Proposed solution for the Records for Life contest 2013 by the Bill and Melinda Gates Foundation. Focus is on improving the experience of the primary user of the health card: the Health Worker.

1. 1
The Mother Child Health Card
(MCH Card)
A prototype proposal for the Records for Life contest
Team
Mridu Mehta • Rahul Abhisek • Valtteri Wikström
Aalto University

2. 2
Introduction
04 • The Public Health Care System
05 • Stakeholders in RI System
06 • ANM’s Responsibilities
07 • Target Location: Bihar & Gujarat
08 • Health Records Researched
OUR PROPOSAL: MCH Card
11 • MCH and Due Date card
13 • Prototype Features
16 • Prototype Layout Design
19 • Flow of information
21 • Design Decisions
22 • Prototype
use case scenarios
34 • Pregnant Mother: Registration
in Village
35 • Pregnant Mother: 1st Visit and
Registration at Local Health Centre
36 • Pregnant Mother: Repeat Visit for ANC
37 • Child delivered: Birth Registration
and 1st vaccination
38 • Child : Repeat Visit for Vaccination
BACKGROUND
RESEARCH ANALYSIS
40 • Basis for Findings Analysis
41 • Field Visits Conclusions
42 • Analysis: Information Sets
43 • Reduced Number
of Fields for Data Entry
45 • Interviews
47 • Field Observations Interviews
51 • Initial Prototypes: For Field Testing
56 • Abbreviations
Contents

3. 3
Introduction

4. 4
Public health care services in
India are delivered through a
well-established network of
health care centres.
In rural areas, Primary Health
Centres (PHCs) / Commu-
nity Health Centres (CHCs)
are responsible for providing
basic health services related
to Antenatal Care and Immu-
nization to citizens who may
not have regular access to
medical facilities.
In urban areas, Urban Health
Centres / Community Health
Centres (CHCs) provide the
same services.
These health care activities
are carried out by frontline
health workers namely ANM
(Auxiliary Nurse Midwife),
ASHA (Accredited Social
Health Activist) AWW (An-
ganwadi Worker) at the com-
munity level.
These field workers travel
through the communities dis-
pensing health care solutions
and form the crucial back-
bone of India’s health care
delivery mechanism.
The Public Health Care System

5. 5
Stakeholders IN RI SYSTEM
Mother
FATHER
VILLAGE HEALTH CENTRE
RELATIVES
/FAMILY
ANM
CHILD
AWW
DOCTOR
SURVEYOR
/FOUNDATIONS
/NGOs
ASHA
DATA
OPERATOR

6. 6
Functional Areas
• Vaccines Administering
• Ante Natal , Post Natal care and
registering
• Family Planning Awareness
• Categorization of Couple about
to be married
• AIDS awareness
• Mobilize Recipients
• Refer difficult labor case to
District hospital
• Rendering advise regarding
health and food habits
• Distribution
• Folic Acid to pregnant women
• Vit A tablets for babies
• Vit B12 syrups
• Iron and ORS tablets
• Contraceptives
• Bleaching Powder
• Prescribing
• Paracetamol
• Glycodine
• Momentazol
• Antibiotics
ANM’s RESPONSIBILITIES
ANM is the primary provider of the RI and ANC services but she is overloaded with work.
Therefore the design of the health record needs to be as simple as possible.
Detailed Activities
while in Course
• Scheduled vaccines to be
administered
• Basic medicine course (fever,
cough cold, swelling)
• Body positions
• Syringe disposal
• bed making
• First Aid
• Hygiene
• Emergency Accidental Cases
• Assisting Deliveries
• AIDS Awareness
Report Structure
Reports to
• LHV
• MOIC or Educator
• CDPO
• Cold Chain
Supervision by
• MOIC
• DIO
• ACMO
• Supervisor
Co-Ordinates with
• Computer Operator
• AWW
• ASHA
• Village Mukhiya
• Cold Chain
• Courier Boy/Helper
• Commute source
Public Interface
Meetings
• Mahila Divas
• ASHA Divas
• ANM Meeting
• Micro Plan Meeting
Training sessions
• AIDS
• Immunization Practices
• Record keeping, if new register
introduced
Administration
Data Keeping
• Immunization tally sheet
• MCH Register
• Ante-Natal Register
• Out Door Register
• Mala D and Copper T register
• Stock Register
• Cold Chain register*
• Courier register
• Survey Register
• Advance Program register
Reports
• Monthly/Weekly report - AEFI
register
• Daily/Yearly vaccine
consumptions
• MCH (Mother Child Health)
report
Supervision and Approval
• Tuberculosis Report
• Leprosy report
Create Microplan

7. 7
Our team member Rahul Abhisek
worked with Center for Knowledge
Societies, New Delhi conducting ethno-
graphic research on Routine Immuniza-
tion in Bihar, India in 2009-2010.*
Building our current process with
this foundation, further research was
conducted in mid-2013 in district Kis-
hanganj, Bihar and Ahmedabad, Gujarat
* Have a look at the BMGF funded report: the Vaccine
Delivery Innovation Report here.
.
Immunization coverage of Bihar and Gujarat in India
http://planning.bih.nic.in/Ppts/PR-05-02-12-2009.pdf
www.gujhealth.gov.in/images/pdf/routine_immunization_in_gujarat.pdf
TARGET LOCATION: BIHAR GUJARAT
The design of our prototype is targeted at these regions
INDIA
Bihar
53.8 %
Gujarat
73.2 %

8. 8
HEALTH RECORDS RESEARCHED
The information flow and
design of our prototype has
been informed by the existing
health records maintained in
Bihar and Gujarat.
Desk research on records in
other countries (as provided
by the contest guide) was also
conducted.
LEFT: Mother and Child Health Record from Bihar
ABOVE: Mamta Card from Gujarat

9. 9
Our proposal:
MCH Card

10. 10
PROPOSED SOLUTION
MCH Card + Due Date Cards
+
Ma, please get
me vaccinated on
Ma, please get
me vaccinated on
Your next
checkup
is on
ANC Due Date Card
RI Due Date Card

11. 11
DUE DATE CARDS
LEFT
ANC Due Date
RIGHT
RI Due Date
Card sheets for ANM to write
due date, tear off and insert in
pocket of MCH card cover.
The ANM will be required to
carry these during her visits.

12. 12
VALUE OF MCH CARD
We think that the card designed
like a passport will be treated
more as an official document,
and the caregivers will therefore
keep it in better shape.
COMPACT
Easy to carry around
Easy to maintain
The hard plastic cover and
weather proof papers are
unaffected by water and other
environmental factors.
Long lasting
The design will also prolong the
life of the card to the required
5-6 years of active usage.
PROTOTYPE: MCH CARD
Designed to look like a passport: Increase value and care of card by users
RESISTANT TO WEAR AND TEAR
It is also better protected from
careless usage by caregivers/their
families as they cannot roll it or
fold it. The design is resistant to
tearing.

13. 13
PROTOTYPE: MCH CARD
Features
BINDING
Centre Sewing
Cover
Soft hard cover,
vinyl pasting +
knurling
SIZE
CLOSED SIZE
3.5 x 4.9 in
Open Size
7 x 4.9 in
Edges rounded
to reduce wear
and tear and
avoid dog ears
Transparent plastic
pouch to hold and
protect Due Date
card
Gold embossed
lettering to give
look and feel of
importance

14. 14
PROTOTYPE: MCH CARD
Features
Form of booklet is
compact and strong.
The materials are
weather proof.
SUGGESTED PAPER
OPTIONS
• Stone Paper
• All Weather Paper
PAPER THICKNESS
150 GSM
Number of spreads: 7
WEATHER PROOF PAPERS
STONE PAPER
• Anti-moth
• Tear-resistant
• Safe soft
• Water grease resistant
• Annotate with ink, felt tip, ball pens
• Recyclable
• Professional Print Quality
• Printer friendly
• Used in stationery, bags, packaging,
adhesives, containers etc.
All Weather Paper
• Tear and Puncture resistant
• Waterproof
• Professional Print Quality
• Printer friendly
• Annotate with ink, felt tip pens
• Used for maps, signs, notepads for
travellers and mariners, banners,
product labels and barcode labels

15. 15
PROTOTYPE LAYOUT DESIGN
Look and Feel
Minimal and clean
Soft colour and rounded edges of
card suggest mother and child care
Focus on easy and efficient:
• Information recording
• Accessing information
Child’s Passport
photograph
Mother’s Passport
photograph
Father’s Name
Mother’s Name Age
Home Address/Village
Change in Address
Phone Number
FAMILY IDENTIFICATION
CHILD’S BIRTH RECORD
MOTHER’S PREGNANCY RECORD
Last delivery conducted at
Mother’s MCTS Number
No. of pregnancies No. of previous live births
Date of last menstrual period
Date of expected delivery
Date of Birth
Child’s Name
Weight at Birth
Child’s MCTS Number
Girl Boy
Institution Home

16. 16
PROTOTYPE LAYOUT DESIGN
Colour Palette
PRIMARY COLOURS SUPPORTING COLOURS
MCH DARK PINK
CMYK 0,60,0, 25
USAGE
Body Text
Display Text (Headings)
MCH LIGHT PINK
CMYK 0,60,0, 25 / TINT 20%
USAGE AS BACKGROUND COLOUR
Tables
Check boxes
MCH PALE YELLOW
CMYK 0,0,100, 0 / TINT 10%
USAGE ACCENT COLOUR
MCH cover
shade of dark maroon
MCH gold
USAGE
Lettering
MCH GREY
CMYK 0,0,0, 70
USAGE
Text

17. 17
PROTOTYPE LAYOUT DESIGN
Typography
DUE DATE VACCINE
DATE
ADMINISTERED
BIRTH
☐ BCG
☐ HepB
☐ OPV 0
1.5 MONTHS
☐ Penta 1
☐ OPV 2
2.5 MONTHS
☐ Penta 2
☐ OPV 3
3 MONTHS ☐ BCG
(Repeat dose
if no scar)
3.5 MONTHS
☐ Penta 3
☐ OPV 4
6 MONTHS
☐ Folic Acid
☐ Iron Tablet
☐ Vit A
VACCINATION AND SUPPLEMENT SCHEDULE
Notes
Univers Font Designer:
Adrian Frutiger
The font Univers is one of
the greatest typographic
achievements of the second
half of the 20th century.
The clear, objective forms of
Univers make this a legible
font suitable for almost any
typographic need.
Univers has been employed
in numerous applications in-
cluding corporate branding,
signage, maps, standardized
testing and consumer elec-
tronics devices.
The Univers font family suits the
needs of the MCH card because:
• It is highly legible at small sizes
• Functions well across all paper
types
• Versatile font that is legible
irrespective of printing technol-
ogy used
Didot is an elegant modern
serif typeface
COVER
Didot bold
Type size
18 pt
INSIDE PAGES
Univers 55 Roman
Univers 65 Bold
Univers 75 Black
Type size
7 pt for all text

18. 18
FLOW OF INFORMATION IN PROTOTYPE
Designed to match the sequence of recording process as conducted on field
cover
Due Date
BACK
cover
1
Introduction
and instructions
for Mother
2
Notes
•
Institutional Identification
8
Notes
5
After Delivery Check Up
•
Notes
4
Ante Natal Check Up
•
Notes
67
Vaccine and Supplements
Schedule
•
Additional Vaccines
3
Family identification
•
Mother’s Pregnancy Record
•
Child’s Birth Record
The only exception
is the Child’s Birth
Record which is
placed along with
Identification infor-
mation on spread 3,
instead of following
After Delivery Check
Up information. This
has been done to
ensure all identifica-
tion related infor-
mation

19. 19
FLOW OF INFORMATION IN PROTOTYPE

20. 20
DESIGN DECISIONS
For Information/Content
Minimal Illustrations
(Only used for Due Date card targeted at
caregivers)
The card’s primary user, the ANM is
literate and illustrations are unnecessary
to her task of record keeping
VALUE FOR Caregivers
MCH card designed for minimal
engagement with caregivers. Caregivers
prefer other mediums of communication
like TV, radio, verbal training sessions
to learn about and act on health care
information. (Please refer to slide for
research that validates this)
Design FEATURES
• Clarity in recording data
• Ease in accessing data by
secondary users
• Integrating with other
stakeholders
• Minimal critical Information
fields for data recording
• Ease in updating
• Information fields not being
currently recorded have been
eliminated
Primary User: ANM
• Responsible for main-
taining the records in
the MCH card.
• She conducts the
check ups on mother
and child and admin-
isters vaccines
Secondary Users
The data recorded is
useful to:
• MCTS
• Caregiver
• Doctor/Health Care
provider
• Surveyor
• Policy Makers
• NGOs Foundations

21. 21
Mothers!
This booklet is the main record of you and
your child’s health starting from pregnancy
to age 5 of the child.
Carry it whenever you visit
• A local health centre
• A Doctor
• A Hospital
• Any other health care provider
You may be asked to furnish this booklet
• By your local health worker during
visits to you or your village
• By Surveyors and government officials
• During vaccination drives at your village
YOUR HEALTH CARD IS IMPORTANT.
TAKE CARE OF IT AND KEEP IT IN A SAFE
PLACE WITH YOUR VALUABLES.
PROTOTYPE
SPREAD 1: Introduction and instructions for Mother
The information on
this page establishes
the value of the card
for caregivers and
instructs them on
how to use it.
It will need to be
verbally communi-
cated by the ANM
to illiterate mothers.

22. 22
USAGE OF Mamta Card
Informs design of spread 2 our prototype
The front page of this
example contains data
records of the moth-
er’s antenatal check
up. This ANM seems
to have abandoned
the use of the inside
information fields for
the ease of writing
and accessing all the
information from the
front page itself.
Idea for prototype:
Include Notes in
the beginning for
extra information
and ease of access
for ANM

23. 23
AWW Name
ASHA Name
Anganwadi Centre / Block
ANM Name
AWW Phone Number
ASHA Phone Number
ANM Phone Number
INSTITUTIONAL IDENTIFICATION
SHC / Clinic
Hospital / FRU
Primary Health Centre / Town
NOTES
PROTOTYPE
SPREAD 2: Notes and Institutional Identification
The phone numbers
of all the health
workers can be
easily accessed by
the mother in case
of need.
Our field research
showed that
institutional
identification
information is not
rigorously filled by
ANMs. Placing it
at the beginning
with a clean and
clear design should
increase its usage.
Space for notes
have been included
in the beginning
of the card, as well
as in other places.
Studying the usage
patterns of health
workers during field
research indicates
that there is a need
for custom notation
on the RI card.
(Refer previous slide)

24. 24
PROTOTYPE
SPREAD 3: Family Identification, Mother’s Pregnancy Record, Child’s Birth Record
The Mother and
Child’s MCTS number
The MCTS ID
numbers, as well
as demographic
information are
used to identify the
mother and child.
Including different
kinds of identifying
information, such
as the MCTS id
number, name,
address and phone
number supports
the identification of
persons by health
workers, hospitals and
surveyors.
Father’s Name
Mother’s Name Age
Home Address/Village
Change in Address
Phone Number
FAMILY IDENTIFICATION
CHILD’S BIRTH RECORD
MOTHER’S PREGNANCY RECORD
Last delivery conducted at
Mother’s MCTS Number
No. of pregnancies No. of previous live births
Date of last menstrual period
Date of expected delivery
Date of Birth
Child’s Name
Weight at Birth
Child’s MCTS Number
Girl Boy
Institution Home
3.467 kgs

25. 25
Left Page: Ante Natal Care records of a mother who has
delivered the night before this photograph was taken
Right Page, Above: Space for notes.
Below: Care during pregnancy
This ANM seems to
have abandoned the
use of the Ante Natal
Care table and de-
signed her own table
in the notes section
on the right.
Idea for prototype:
Our design of the
ANC is directly
inspired by this
example. This
ANM has avoided
the unnecessary
repetition in re-
cording dates per
visit
USAGE OF Mamta Card
Informs design of ANC in our prototype

26. 26
PROTOTYPE
SPREAD 4: Ante Natal Check Up
The included ante
natal check up tests
have been reduced
from the current
Bihar RI card based
on field research
of what tests are
practical for the
ANM to carry out
on field/in the local
health centre.
The organisation of
the information has
been informed by
the usage patterns
seen on field. (Refer
previous slide)
VISIT
DATE
POG
(WEEKS)
WEIGHT
(KG)
PULSE
BLOOD
PRESSURE
urine
ALBUMIN
ANTE NATAL CHECK UP
26/2/13
Notes
urine
SUGAR
HAEMO-
GLOBIN
IRON
TABLETS
T.T
(Y/N)
PALLOR
(Y/N)
OEDEMA
(Y/N)
JAUNDICE
(Y/N)

27. 27
PROTOTYPE
SPREAD 5: After Delivery Check Up and Notes
Space for notes
provided for
complications,
doctor referrals,
tracking patient
medication in case
of problems etc.
If at institution, period of stay post delivery
Cried immediately after birth
Initiated exclusive breast feeding within 1 hour of birth
Type of delivery
after delivery check up
Term
Preterm
C-Section
Normal
Institutional
No
No
Yes
Yes
Complications, if any
Place of delivery
Institution Home
NOTES

28. 28
Section of the Vaccination Schedule
Good example of how the current design of the
card has unnecessary repetition of information
fields that need to be filled by the ANM.
ANM has filled in date of administration only
once for the 3 doses given to the child at birth.
The due date, (in this case date of birth) has also
not been recorded. This is probably because it is
already recorded on the front page.
This schedule is an older design which does
not include the newly introduced Pentavalent
vaccines. The ANM has crossed out the older
vaccines and handwritten pentavalent in the
margins.
There appears to be an error here in recording
of the due date for the Pentavalent vaccine at
1.5 months.
USAGE OF Mamta Card
Informs design of vaccination schedule in our prototype

29. 29
PROTOTYPE
SPREAD 6: Vaccination and Supplement Schedule
The vaccination
schedule is based
on the pentavalent
vaccine schedule
introduced in
Gujarat and is
recommended
for national
scale up by the
National Technical
Advisory Group
on Immunisation
(NTGAI) India, in
2008.
The vaccination
record has been
structured to
eliminate repeated
date entry and
to keep the
chronological
organisation
of information
consistent. (Refer
previous slide)
Repeat BCG dose
highlighted as a
reminder for the
ANM and caregivers.
There is no field to
record and track
this repeat dose
in current health
records.
VACCINATION AND SUPPLEMENT SCHEDULE
DUE DATE Vaccine
Date
Administered
9-12 Months
☐ Measles
☐ Vit A
☐ Deworming
18 months
☐ DPT Booster
☐ OPV Booster
☐ MMR 2
☐ Vit A
☐ Deworming
24 months
☐ Vit A
30 months
☐ Vit A
36 months
☐ Vit A
DUE DATE Vaccine
Date
Administered
Birth
☐ BCG
☐ HepB
☐ OPV 0
1.5 MONTHS
☐ Penta 1
☐ OPV 2
2.5 MONTHS
☐ Penta 2
☐ OPV 3
3 MONTHS ☐ BCG
(Repeat dose
if no scar)
3.5 MONTHS
☐ Penta 3
☐ OPV 4
6 Months
☐ Folic Acid
☐ Iron Tablet
☐ Vit A
VACCINATION AND SUPPLEMENT SCHEDULE
15/10/13 15/10/13
Notes

30. 30
Vaccination Schedule in Hindi
Supplements like Folic Acid and Iron tablets
along with medicines for deworming have been
added as side notes. There is no place to record
their administration to the child.
DESIGN OF BIHAR RI Card
Informs design of vaccination schedule in our prototype

31. 31
PROTOTYPE
SPREAD 7: Vaccination and Supplements Schedule + Additional Vaccination
Space has been
included for
out of schedule
vaccinations, and
to accommodate
schedule changes
by the state.
Supplements like
Vitamin A, Folic Acid
and Iron Tablet have
been given the same
importance as the
vaccines by placing
them sequentially
in the vaccine
schedule. This has
been done to ensure
all doses necessary
for the Child’s
survival and good
health are provided.
(Refer previous slide)
ADDITIONAL VACCINATION
Record new vaccine/out of schedule vaccines session here
DUE DATE Vaccine
Date
Administered
DUE DATE Vaccine
Date
Administered
42 months
☐ Vit A
48 months
☐ Vit A
54 months
☐ Vit A
60 months
☐ Vit A
48-60 months
☐ DPT Booster
AFTER 1
Month
☐ DPT Booster
VACCINATION AND SUPPLEMENT SCHEDULE
Notes

32. 32
NOTES
PROTOTYPE
SPREAD 8: Notes
Space for notes
provided at the end
of the card.

33. 33
Use Case Scenarios
Illustrating how the MCH card’s usage
will function within the current system
Pregnant Mother
• Registration in Village
• 1st Visit and Registration
at Local Health Centre
• Repeat Visit for ANC
Child
• Child delivered: Birth registration
and 1st vaccination
• Repeat Visit for vaccination

34. 34
USE CASE SCENARIOS
Pregnant Mother: Registration in Village

35. 35
USE CASE SCENARIOS
Pregnant Mother: 1st Visit and Registration at Local Health Centre

36. 36
USE CASE SCENARIOS
Pregnant Mother: Repeat Visit for ANC

37. 37
USE CASE SCENARIOS
Child delivered: Birth registration and 1st vaccination

38. 38
USE CASE SCENARIOS
Child’s Vaccination: Repeat Visit

39. 39
BACKGROUND RESEARCH
ANALYSIS

40. 40
BASIS FOR FINDINGS ANALYSIS
• Ethnographic research in
Kishanganj district, Bihar and
Ahmedabad city, Gujarat
• Desk Research of existing
child records from Bihar,
Gujarat and other countries as
provided by the contest
• Usage patterns of 8 used
Mamta Cards and 2 used cards
from Bihar

41. 41
ANALYSIS: FIELD VISIT CONCLUSIONS
OUR ASSUMPTIONS BEFORE FIELD VISIT OUR PREMISE AFTER FIELD VISIT
Main user of the card: Mother/Caregiver Main user of the card: ANM
Need to increase illiterate mothers engagement with
Health Card
Need to simplify ANM’s recording process
Minimal text and more illustrations/images to
communicate to mother
Illustration unnecessary in Health Card as main user is the
Nurse who is literate
Content of card can lay more emphasis on instructional
information like Nutrition, Mother and Child Care, Childs
growth and development
Content of card needs to be minimal and focus on
recording information most necessary for service delivery
of ante natal care for mother and vaccinations for child
The size, material and shape of the card needs to last a
period of 5-6 years of usage
The size, material and shape of the card needs to last a
period of 5-6 years of usage, which includes a minimum
of 20 interactions between a health care provider and the
Health Card
The design of the card needs to cater to the record
keeping requirements and also inform caregivers about
nutritional and health requirements of mother and child
The design of the card needs to be compact. A lot of
information is not being filled by ANM due to lack of
time. These information fields can either be removed or
redesigned.
Need to reduce unnecessary repetition of information
fields that ANM needs to record.
Need to reduce unnecessary repetition of information
fields that ANM needs to record.

42. 42
Existing Health Card
usage
Proposed prototype
Information set type
Data set
being
recorded?
If not, possible reasons
for not recording
Data set
included in
prototype?
If not, why has it been
excluded?
Family Identification
(Mother’s Father’s Name, Age, Address, Phone number)
Yes Yes
Pregnancy Record
(Mother’s ID number, Date of last menstrual period, expected
date of delivery, previous pregnancies, place of delivery)
Yes Yes
Birth Record
(Childs name, date of birth, weight at birth, gender, Child’s ID)
Yes Yes
Institutional Identification
(Names phone numbers of Health workers,
Partially
recorded
Yes
Ante Natal Check Up
(Ante natal visits, Basic Abdominal investigation, Weight, B.P,
Hb, Urine, T.T, Iron tablet)
Partially
recorded
Cumbersome design, card not
maintained/lost/forgotten by
mother during visits, tracking
mother difficult
Yes
Ante Natal Care
(Obstetric complication, Past history, Abdominal investigation) No
Information to be recorded by
gynaecologists who do not use
the Health Card
No
The ANM does not have the time
or the equipment or training to
carry out most of these functions
Post Natal Care
(Mother and Child’s check up care)
No
Information to be recorded by
gynaecologists who do not use
the Health Card
No
The ANM does not have the time
or the equipment or training to
carry out most of these functions
Vaccination Schedule
(Vaccine, due date, date administered)
Partially
recorded
Yes
Growth Chart No
ANMs too busy, Child’s develop-
ment monitored unsystemati-
cally during visits to village
No
Records not being maintained
due to lack of time
analysis: Information sets
Current health record vs. proposed prototype

43. 43
0
10
20
30
40
50
60
70
80
ANC1
ANC2
ANC3
ANC4
Delivery
RI1
RI2
RI3
RI4
RI5
RI6
RI7
RI8
Current
Health
Record
Our
prototype
Reduced number of fields for data entry
Current health record vs. proposed prototype
Visits
Numberofinformationfieldsfilled
ANC VISIT 1
Current record: 73 fields
Prototype: 34 fields
ANC VISIT 2
Current record: 25 fields
Prototype: 12 fields
subsequent visits
Current record: 24 fields
prototype: 11 fields
RI visits
With only the next due
date and the current
date being recorded in
our prototype, there is
an increase of one check
box vs the current health
record, but this is kept
to keep the design of the
record consistent over
each visit.

44. 44
0
10
20
30
40
50
60
70
Text
Number
Date
Checkbox
Mulple
ch.
Current
Health
Record
Our
prototype
Reduced number of fields for data entry
Current health record vs. proposed prototype
TYPE OF INFORMATION FIELD
Numberofinformationfieldsfilled
We have significantly
reduced the amount
of numbers, dates and
multiple choice fields
by eliminating repeat-
ed information and in-
formation usually left
unfilled by the ANM.
The number of check
boxes is higher in our
prototype, because
we have replaced re-
peated date entry on
several occasions with
check boxes to make
the process of filling
out the data more ef-
ficient.

45. 45
INTERVIEWS
“We rely on the women in our family and
community for information on how to take
care of pregnant mothers and children.
Television and radio are also good”
- Mumtaz, Mother (Age 21) with Grandmother, Saira Bano
For final prototype:
Illustrations are
not the most
effective way
of increasing
caregivers
engagement with
mother and child
health care
OBSERVATION
This mother and grandmother
are illiterate and could not
comprehend any of the existing
health records or the 1st set
of prototypes shown to them.
They were uncomfortable
even when verbal instructions
complemented the information
on the cards. They understood
some of the illustrations but
were reluctant to engage with
the card. Similar observations
were made with other illiterate
mothers/caregivers on the field.

46. 46
INTERVIEWS
“Most mothers wont look at the entire card. In
fact the staff at the clinic also wouldn’t have
gone through the entire card. ”
- Dr. Hardik Mewada
MOIC, Arjun Urban Health Centre (Slum Area), Vasna, Ahmedabad
For final prototype:
Only include
information fields
that the ANM
can currently
record given
her roles and
responsibilities.
Dr Hardik said:
Only the following basic info is
generally entered on the card:
• Date of meeting mother
• Height
• Weight
• Blood Pressure
• Date on which tablets (iron,
calcium) and vitamins are
administered to mother
• T.T. administration
• Maybe HIV, thalassaemia
• Vaccination schedule of child
“Information on the ANC and
PNC can be filled largely by the
Gynaecologist, not at Health
centres. Foetal length, heart
rate etc can be ascertained
only through Sonography. The
equipment to do this is only in
hospitals, not in PHC/UHCs.
Hospitals have their own records
and do not document this in the
mamta card.”

47. 47
FIELD OBSERVATIONS INTERVIEWS
ASHA Worker Bharti Ben providing samples of the
Mamta Card and explaining her duties
MCH register maintained by ANM Zankhani Ben
for digitization by Data Operator
ANM Zankhani Ben comments on our prototype for
the child’s growth and development
ANM Zankhani Ben demonstrates her recording
responsibilities on the Mamta Card and her set
of MCH registers
ANM Zankhani Ben describes how she uses illustra-
tions during counselling sessions to inform young
mothers about breast feeding
ANM Zankhani Ben approves of our prototype
for the vaccination schedule

48. 48
Multi Purpose Health Worker (MPHW) Shailaja Ben
at the V S Public Hospital, Ahmedabad, Gujarat
preparing to vaccinate a new born child
FIELD OBSERVATIONS INTERVIEWS
The MPHWs assistant fills out the date for the 1st set
of vaccines being administered to a new born child
onto the Mamta Card
She then replicates this onto MCH register
MPHW Shailaja Ben describing usage of the ANC
table in the Mamta Card while caregivers wait for
her to vaccinate their child
MPHW Shailaja Ben explaining the sequence of
information recording in the Mamta card
She looks at our prototype and doesn’t seem
to understand the logic of information distribution
at first glance

49. 49
FIELD OBSERVATIONS INTERVIEWS
Dr Sarkar, (Retired National Tech Advisor to WHO)
offering suggestions for the redesign of the
vaccination schedule
Caregivers queuing up for vaccinating their child.
One grandmother had forgotten the Mamta card
and had been asked to go home and get it
Expectant mother and grandmother at V S Public
Hospital. They rely on family for information re-
garding child care and do not use the Mamta card
Posters and information graphics on the walls inside
the UHC
Entrance to Urban Health Centre (UHC), Vasna,
Ahmedabad
MOIC at the UHC pointed out information that is
frequently recorded, and information that doesn’t
get recorded on Health Cards

50. 50
FIELD OBSERVATIONS INTERVIEWS
Weekly ANM meeting, where ANM’s put forth their
trouble and challenges to the Medical Officer in
charge (MOIC)
Conducting a mini-group discussion with ANMs in
Kishanganj.
ANM Savitri devi explaining the Bihar RI card and
information getting translated from RI card to the
MCH register
Documentation of the register storage room at Potia
block in Kishanganj district, Bihar
ANM explaining the columns of hand made MCH
register
Data operator room. Prints of the seven block in the
Kishanganj distract and the figures of RI coverage.

51. 51
INITIAL PROTOTYPES: FOR FIELD TESTING
PROTOTYPE 1 PROTOTYPE 2 PROTOTYPE 3
PROTOTYPE 4

52. 52
PROTOTYPE 1: RATIONALE
AIM
To improve illiterate mother’s
engagement with the Health Card
and her child’s health
• Divided input information and
illustration/instructional information
to target different ANM and Mother
respectively.
• Protective folder to improve
durability
• Sequencing of information designed
to increase engagement from
mother, by making illustrated and
instructional material highly visible.

53. 53
PROTOTYPE 2: RATIONALE
AIM
To improve illiterate mother’s engagement with the Health
Card and her child’s health
PROTOTYPE IDEA
Includes vaccination schedule, growth chart and nutritional
and child’s development information on one large chart as a
timeline to be hung as a chart in the mothers house.

54. 54
PROTOTYPE 3: RATIONALE
AIM
Incorporate all possible information relevant to the
vaccination schedule within one table
• Due date and date vaccine administered designed
for clarity
• Disease information incorporated to inform the
mother
• Visual communication about vaccine administration
position

55. 55
PROTOTYPE 4: RATIONALE
AIM
Increase mother’s engagement in her
child’s vaccination process by high-
lighting Due Date through illustrations.
Reducing repeated data entry of date
administered and due date.

56. 56
ABBREVIATIONS
anc: Ante Natal Care
anm: Auxiliary Nurse Midwife
asha: Accredited Social Health Activist
aww: Anganwadi Worker
phc: Primary Health Centre
mch Card: Mother and Child Card / Our prototype
MCH register: Mother and Child Register
mcts: Mother and Child Tracking System
MOIC: Medical Officer in Charge
mphw: Multi Purpose Health Worker
RI: Routine Immunization
UHC: Urban Health Centre

57. 57
THANK YOU!
Mridu Mehta
mridu.mehta@gmail.com
•
Rahul Abhisek
rahul.abhisek@gmail.com
•
Valtteri Wikström
vatte.wikstrom@gmail.com