Bill & Melinda Gates Foundation
While studying policy at the London School of Economics (LSE), I learned about health conditions in Uttar Pradesh (UP), India — the home state of a classmate (and Health Minister). After graduation I joined him and the Bill & Melinda Gates Foundation team to improve health outcomes in UP.
Pregnant women and children were dying at alarming rates from very preventable and treatable conditions. This crisis was magnified because of UP’s massive population: 205 M (for context — Brazil: 203 M; US: 320 M)
What followed was a 2 year exploration of field research linking cultural norms to medicinal practices that led to the co-creation of sustainable decision making tools in the state’s health system to reduce maternal and child mortality in Uttar Pradesh.
Pressing Challenges
Realization:
Managers didn’t have a clear understanding of performance, which caused drastic inefficiencies in resource allocation and utilization
Observations + Context:
Compared to the rest of India, Maternal mortality was 50% higher in UP. Postpartum hemorrhage (PPH) accounted for 1/3 of those deaths, and PPH is treated with a simple and inexpensive medicine, oxytocin, which was readily available — but not at the right place + time.
Making Sense of the Health System
Process + Insight:
My team and I teased apart the state’s 12 data sets; I shadowed and spoke with managers, and I observed review meetings at all levels. I realized that managers didn’t need more data — they needed an interpreter; a tool to make sense of that data in order to direct action.
Solution:
The key to unlocking the state’s health system was to help managers change their own behavior, by buying into a culture of data-driven decision-making.
State-Level Solution
Actionable Analysis:
The matrix shows that districts were only using a small % of their budgets, resulting in massive under-utilization + misallocation of funds
Key Features: Left side
Rank lists highlight extreme performers to help state managers focus their attention
Heat maps are visually engaging and trigger action; they also give performance benchmarks
Key Features: Right side
Matrix covers clinical and administrative indicators such as maternal health and health budget utilization (shown)
Pictured above is the Executive Summary Dashboard tool co-created with the government to help state managers focus on high-level challenges, based on qualitative data I collected during my immersive research
Pictured above is the Diagnostic Dashboard tool I co-created to help district, town, and facility managers focus on specific challenges, based on qualitative data collected during field visits, interviews, and observations.
Grassroots Solution
Actionable Analysis:
The absence of critical resources (bottom left), was as the primary bottleneck to quality service delivery and healthy communities (top left).
Key Design Features:
The heat map plots the most important health outcome to quickly engage the user to initiate corrective action
Ability to drill-down to the core of problem: state > district > town > facility
At one glance, grouping of information
District-level, monthly planning and review session in Hardoi District, where the dashboard tool was featured. After piloting the tool, I worked with government managers and the Chief Minister’s Office to draft an Executive Order mandating the tool’s use.
Empowering Managers
Roadmap for Success:
We collaborated with the government to develop an implementation plan, and embedded the tool within their review meetings. They adopted and used the tool as their own.
Hands on Support:
We recruited and trained district staff on how to use the tool and as well as how to train their respective government managers. They conducted training events that we attended for quality control, and I worked with the Chief Minister’s office to draft an executive order instituting a new monthly planning meeting and during that meeting, also required review of the dashboard.
*The National Family Health Survey 2015-16 (NFHS-4), the fourth in the series, provides information on population, health and nutrition for each State; Institutional Deliveries (pregnant women in Uttar Pradesh (UP) delivering in a government run health facility) increased from 22% to 68%; Maternal Mortality Rate (MMR) declined from 440 to 216 deaths/ 100,000 live births in Uttar Pradesh (UP)
**The success of this intervention ultimately comes down to: (1) project leadership and oversight by the University of Manitoba, the Bill & Melinda Gates Foundation, and the Government of Uttar Pradesh (2) Hard work on the ground from the Technical Support Unit teaching and training best clinical and public health practices to nurses/ doctors in medical facilities and community health workers in towns across UP, and (3) collaboration with government health system managers, NGO, and private sector partners. For first time health-seeking behaviors and clinical practices were being captured and analyzed holistically and comprehensively. This dashboard tool helped illuminate opportunities for the Government to close gaps in the state’s health system on its journey towards improved maternal, newborn, and child health.
Delivering Change
Data-Informed Planning + Review:
6 months after implementing the dashboard, managers were empowered to take action — improving resource availability by as much as 85% in Districts across the state, improving access to life-saving medicine, equipment, supplies and infrastructure.
Impacting Lives & Communities:
Greater availability and utilization of resources resulted in wider access to quality service delivery, positively impacting women, children, families, and communities:
> 52% DECLINE in Maternal Mortality Rate (MMR)*
> 201% INCREASE in pregnant women delivering in a government facility*