free and usually in deteriorating condition, the medical facilities are not trustworthy.
People prefer to consume medicines from private health institutions and are often overcharged or scammed by the practitioners.
One resident kept safe a prescription with any name- contact of the doctor. This demonstrates their blind trust in private consultants.
Focused Group Discusions
People feel loss averse while wearing a mask and perceive them as an obstacle between freedom and social image inside the village and people around them find it odd to wear masks following a normative Conformity Behaviour.
The masks they get/ purchase in the hospitals/ market have a hard time blending with their attire and becomes highlighted. Many women tend to cover their face with a saree as it blends in the social context of the village and somehow acts as a preventive measure.
People do not use proper First Aid due to a lack of resources and awareness. They tend to leave cuts/ wounds and animal bites in the open as they believe it will heal faster if it’s dry. Tetanus injections are a far cry as there’s no sub-center in the village.
Preventive measures are positioned with a factor of fear to gain more impact but people in the village tend to reject them as having fear in a social scene is a display of cowardice for the villagers.
Insights
Health Perceptions
Insight 1
Doctors are unable to diagnose properly as patients do not preserve Medical Documents/ Prescriptions(which they feel inferior and of low quality) that could state their medical history, which in turn leads to a lack of trust formation from the Patient's side they prefer local private health practitioners.
Opportunity Area
There is a need to need to revamp how patients perceive government hospital prescriptions and design a way to preserve their medical history.
Insight 2
People in villages tend to leave small cuts/ wounds/ animal bites without any treatment since they lack First Aid materials and awareness. This can lead to severe complications. People having lower perceived severity do not seek First Aid help during an accident/ emergency which is a metaphorical indicator of Health Seeking Behavior in general.
Opportunity Area
There is a need to establish the value of First Aid treatment and make people aware of susceptible illnesses caused by small injuries, animal bites, etc.
Insight 3
Awareness programs fail to produce the desired optimal behavior because they are not propagated through proper channels and target specific ages, gender, and community.
Communication materials are too ambiguous and don't communicate proper step-by-step prevention. Give them a sense of progress.
Opportunity Area
There is an opportunity to design communication strategies defined by its target audience and propagate through proper channels leaving no person/ kid behind
Insight 4
Rural Healthcare service on the ground does not function as per the given guidelines (2012) due to the varying context of Rural areas in India. One size fits all model fails to create the desired impact and foster positive optimal behavior in both staff & patients.
Opportunity Area
There is a need to relook and revamp the whole Rural Healthcare Model after detailed service and design audit. Government healthcare providers should act as a leader in society.
Insight 5
Due to no tangible Healthcare service touch points in the village tend to avoid consulting with ASHA/ ANM at their residence for Health related consultations because of social stigma and shyness. This results in infrequent visits to Healthcare facilities and people become more susceptible to illnesses.
