Kramati

Connects the various players in India’s rural healthcare system to keep health workers more appraised of their sick patients to improve tracking, efficiency, and quality of care provided to these patients.




The Problem:

India’s rural healthcare is tiered, with patients being referred upward to more advanced medical institutions depending on the severity of their ailment. This system has problems related to motivation, inefficiency, tracking that result in patients not getting the care they need.


The Process:

Research into the existing system; followed by a contextual inquiries and telephonic and on field interviews with the players involved. Defining scope, brainstorming, card sorting and creating a visual design that was refined after a review.


The Outcome:

Kramati reduces confusion, information unavailability and inefficiency by keeping Community Health Workers updated on their patients diagnosis and treatment plan, giving customised care plans and tracking floating population. It also helps Primary Health Centeres plan their day based on patient intake.


Secondary research:

Besides doctors, India's rural healthcare system has several other workers, all with different levels of qualification and training.

Accredited Social Health workers (ASHAs) visit homes to increase awareness of maternal health, sanitation, immunizations etc, help villagers access services, and provide basic medication, while Auxillary Nurse Midwives (ANMs) manage immunisations, prenatal and antenatal programs at primary health centers, and Anganwadi workers (AWWs) work in schools, focussing on childrens health.

The rural healthcare system is tiered, as shown here. Each village has ASHAs and AWWs, every Sub Centre (SC) has an ANM, and each Public Health Centre (PHC) has a doctor. ASHAs and SCs refer patients to their PHC, and PHCs further refer upwards.




Contextual Inquiry:

Primary Health Centers are the main unit for rural healthcare. In order to get an in depth knowledge of the structure, facilities and interactions, I visited one in Shikrapur village in Maharashtra. ~1,00,000 people from 16 villages and 6 sub centres visit the PHC. It has IPD facilities (8 beds), and performs deliveries, treatment, medication and screening.




Key Personas:

I interviewed ASHA workers, ANMs, doctors and admin staff in villages and PHCs to get a deeper understanding of their schedule, motivations and blockers, which are summarised through these personas.



Key problems and ideation:


Inter entity communication:

Currently, ASHAs, sub centres and PHCs share information about a patient through a referral chit sent with the patient outlining the prognosis. The ASHA has to manually follow up with each patient / relevant PHC to find out about referral completion, outcome etc




Planning and forecasting:

PHCs often have no way to plan for patient inflow on a particular day, especially in surge situations. Doctors also may not always have context on a patient's prior care journey, often leading to repeated procedures that waste effort and resources.


Floating population:

These issues rise seriously when it comes to the floating population (labourers, temporary workers etc), as their frequent travelling makes it difficult for their ASHA workers to keep tabs on them if they leave the village, they lose referral chits while moving etc.




Patient motivation:

Women tend to seek care only in the second trimester mainly to confirm pregnancy, and need constant reminding for follow ups, ANC etc. The main drop offs rise when referred to higher centres.




Concept 1:

The solution deals with different ways of motivating women to go for referrals, without needing their ASHA workers to intervene each time.

This involves inserting bite sized knowledge and visually strong educational material as they are browsing social media, as well as using a Whatsapp bot to send them reminders and updates.

Feedback received:

Women are aware of what needs to be done, but lack the motivation to do so due to percieved inaccessibility, concern about finances, opposition from family and inability to take time off work. In this case a more personal touch in the form of an ASHA worker who can convince the women and their families, assuage their fears and suggest more flexible options is a better alternative.

Hence, a solution that supports and bridges gaps in the current system would be more effective, rather than one that works isolated from the current system.



Concept 2: Kramati:

Kramati connects siloed data and uses it to create contextual workplans and recommendations to the different entities in the rural healthcare system, creating a more effective and efficient way to treat referrals. Here is how Kramati can achieve this, and the various features that can be incoporated for the same:

Kramati offers different, customised functionality to the different stakeholders in the healthcare system, so as to meet their specific needs through content and format. Here is how it can be used by the differnt players, and how they can interact with eachother:



Journey Mapping:

Multiple journey maps were made from the perspective of patients, ASHA workers, doctors etc. These were ued to lay out the precise pain points across the process and map out and connect the identified interventions at relevant points.




How it Works

Asha Mobile App: Sign up, Home, Account:

Users can select another language for the app if they aren't comfortable in English. State automatically entered through cell tower triangulation, and the relevant languages are displayed according to that region, to prevent having searching through long dropdowns.

In the records, patients new to village given priority as the ASHA hasn’t connected with them even once. The dots on the left indicate the severity of the ailment

They can search for a patient, or sort and filter the lists.

The account section has a to do list for each day, according to which they can opt to get notifications; as well as having their details and professional history.

ASHA Mobile App: Patient Records

Along with an update of the previous referral and the patient's medical history, the protocol to be followed for each patient is given in the form a to do list.

a summary of each section is provided on this screen, and the dropdown arrows indicate which sections have in depth information that can be accessed.

Progressive disclosure is used and detailed information is a couple of taps away, as these records may not always be needed, and providing a quick to read brief is of more importance.

ASHA Mobile App: Send patient records, Chat:

While sending records, users default search is by village as they know that more than the ASHAs names. A drop down appears after they start typing, to reduce the number of options.

It shows them a summary of the record they want to send, lets them select more.

The chat section is so that they can communicate with other ASHA workers directly, in case more clarification about a patient is needed.

PHC Web App: Dashboard:

The clerk at the PHC can send a notification that has a quick summary of the respective patients records, when the patient gives the clerk their name on entering.

They can send the relevant record to the doctor from the home screen itself.

They can sort/ filter according to their needs

A summary at the top tells users quickly about the patients expected. Doctors and clerks can go through this summary while setting up the PHC for the day.

PHC Web App: Dashboard:

They can adjust the amount of cards they want to see.

PHC Web App: Dashboard:

The receptionist/ doctor can access each patients’ records. The patient’s name and send to doctor button remains sticky. It is a summary of this screen that gets sent to the doctor's phone when the receptionist taps 'send to doctor.'

They can access more details on clicking the appropriate cards.

PHC Web App: Patient Records:

Information about each past visit, and previous SC visits is also available.