Recognize and Respond to a Seeker’s Understanding of Care

All the strands that make up the idea of health for seekers should be acknowledged and considered during the course of their health journey

Strands of Health §

Project ARC found that individuals’ perception of their health was expansive and went beyond their physical health and the presence/absence of disease. Participants identified multiple components of health, which we see are interwoven ‘strands’: financial, emotional, spiritual, social, environmental, and physical. Health-seekers often have to make difficult decisions and trade-offs between their health strands to receive physical health care.

Being healthy does not only mean good physical health. If a person goes through mental pressure, then he or she cannot be called healthy. If he is healthy in all aspects, mentally, physically, economically, only then can we consider him to be in good health.

57y COVID-19 patient with comorbidities 🇧🇩

The strands of health approach are built on the recognised social determinants of health¹. However, while the social determinants of health are (or at least understood as) factors that influence health, the strands were, in many ways, for health seekers, health itself.

Forced to Make Tradeoffs §

People here work in the agricultural fields, markets etc. They will not waste their time going far to get a vaccine. If they have to go far, they will need more money, they will also lose wages for that day as they cannot work and earn. For this reason they are not interested.

🇧🇩 Respondent from the community FGD

While health seekers subscribe to an expansive view of their health, the health system is often singularly focused on physical health. As a result, for health seekers, a number of prescribed preventive and curative advisories and treatment regimens can appear out of sync with their own perception of what is good for their health.

Over several interactions with the health system, which may appear to many health seekers as ignorant or dismissive of their other strands of health, trust in the system erodes, leading to poor health outcomes for health seekers.

A person who has a food shortage can bear that suffering, but nobody came to help when someone died. That caused an unbearable mental crisis.

🇧🇩 Respondent from a community FGD, reflecting on the impact of social distancing and burial protocols

Health and wellness education is one of the things that Xolile and her community in Kwazulu Natal would love to have access to. Xolile prefers the private healthcare system over the public one because of long waiting times and the poor service of the public system, but during COVID, she discovered that “even pharmacies were running out of vitamin tablets and essential oils.”

If community healthcare workers came around and educated people on how to live in a global pandemic, and what to do when they are infected, we would be better prepared and safer.

🇿🇦 Health seeker, Kwazulu Natal

Integrating the Strands of Health in Care §

In line with the ever-growing understanding that social determinants of health heavily impact health outcomes, employing a more expansive view of health and integrating this into design can enable individuals to make fewer trade-offs between the different facets of their health and therefore increase their engagement and satisfaction with care. For example, digital care platforms could include screening questions on the health strands to help providers tailor care plans to meet health seekers’ more holistic needs. The financial trade-offs health seekers have to make could be alleviated through digital solutions, such as online appointment booking or digital queuing systems, rather than having to queue all day and miss a day’s wages; digital return of lab tests could alleviate the need for unnecessary return visits. Digital platforms can also be leveraged to connect social service providers to each other and share patient data to facilitate referrals and continuity of care.

Provocations §

How might we sensitize providers to consider the overall health of a person, in order to provide the most effective care
How might we imagine cost-effective ways of extending the focus of health care providers beyond physical healthcare and to the other strands of health to ensure that healthcare journeys are viable and satisfactory for health seekers
How might we leverage non-experts in healthcare provision to address necessary strands beyond physical healthcare
How might we leverage phygital tools and services to provide health seekers and their care networks the necessary tools to assist them in making difficult tradeoffs between their health strands when necessary for healthcare

“Social determinants of health.” n.d. World Health Organization website. Accessed August 29, 2022. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

Innovations §

Examples of pre-existing movements and interventions that utilize this principle in their design
- Funeral Process
  
  Funeral process in any community is inevitably linked with religious beliefs and sentiments. In West Africa, the Ebola epidemic surfaced incompatibility between some religious and cultural practices and prescribed scientific methods for burials of those who had been infected. Practices of washing and cleansing the corpse and many such burial rituals were an important cause of spread of the disease in Ebola outbreaks of Africa. In Kerala during the Nipah virus outbreak, addressing the funeral issue was an important concern for the government, which saw building trust with communities as an important step for containing the outbreak. The situation was efficiently managed by effective scientific communication between the government, religious, local leaders, and the public that resulted in a culturally acceptable and scientifically sound protocol for funeral procedures.
  
  Sustainability of the Innovation
  
  Although the guidelines were formulated in line with known and available information, it came into being that not much attention was given to the cultural implications of communities of some affected individuals initially. Resistance was faced by the officials from the public wherever a prescribed scientific protocol was implemented in the funeral processes. This required constant discussion of administration with local and religious leaders that ended with the leaders extending their support for the same. The success of the scenario lay in the fact that the religious leaders could consider scientific facts and humanitarian values above their religious sentiments in the crucial situation. There was a need for effective scientific communication between the government, religious, local leaders, and the public that resulted in a culturally acceptable and scientifically sound protocol for funeral procedures. There has been evidence of such partnerships through ebola and nipah virus cases in Africa, India, and Bangladesh which show how such collaborations can come together in a short time and with low effort.
- Grameen Kalyan Health Program
  
  Grameen Kalyan Health Program- As an insurer and health service provider, GK implements an affordable health microinsurance scheme, running a network of community-based health centers and satellite clinics, managing a referral system for secondary and tertiary care, and coordinating outreach health services (domiciliary service) by community-based female health workers in Bangladesh. GK’s health centers are usually attached to a Grameen Bank branch and provide primary health care using a staff of doctors, paramedics, managers, lab technicians, and community health assistants. Medical staff also organize weekly satellite camps for members in remote areas. The salary structure considers the distance of the workplace from the capital city.
  
  Sustainability of the Innovation
  
  Grameen Kalyan Health Program operates 48 health centers in 14 districts and 50 upazilla (subdistricts) and provides primary healthcare services to 2.2 million people. The target population is low-income households (mostly headed by women) near Grameen Health Centers. Health microinsurance is pivotal in GK activities, ensuring target group participation and raising revenue for the program. The scheme employs a sliding scale fee structure. Nonmembers of Grameen Bank pay slightly more (300 taka or about $4.28) than members (200 taka or about $2.85), but there is no distinction in service and benefits, and each plan covers up to six members of a cardholder’s family. The plan provides free preventive care, family planning, and health education services to all, irrespective of enrollment. For health center visits enrollees pay 20 taka or about $0.29 and nonenrollees pay 50 taka or about $0.71. Enrollees also receive a discount on medicine and laboratory tests. In catastrophic circumstances enrollees can receive a subsidy from GK of up to 2,000 taka or about $29. GK’s operational cost recovery rate has reached 83% (at the stage of continuous expansion) in 2008, up from 38% in 1997.
Concepts §

Artefacts embedded within Project ARC's 'Stories of the Future' that represent the values of this design principle