Improving healthcare support for rural communities in India

Lead Research Organisation: Cardiff Metropolitan University
Department Name: Cardiff School of Art and Design

Abstract

The main aim for the project will be to explore how a multidisciplinary partnership, bringing together user-led design skills with technical and medical expertise, can help improve healthcare support for rural communities in India. Currently, the number of health workers in rural India is below the minimum level recommended by the World Health Organisation (WHO). The WHO proposed several strategies to improve the resources for health in areas such as rural India including how to harness information and communication technology (ICT) more effectively, and how to build "greater resilience and self-reliance in communities". This project will explore how user-led design research methods such as 'design thinking' can be used to harness ICT more effectively to create new solutions that are culturally and contextually appropriate, affordable and effective.

Design thinking uses methods such as rapid ethnography to understand people's everyday lives including their behaviours, motivations, beliefs and values. Design thinking also uses fast prototyping of ideas and gaining feedback from end users and stakeholders. The aim of 'design thinking' is to generate several possible solutions that meet the needs of users, but are also technically feasible and economically viable.

The project is a collaboration between the Cardiff School of Art and Design at Cardiff Metropolitan University; the Schools of Engineering and Medicine at Amrita University, India; and the Centre for eHealth at the University of Agder, Norway. The project will also harness knowledge from key participants and stakeholders in India including healthcare workers, non-governmental organisations, governmental policy makers and technology companies.

The objectives for the project are to:
1. Understand and document the current situation and challenges faced in rural villages in India with regards to healthcare, including the cultural context.
2. Establish a multidisciplinary research network of international experts in the fields of user-led design, medicine, computer science and technology to share knowledge and exchange ideas in relation to healthcare support for the developing world.
3. Train researchers and health workers in India on how to employ user-led design research methods such as 'design thinking' to generate new ideas and possible solutions.
4. Run an interactive 'design thinking' workshop with key stakeholders and international experts to discover key challenges and opportunities; generate ideas for possible new solutions; and evaluate their potential benefits as well as their feasibility and viability.
5. Create a plan for developing possible solutions further, through future collaborative projects.
6. Disseminate findings from the project to the academic community, policy makers, the healthcare community in India, and technology companies.

The longer-term aim is to develop and deploy ideas generated from the research in several rural communities in India to improve their healthcare support. The plan is to use the insights gained from the project to apply for a large collaborative project grant.
The project will strengthen the capacity for research and innovation at Amrita University, Cardiff Metropolitan University and the University of Agder. In addition, the project will train volunteer health workers, and non-governmental agency workers, who are working with rural communities in India, in how to gain insights and generate new ideas to improve healthcare provision. Insights gained from the project will be shared and discussed with the National Rural Health Mission in India and the state government in Kerala, in relation to possible policy implications, and opportunities for further development. The project will also show how multidisciplinary networks, combining international and local expertise from a range of complementary fields, can be used to tackle very complex problems such as healthcare provision for rural communities in India.

Planned Impact

There will be several direct beneficiaries from the proposed multidisciplinary research project. These include healthcare workers, university researchers, non-governmental organisations working with rural communities in India, the rural communities themselves, policy makers and technology companies developing healthcare solutions for rural India. The project will also generate a range of new ideas for possible solutions to current healthcare problems identified during the research. The longer-term aim is to develop and deploy ideas generated from the research in several rural communities in India to improve their healthcare support. The plan is to use the insights gained from the project to apply for a large collaborative project grant.

The research project will enable the sharing of knowledge and the exchange of ideas between different disciplines and strengthen the international research networks for all project collaborators. The project will strengthen the capacity for research and innovation at Amrita University by sharing knowledge on how user-led design research methods, such as 'design thinking', can be used to understand the needs of people in rural communities in India as well as the needs of key stakeholders in the healthcare provision, and then how to translate those insights into viable and feasible solutions. Other international experts will also share their knowledge on how to design and develop remote healthcare systems, and how other developing countries are tackling healthcare challenges. In addition, the research project will train volunteer health workers, and non-governmental agency workers, who are working with rural communities, in how to gain insights and generate new ideas to improve healthcare provision.

The project will show how multidisciplinary networks, combining international and local expertise from a range of complementary fields, can be used to tackle very complex problems such as healthcare provision in the rural communities of India, particularly when they are structured around an effective innovation process such as 'design thinking'. The research project will also strengthen the capacity for research and innovation at Cardiff Metropolitan University and the University of Agder in Norway as they will gain important insights into the challenges faced by rural communities and health workers in India; gain a deeper understanding of how to further improve design thinking methodologies; and discover new challenges that need further research and development.

All material generated from the project will be made publicly available online. This includes insights gained from the research including the current challenges faced by rural communities in India, policy implications, ideas for new healthcare solutions and training resources from the innovation workshops. Material will also be translated into Malayalam and Tamil so that local groups can use the information more easily. Insights gained from the project will be shared and discussed with the National Rural Health Mission in India and the state government in Kerala, in relation to possible policy implications, and opportunities for further development.

Other indirect beneficiaries from the research are organisations in the UK, India and Norway (and beyond) working in international development, including researchers, policy makers, non-governmental organisations, healthcare providers and technology companies. All collaborative partners will use their extensive networks to share the findings from the research project at various networking events and discuss the wider implications for other research projects and collaborations. Work from the project will also be published in internationally peer-reviewed articles.

Publications

10 25 50
 
Description The project has had four main achievements:
1. New knowledge generated: The project has enabled a deeper understanding, by all project participants, of the cultural and linguistic diversity of rural communities in the states of Kerala and Tamil Nadu, particularly indigenous communities, and the impact that has on their healthcare and livelihood needs. In addition, the project has helped provide a deeper appreciation of the value system of indigenous communities in Kerala and Tamil Nadu. As a result, the project has identified key new projects to develop in the short term to help improve the healthcare of the indigenous communities of Kerala and Tamil Nadu.
2. Increased research capability: The project has increased the research capability and skills of key practitioners and researchers working with indigenous communities in Kerala and Tamil Nadu, in terms of gaining an understanding of the importance of using 'design thinking' methods; the importance of forming multidisciplinary teams; and in how to practically apply these design thinking methods to improve the healthcare support for the indigenous communities. Key practitioners and researchers trained in the project include staff and students from Amrita Vishwa Vidyapeetham, covering areas such as engineering, social science and agriculture; doctors, healthcare workers and other staff from Amrita SeRVe (a non-governmental organization in India set up to help rural communities develop the skills they need to be prosperous and self-reliant); and doctors and medical students from Amrita Institute of Medical Sciences (AIMS). It is important to note that members from the indigenous communities themselves were also trained in how to use these design thinking methods.
3. Improved research methods: By applying the design thinking research methods throughout the project, key insights were gained on important factors to consider when working with indigenous communities in India. These insights have been documented and will be presented at the AHRC Indigenous Methods workshop in Brazil in March 2019.
4. New networks established: Several new networks were formed as a result of the project. The main new network including Cardiff Metropolitan University (with its skills in user-led design methods); the Department of Electronics and Communication Engineering and the Amrita Institute of Medical Sciences at Amrita Vishwa Vidyapeetham; the non-governmental organization Amrita SeRVe; the Amrita Kripa Charitable Hospital in Kerala; and the Centre for eHealth at Agder University in Norway. Other networks were also formed with commercial organisations in India, such as Tata Consulting Services (https://www.tcs.com/) and Lattice (https://www.thelattice.in/) who are interested in helping to develop the clinical solutions needed. In addition, key connections were made with policy makers in government at the state level in Kerala and at the national level in Delhi to explore how best to move forward with the project.
Exploitation Route The multidisciplinary team plans to work towards the following objectives moving forward:
1. Develop solutions for how to take the speciality healthcare to rural communities.
2. Develop tools for empowering healthcare workers, based in the rural villages, to screen villagers for healthcare problems.
3. Creation of a technology platform to allow the sharing of best practice, in terms of supporting healthcare and well-being, between rural communities.

For objectives 1 and 2, it is planned to engage with the leading industries in India working on the development of healthcare solutions. This work initially started during the project workshops and has since continued with further detailed discussion and planning. The new solutions developed will be based on a new eHealth framework. The new eHealth framework has been designed based on the needs of the healthcare infrastructure of Amrita Institute of Medical Sciences, the needs of primary care and specialist doctors at Amrita, and critically, on the needs of rural communities in Kerala.

In addition, the team will share their insights and knowledge of working with indigenous communities at a four day international seminar event about Indigenous Engagement, Research Partnerships, and Knowledge Mobilisation from Tuesday 19th-Friday 22nd March 2019, to be held in Rio de Janeiro, Brazil. The intention of the four-day seminar is to provide a better understanding of current research practice (including challenges and uncertainties) in this area and in turn identify areas where good practice is established or additional work is required. The broader aim is to ultimately help to shape and guide research practice within the broader cross disciplinary research community and funding ecosystem.
Sectors Agriculture, Food and Drink,Communities and Social Services/Policy,Creative Economy,Digital/Communication/Information Technologies (including Software),Education,Environment,Healthcare,Culture, Heritage, Museums and Collections

URL http://www.indiaruralhealthcareproject.org/
 
Description The findings developed from the research networking project are being used in several ways. Firstly, a new multidisciplinary team has been established, including Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences; Amrita SeRVe; Amrita Kripa Charitable Hospital and key technology companies, to develop new eHealth solutions for, and in collaboration with, indigenous communities in Kerala and Tamil Nadu. The social, health and economic impact of these new eHealth solutions will be shared at a later date. However an immediate impact has been the inclusion of indigenous communities themselves in helping to set the agenda and plans for their healthcare needs. Another immediate impact has been a new initiative started by one of the indigenous communities involved in the research project (from the Wayanad district of Kerala), where they have leased land near to their village (with the help of the healthcare worker supporting the village) to start farming. This initiative came from ideas and best practice shared in the workshops. The reasons for starting the farming activity was threefold: 1) to create income for the villagers; 2) to give them a sense of purpose, as many of the male villagers were unemployed; and 3) to indirectly help improve their health and well being. Studies in another village had found that alcoholism and malnutrition reduced significantly when they introduced such activities (with malnutrition and alcoholism being two of the major health problems in the tribal communities in Wayanad).
First Year Of Impact 2018
Sector Agriculture, Food and Drink,Education,Healthcare
Impact Types Cultural,Societal,Economic

 
Description Design Thnking Training Course for Amrita Vishwa Vidyapeetham
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Key staff working to improve the healthcare of rural communities in the states of Kerala and Tamil Nadu in India, gained training on how to apply user-led design research methods, such as design thinking to better understand: the current healthcare challenges in rural communities (particularly indigenous communities); the impact of culture, infrastructure and other factors on their healthcare; and to generate new solutions that are desirable, feasible and viable. The training also helped participants realise the importance of multidisciplinary collaboration to effective address all the challenges.
 
Description RCUK Indigenous Methods Case Study award
Amount £4,958 (GBP)
Funding ID AH/R003882/1 
Organisation Arts & Humanities Research Council (AHRC) 
Sector Public
Country United Kingdom
Start 09/2018 
End 03/2019
 
Title Design Thinking Research Tools 
Description The main research method used for the project, 'design thinking', is not new to the design community, but was new to Amrita Vishwa Vidyapeetham and other key groups in India involved in the project. Therefore this project established a new way for conducting collaborative research at Amrita Vishwa Vidyapeetham. Design thinking is a user-led design research methodology that uses methods that stem from anthropology, such as rapid ethnography, to understand people's everyday lives including their behaviours, motivations, desires, beliefs and values. Rapid ethnography is also used to describe what meanings people place on objects, products, services, cultures, events and histories; and to describe how objects, products and services are used. In addition to understanding people's everyday lives, design thinking is also about the fast prototyping of ideas and gaining feedback from end users and stakeholders. Design thinking demands multi-disciplinary collaboration to gain a range of perspectives and insights. The aim of the 'design thinking' process is to generate a number of possible solutions that meet the needs of users, but are also technically feasible and economically viable. It is important to note that the application of the design thinking research methodology throughout the project highlighted new insights in terms of key factors to consider when working with indigenuous communities in India. These insights have been documented and will be presented at the Indigeous Methods workshop, organised by the AHRC, in Brazil in March 2019. 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact The main impacts from the use of design thinking in this project are: 1. The gaining of an understanding on the current situation and challenges faced in rural villages in India with regards to healthcare, including the cultural context. 2. The formation of a multidisciplinary research network of international experts in the fields of user-led design, medicine, computer science and technology to share knowledge and exchange ideas in relation to healthcare support for the developing world. 3. The training of researchers and health workers in India on how to employ user-led design research methods such as 'design thinking' to generate new ideas and possible solutions. 4. The generation of ideas for possible new solutions; and an evaluation of their potential benefits as well as their feasibility and viability. 
URL https://www.ideo.org/
 
Description Healthcare support for rural communities in India 
Organisation Amrita Vishwa Vidyapeetham University
PI Contribution Our contribution was to help Amrita Vishwa Vidyapeetham understand how user-led design research methodologies, such as design thinking, can be used to help design culturally and contextually appropriate healthcare solutions for rural communities in India. Design thinking is a user-led design research methodology that tries to gain a deeper understanding of the role of culture and context in the design and use of products and services. Design thinking uses methods that stem from anthropology, such as rapid ethnography, to understand people's everyday lives including their behaviours, motivations, desires, beliefs and values. Rapid ethnography is also used to describe what meanings people place on objects, products, services, cultures, events and histories; and to describe how objects, products and services are used. In addition to understanding people's everyday lives, design thinking is also about the fast prototyping of ideas and gaining feedback from end users and stakeholders so that the resultant solutions are appropriate, usable and effective. Design thinking demands multidisciplinary collaboration to gain a range of perspectives and insights. The aim of 'design thinking' is to generate a number of possible solutions that meet the needs of users, but are also technically feasible and economically viable. We have been undertaking internationally leading user-led design research for over two decades for blue chip companies such as Apple, Ericsson and Samsung to help in the design of new technology products. We also have half a decade of experience in developing healthcare solutions in developing countries using 'design thinking' approaches (including Malawi, Zambia and Namibia) in collaboration with the School of Medicine at Cardiff University. One of our main contributions to the partnership, through the AHRC project on 'improving healthcare support for rural communities in India', was to provide training on how to use design thinking methods to help generate new and appropriate solutions for rural communities in India (with a particular focus on indigenous communities in the Kerala state of India). Training was delivered to members of the indigenous communities themselves, as well as healthcare workers, doctors, academics, students, commercial companies and policy makers.
Collaborator Contribution The Department of Electronics and Communication Engineering (DECE) at Amrita School of Engineering, Coimbatore, India has been leading research together with the Amrita Institute of Medical Sciences (AIMS), Kochi and Amrita Kripa Charitable Hospital, Wayanad in how to improve the sustainable health and well-being of rural communities in India. They have also been exploring how information and communication technologies (ICT) could be used to assist the community health volunteers, for example through the use of intelligent mobile based ICT systems, or by connecting to doctors in neighbouring clinics or specialist hospitals in the urban cities. In this project they provided key technical and medical expertise, as well as sharing the knowledge and experience of working with rural communities in India through their collaboration with the non-governmental organization Amrita SeRVe. In addition, they had access to, and strong relationships with, volunteer healthcare workers working in rural communities, as well access to the communities themselves. Amrita organised visits to four rural communities as part of the project, and also helped organise two key workshops ran during the project. They also had links with industry and government officials to explore the business and policy implications of ideas generated from the project.
Impact 1. Understood and documented the current situation and challenges faced in rural villages in India with regards to healthcare, including the cultural context. 2. Established a multidisciplinary research network of international experts in the fields of user-led design, medicine, computer science and technology to share knowledge and exchange ideas in relation to healthcare support for the developing world. 3. Trained researchers and health workers in India on how to employ user-led design research methods such as 'design thinking' to generate new ideas and possible solutions. 4. Ran an interactive 'design thinking' workshop with key stakeholders and international experts to discover key challenges and opportunities; generate ideas for possible new solutions; and evaluate their potential benefits as well as their feasibility and viability. 5. Created a plan for developing possible solutions further, through future collaborative projects. 6. Disseminated findings from the project to the academic community, policy makers and the healthcare community in India, as well as other key groups such as technology companies.
Start Year 2017
 
Description eHealth and user-centred design 
Organisation University of Agder
Country Norway 
Sector Academic/University 
PI Contribution We have been working with the Centre for eHealth at the University of Agder for several years in relation to applying user-centred design methods to the design and development of new eHealth solutions. This has included tools for the rapid prototyping of new solutions as well as ways in which new concepts and prototypes can be tested and evaluated duing the design and development process. In the context of the AHRC project on 'improving healthcare support for rural communities in India', we linked up the team at the Centre for eHealth with the team at Amrita Vishwa Vidyapeetham and led the collaborative project, sharing insights on the healthcare needs, challenges and opportunities of rural communities in India.
Collaborator Contribution The Centre for eHealth and Care Technology at the University of Agder in Norway are internationally leading experts in remote healthcare solutions covering aspects of user-centred design and technology research and have successfully deployed mobile health solutions across Norway in collaboration with local health authorities. In the boarder collaboration with us, they have shared their knowledge, techniques and user-centred design methodologies for designing and developing new eHealth solutions. They have also shared their experience of the practical implementation of such systems in Norway. During the AHRC project on 'improving healthcare support for rural communities in India' they shared their knowledge with Amrita (and us) and also participated in all the main workshops during the project, sharing their knowledge and expertise in eHealth and user-centred design with all the other participants. This helped to shape what eHealth solutions would be feasible and viable during our discussions.
Impact 1. Established a multidisciplinary research network of international experts in the fields of user-led design, medicine, computer science and technology to share knowledge and exchange ideas in relation to healthcare support for the developing world. 2. Trained researchers and health workers in India on how to employ user-led design research methods such as 'design thinking' to generate new ideas and possible solutions. 3. Ran an interactive 'design thinking' workshop with key stakeholders and international experts to discover key challenges and opportunities; generate ideas for possible new solutions; and evaluate their potential benefits as well as their feasibility and viability. 4. Created a plan for developing possible solutions further, through future collaborative projects.
Start Year 2017
 
Description Creative Thinking and User Centred Design workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The two-day interactive 'design thinking' workshop involved 30 participants and was held at the campus of Amrita Vishwa Vidyapeetham, Coimbatore, India in May 2018. The focus of the workshop was to train staff and students from Amrita Vishwa Vidyapeetham, and healthcare workers from Amrita SeRVe, in how to use 'design thinking' methods and techniques for idea generation and exploration. The workshop covered methodologies for user insight such as rapid ethnography, including techniques in observation, participation and semi-structured interviews; methodologies for idea generation including participatory design and brainstorming techniques; and methodologies, techniques and tools for fast prototyping and user testing. Participants also practiced these methods and techniques during the workshop by applying them to a healthcare challenge.
Year(s) Of Engagement Activity 2018
URL http://www.indiaruralhealthcareproject.org/workshops/
 
Description Design Research for Change Showcase at London Design Fair 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Our project work on 'Improving healthcare support for rural communities in India' was part of the 'Design Research for Change' showcase at the London Design Fair in September 2018. The showcase presented a range of projects funded by the Arts and Humanities Research Council over the last few years that applied design-led approaches to challenges faced in society.
Year(s) Of Engagement Activity 2018
URL https://www.designresearchforchange.co.uk/showcase/
 
Description International Workshop on Rural Healthcare in India 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The two-day interactive 'idea generation' workshop involved 30 participants and took place at Amrita Vishwa Vidyapeetham in Coimbatore, India. The aim of the two-day workshop was to highlight key challenges and opportunities with regards to healthcare support in rural India; to generate ideas for possible new solutions; and to evaluate their potential benefits as well as their feasibility and viability. Participants at the two-day workshop included doctors; researchers at Amrita Vishwa Vidyapeetham; representatives from leading technology companies in India who are developing healthcare solutions; staff from Amrita SeRVe; government advisors; and representatives from Cardiff Metropolitan University and the University of Agder.
Year(s) Of Engagement Activity 2018
URL http://www.indiaruralhealthcareproject.org/workshops/