Even though the provision of public health services for mothers, children, and other vulnerable populations in rural areas represents an extraordinarily multimodal challenge, the question of who is responsible for the 'intentional design of these public health services' and how they must accomplish it is not often asked. We continue to lose innumerable mothers and children every day due to reasons that are mostly avoidable. There is a pressing need for radical innovation and rethinking of health services to save lives and ensure a higher quality of health and wellbeing for mothers and their children. While this may not be unique to Bihar, the state can form the converging point for a discussion on how design and innovation can contribute to the strengthening of the public health system. We can do much more to activate the 'unrealised' potential of a health and care ecosystem with newer possibilities of design, crowd-sourcing, open source technologies, open data, rapid product and service prototyping, and unconventional partnerships.

The Bihar Innovation Lab, a first-of-its-kind user-centered and systems design thinking led program run by Center for Knowledge Societies in collaboration with the Ananya Partnership (Bihar), has been formed with a vision to address this need - to 'design' health services and specific key components of their delivery. These components range from new products, tools and technologies, protocols, communications strategies, new services and service delivery mechanisms, and new systems for reaching out to patients, with a laser intention and purpose towards improving the health of mothers and their children.

Systems Innovation for Radically Improved Maternal and Child Health22nd August 2014, Vihara Innovation Campus, New Delhi

presentsA First-time Health Innovation Edition of Design Public

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Among the Lab's seminal pieces of work is a wide-ranging ethnographic study focused on identifying the critical junctures in the 1000-day window from the conception of a woman's pregnancy to her child turning two years of age, that have the maximum and most direct impact on the health and wellbeing of the mother and the child and within those junctures, prioritize those that are critical to the challenge of saving more lives, and where design intervention can lead to radical improvement in health outcomes.

Health ! Public is the platform where we will organize and present field data and myriad health innovation solution concepts that spark dialogue, innovation thinking, collaborative solutioneering, and live partnership building among key discussants for intense, fecund, and outcome-based health innovation dialogue.

We are looking to initiate dialogue and work closely, in the lead up to and on the day, with individuals and organizations that can bring to bear their expertise, perspectives, and resources to address these challenges with us. Following are some potentially high-impact concept solutions that we aim to design, develop, and prototype over the next three months and on the day of the conclave, ideally co-jointly with our partners.

Tools to generate an accurate health profiling and progression mapping of the pregnant woman and children to and enable the healthcare providers to provide appropriate, timely and tailored care

Low-cost diagnostics tools to track, record, and co-relate maternal health vitals: HB, BMI, nutritional status, BP and child health vitals: BMI, Head Circumference, Nutritional Status etc.

Action Tools, Checklists, Care Plans and Frameworks to aid evidence based medical decision making amongst Frontline Health Providers

Tools and Protocols to Ease and Automate the

Provision of Differential Care Even at Scale

A suite of maternity artefacts that inspire adoption and continuation of best health practices at the home i.e. nutrition plates that inspire healthy behaviour, breast feeding 'reminder' bottles, nutrition diurnal plans, recipe cards, diet diaries and kitchen budgeting tools for mothers, low cost infant warming 'swaddles' for hypothermic babies, etc.

Holisitic birth prepardness Tool for families and ASHAs that enables timely and effective labor mobilization including aspects of transportation and ready finances

A band of Barefoot Caregivers, Nutrionists and Behaviour change agents, comprising of Key Community Influencers, by leveraging upon their Social agency, Proximity to mothers and Capacity

Home based Patient health '1000 day information records' responding to information needs of the family in a colloquial and culturally resonant format

Nutrition Security: New local agriculture supply chain and community 'nutrition' kitchen entreprenuerial models for to supply and ensure routine availability of high nutrition foods for mothers for anemia, malnutrition, inadequate lactation etc.

1000 day care scheme': health financing programs, emergency mobilization and local transporation passes, and ancillary public utilities benefits

Neo-natal Care and Child Growth Tracking Aids and Protocol for ASHAs Routine Home Visits.

Collaboration models between PHCs, District Hospitals and Private Hospitals for patient information systems, smooth patient referral systems and advance preparedness, subsidized resource sharing and complimentary service strengthening.

Labor Mobilization Protocols for (rural care givers) ASHAs and Labor Management Tool for ANMs for High Birthing Volume Environments

Moving from a Public Health System to a 'Mother and Child'

centric Health and Well-being Ecosystem: Self,

Home, Community and Institution Based Care

across the 1000 day Window

Building Citizen Demand for Quality Services:

Creating Pressure Points for the System to Perform

Community Maternal Health Dashboards linked to real-time Community Controlled Audits, Ratings and Performance Tracking of Public Health Services, synced with VHSNCs

Text / Audio-blog feedback service for beneficiaries' sms based for anonymous grievance redressal and service direct feedback from workers, by repeatedly polling workers through their mobile phones.

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Building A Self Aware System: Evidence based

Decision Making and Creative Problem Solving

Capacity

Dynamically updated best MCH practices 'dashboard' for Block Health Managers and Frontline workers: that collates Local and Global Learnings for Quick Access to Solution Options and Rapid Piloting #ways to tackle anemia #ways to prevent eclampsia #ways to tackle malnutrition

Village / Block Qualitative Profiling Dashboards (that map Cultural or Attitudinal Resistance, Local health Vulnerabilities, Coverage, Health Outcomes, Emerging Phenomena etc.) and Data 'Sense-Making' Models for Stakeholders to create Context Responsive Service Strategy and Delivery

Seasonal System Strengthening Strategies to address Demand in Floods, Mobilize in Harvest Seasons, Reconfigure Resources in High Volume Birthing seasons, Align Specific Health Services around Migration and other Socio-Temporal Phenomena

Reflective and Free-Associative' Block and District Meetings and Micro-Innovations Bank

Community Health Needs - HR Skills Alignment framework for Human Resource Rationalization and Upskilling

Experiential Learning and Role-Play based Modules and Simulation Aids for Effective Front-line Healthworker Trainings.

Data Reporting, Performance Evaluation, Accountability, Incentive

Structures and Trust

A differential incentive system based on mobilization of and care for remote and vulnerable

beneficiaries; individual beneficiary centric incentive structures for FLWs spread more consistently

across the 1000 days based on qualitative parameters; community tracking linked to incentives

New 'Field Data Recording - Integrated, Accurate, Easy to Fill' Design (Datapoints and Formats)

that lead to better Medical Decision Making for a variety of Different Kind of Patients as Opposed

to just Reporting Compliance

Automated 'Service Transaction' based Reporting rather than Post Transaction Manual Reporting

Specific Service Components: Spaces,

Amenities, Experiences

Support Aids: Seating that enables postures for faster dilatation or reduced bleeding, ergonomic pillows to ease breathing in asphyxiated babies, home based kangaroo care cum breast feeding thermal wraps, infant body temperature management

Aids for best practices: aided external cephalic version, better oxygen support devices, medical equipment that self-flags dysfunction, birthing beds or contraptions that enable squatting births or support contraptions that allow for delayed cord cutting etc.

Health 'Ambience' and Patient Experience Design at Labor Waiting Rooms, Village Health, Sanitation and Nutrition Days and other service sites

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D-57, Chattarpur, 100 Feet Road, New Delhi

Expectation of the Day and How You Can Shape the Conversation

In order to solve the grand challenge of maternal and child health, it is necessary to foreground and explain the nature of challenges to existing as well as new, non obvious stakeholders, and then to engage in a constructive and productive ideation around how they might work together and curate resources, both financial and intellectual in order to overcome these challenges.

An outcome oriented conclave, Health!Public will consist of a series of intense theme based ideations sessions occurring simultaneously over the course of the day in order to keep solutioneering as detailed, focused and robust as possible. These 'ideation and path to reality' sessions will be led and moderated by public health experts from leading public health organizations and innovation specialists from the Bihar Innovation Lab and will provide stimulus, for co-designing system solutions, in the form of granular field findings, visceral data visualizations, strategic innovation directions and some concept level solutions.

The latter half of the day will consist of expert teams making brief but intense presentations of solutions for open evaluation, to drive forth consensus on their value, to seek resource, knowledge support Outcomes of the day will be summarized in an expert plenary and call to action towards creating strategic partnerships required to make the top rated high potential solutions a reality.

The Lab is now soliciting knowledge support and commitment to these high-impact solutions, from individual experts, organizations, and corporations that are interested in engaging thought leadership and driving health innovation. To explore participation and collaboration opportunities at the Health Public Conclave, please write to Priyanka Dubey, Program Operations Officer ( ). To register please write to Diwakar Rastogi, Outreach Officer priyanka.dubey@cks.in( ).diwakar.rastogi@cks.in

About Design Public

Over the past three years, Design Public has emerged as the premier location for highlevel conversations about the public role and social impact of design and innovation in India. It has attracted speakers and discussants from all regions of the world, from all estates of society and from diverse sectors of industry. Out of the conversations held here, many new realtime innovation initiatives and progams have emerged, including the Bihar Innovation Lab, the Adianta School for Leadership and Innovation, and most recently the Civic Innovation Lab. There has been wide coverage of the themes and ideas emerging from Design Public in the media and blogosphere, including in the New York Times, Economic Times, Times of India, and Mint Newspaper. High value participants in the past have included Arun Maira (Planning Commission), Sam Pitroda (National Innovation Council), Geoff Mulgan (NESTA, UK), Ashok Alexander (BMGF), Rohini Nilekani (Arghyam), Yamini Aiyer (Accountability Initiative), Ashwin Mahesh (Lok Satta Party), Samanth Subramanaian (Writer), Vish Palekar (Mahindra Group), Jeby Cherian (IBM), Riku Makela (Tekes, FI), among many others.

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