Vaccine Delivery Kit

Or as the official name of the project went: Vaccine Services Delivery Kit Innovation & Design (phew!)

Background:

The project was commissioned by the Bill and Melinda Gates Foundation for the Centre of Knowledge Societies, India, in 2010, to conduct extensive research and innovate in the area of Mother & Child Health care in rural India. After the first phase of the project in 2009, child immunization was identified as the biggest problem area with multifold areas of possible intervention. Vaccines were getting spoilt due to avoidable and unnecessary exposure to temperatures beyond its acceptable range, the paraphernalia required for immunization, besides vaccine vials, was very high in quantity and variety and there was no defined system of allotting, carrying and hygienically using this inventory.

The 8 month long project of 4–5 team members had a 3 week discovery research phase & subsequently a 2 week testing and feedback phase conducted in 2 rural districts in in the state of Bihar in India.

Due to the high level of complexity of this project and its many aspects, I have restricted this report to the core focus of the project, the Inventory Kit. If you are interested in all the details of this project please contact me at asmitamisra@gmail.com and I’d be happy to discuss them!

Research Process:

Primary Research employed the following methodologies: 
- Day-in-the-Life Ethnography [mind map prepared]
- In Depth Interviews
- Mini Group Discussions
- Clinic Visits and Site Interviews
- Spot Interviews
- Local Health care Professional Interactions
- Visual Culture Mapping
- Colour, Material, Finish and Form Elicitation

Images from the discovery research phase

Findings:

It was identified that the field-worker reports to the Primary Health Care Center (PHC)on the morning of her duty day, collects the relevant records, refills used inventory and plans her route map for the day along with her delivery boy. The role of the delivery boy is to carry the vaccine carrier box (VCB) to the her first stop for the day and pick it up from her at her last stop. the rest of the inventory was carried entirely by the field worker herself. The day in the life of a VCB was mapped and we tried to understand the various users, their method of handling, treatment, on site infrastructure and weather exposure, in the following chart:

Day-in-life of a Vaccine Carrier Box

We also mapped the inventory used by the ANM, supported by the ASHA on site. This included multiple registers for record keeping, syringes, cotton swabs, medicines, etc. We also observed the varied site types where the ANM gathers her patients to carry out her work. This could range from under a tree, to a proper doctor’s room with a chair, table and a stol for the patient to be seated on.

The visit site for this ANM was the front porch of the village houses, seated on a cot

We then tried to map the amount of time taken per vaccination to understand failure cases, intervention areas and the ideal scenario, if every step was followed for every patient.

Breaking down the time taken per vaccination to observe that a identify the number of steps involved and time taken per phase.

The data collected was the analysed using the following methodologies: 
- Collaborative Data Review
- Mind Mapping
- Use Case Definition and Analysis
- Experts Workshop
- Analysis and Refinement of the Design Brief

Failure cases on field practices were tabulated and then prioritized as per importance depending upon frequency of occurrence and negative impact on health. Short listed failure cases were then formulated into the final refined brief and the product was designed and developed accordingly.

Redefined Brief:

Supported by the research phase, the aim of the project was redefined as innovative solutions to reduce the time taken per immunization, increase on-site hygiene level of health worker and consequently the child and reduce clutter and chaos on site. This would in turn enhance the overall Vaccine Delivery System.

Product Development Life Cycle:

Team CKS along with industry experts, brainstorming on the findings and creating feature sketches

After numerous post-it sessions, brainstorming exercises and internal review sessions, concept cards were developed. Each of these had a feature sketch to be used as a stimulant for the product design process. This led to the design of 3 concepts complete with features, usage processes, carrying ergonomics and setup processes. These were then presented and explained to a panel of experts and feedback was solicited.

A glimpse of the many many concept sketches

We realized the importance of introducing certain new features into the system which are mandatory by health regulations but almost never followed of field, for eg: correct disposal mechanism. We also faced a reality check on the manufacturing requirements of the cold chain. This helped us redesign our own concepts, evolving them into more feasible, structured, and functional products.

Field Validation of Concepts

With 3 fully developed concepts, we prepared mock up models with the help of industry professionals and tested with their intended users and surroundings. Since the infrastructure available at the immunization sites is very variable and minimal, we also devised some roughly improvised record keeping methods so as to ease their register handling problems and reduce the time taken per child.

We asked the health workers to organize their entire inventory in the products we had designed and use it as if it’s their own. They were made to carry it to the site, set it up as per use and infrastructure, use it for the day and then pack it back up before handing it over to us.

Concept 1
Concept 2
Concept 3

With their feedback, our observations and the community reactions, we realised that no concept was complete in its own or at the stage of requiring minor refinements to become the ideal product. We integrated the positive features of each of the concept and imbibed some new features to make the final product.

Final Product Design & Development:

It has 2 parts, one is a kit which is carried by the health worker herself, this opens up on site and can be set up so that all the inventory comes organized with it.

The ANM also gets some defined places to keep inventory during use. This kind of setup, we realised, as enforces a certain task flow for her,which helps increase the level of service delivery and thus increases, the trust on the system and thus the number of beneficiaries. The base of this part is hard and made of formed plastic, while the top flap is made of stretchable cloth and zipped onto the base.

The other part is the cold storage compartment. This is carried by the delivery boy and stored and retrieved from a Health Centre daily. This also has a syringe storage compartment on its left and a disposal unit of its right. to provide a flexibility in the system, we designed a collapsible syringe storage unit on the cold storage, as there is no certainty if syringes will be carried in it on a daily basis. The central cold storage compartment has been designed with newer materials and adequate thickness of insulation so as to keep the vaccines colder for longer. We had also designed some ingenious self-conditioning cold storage unit concepts during the initial phases but could not take them forward due to manufacturing and price constraints.

Project Conclusion:

Team CKS gathered at an evening of presenting to the stakeholders at the Bill and Melinda Gates Foundation, circa 2011

This project was later carried into a engineering development phase and was supposed to be pilot tested in mid 2014.

Role:

  • Research Planning and Logistics Handling
  • Research, Analysis, Problem Identification
  • Conceptualization and Product Design
  • Product Prototyping and Development
  • Preparing Project Collaterals and Media

3D modelling of concepts done by team member Gaurav Kulkarni