The primary goal of this rural healthcare ethnographic study (Feb-Nov 2009) was to provide a leading mobile technology company that funded this research with an in-depth understanding of the healthcare ecosystem and subsystems in rural and peri-urban villages in Bangalore Urban District, Karnataka with a focus on two diseases -namely Malaria and Tuberculosis. The choice of these two diseases of the poor, was useful to the client in understanding the processes and the flow of information under the RNTCP (Revised National TB Control Program) and NVBDCP (National Vector Borne Disease Control Program). Permission was obtained from the Health Commissioner of Karnataka to conduct the research at a Primary Health Care (PHC) centre, Community Health Centre (CHC), District Hospital, Tertiary Health Care centre, as well as the Taluk health Office (THO), District Malaria Office (DMO), District Health Office (DHO), and other NVDCP and RNTCP government offices, information centre, etc. in Bangalore City.

This research project at IIACD’s Centre for Health Ecologies and Technology (CHET) was led by Prof Uma V Chandru, a cultural anthropologist and designer who has extensive field experience in rural Karnataka and is well versed in the local culture and languages (Kannada and Telugu) as well as the language spoken by migrants (Tamil) working in the nearby quarry. Uma and her colleague Malini Ghanathe collaborated with two design researchers from the mobile technology company in the research. They began their research in a PHC where they had conducted a pilot study in 2008. They applied several ethnographic research tools and methods to engage in in depth research in the PHC, neighbouring villages, a quarry site and several patient homes. They also visited private clinics and diagnostic centres in the vicinity. They conducted interviews of patients and healthcare providers, before proceeding to the CHC, secondary and tertiary level hospitals and other government labs, hospitals and health related agencies. They researched and visually mapped the processes of testing, diagnosis, treatment, referrals and data flows of these two diseases from grassroot to Taluk, District, State and National levels, with help of a designer from the technology company and two freelance designers hired by IIACD.

The study deliverables included providing an indepth understanding of and visually mapping the following:

  • Processes and timelines of testing, diagnosis, referrals, treatment of TB and Malaria patients
  • Information flows of TB and Malaria from primary to tertiary levels with key stakeholders, timelines, tools (ICT and other) and methods used
  • Manner by which consistency of diagnosis is maintained at the grassroots rural `mother’ primary health centre and it first referral unit (a Taluk Hospital) in Yelahanka and a District Hospital in Bangalore City
  • A day in the life of a PHC AMO
  • Differences in health records at these facilities, roles, responsibilities, needs and pain points of key stakeholders involved in data collection, recording, aggregation and reporting to nodal agencies and other key stakeholders
  • Needs, desires and aspirations of patients
  • Profiles of patient healthcare choices
  • Several healthcare organisational charts
  • Control room and information centre visuals
  • Government laboratory networks
  • RNTCP, NVBDCP and IDSP (Integrated Disease Surveillance Project) visuals

CHET researchers analysed the data and presented the following to the client:

  • In depth textual report with visuals
  • DVDs of the extensive photo documentation