Litrature review

Literature Review

Project Diabetes

Introduction:

As per World health organization 180 million diabetics in world and the number is about to reach 230 million by 2030. Out of these more than 30% diabetics are from India and China. The known diabetics count in India has reached 32 million and more than 50% of them reside in rural sector. There is a real need to understand the fact of the rapid growth in the number of diabetics and work towards coming out with possible design interventions in the community benefit. This requires extensive research about the field and need to understand the healthcare system which supports in managing chronic diseases like this. If we see the broader picture most of the diabetics lack in managing their regular blood sugar levels because of several reasons such as lack of knowledge, poor resources, poverty, and mismanagement etc. the increasing growth in rural diabetics is an good example of lack of resources. The rural diabetic can’t manage his BGL because he in capable to afford the cost involved with the disease and no proper channels through which he can take benefit. Where as half of the diabetics suffer with lack in early diagnose and most of them die identified. On the other hand an urban diabetic is busy in his daily activities, which makes him difficult to find time to regulate his BGL. The fast urban life has developed irregular food habits and fast food culture, where a diabetic really can’t keep a record of every day food management. Hence this develops a need of support product service system where the rural diabetic can get benefited with low cost services, education and product support and the urban diabetic gets a service where he can manage his daily data and gets regular feedback. The overall dialogue is suggesting that an effective product service system can stand efficient to help the diabetic to manage their condition.

Visualizing the service

The term “Product service system” has been defined as a marketable set of products and services capable of jointly fulfilling a user’s need. The product and service ratio in this set can vary, either in terms of function fulfillment or economic value” in case of diabetes home care model the service will be looking at the both the perspective but in different user needs as the rural sector needs the economic value where as the urban sector needs functional fulfillment and both carry equal weightage. The service is apparently works in conjunction with different stakeholders. There are various approaches and trends are outlined towards the development of product service system (PSS) are outlined as

• Sale the use of product rather than product itself

• The change to leasing society

• A repair society rather than throw away society

• Change in user’s mentality from sales to service orientation.

The challenge new approach lies in system solutions, where bits and pieces fits together, integrated to a support care system which will the diabetic to self manage his/her conditions to a satisfactory level. Such system based solutions should facilitate the shift from other healthcare systems, in which products, services, supporting infrastructure and necessary networks are designed, so that to provide a certain quality of life to the diabetic and same time reduces the environmental impact of the system.

For a diabetic, this service means a shift from buying expensive products and spending time and money on doctor’s visits to buying a service which has potential to provide vital data through web based interface and the required product support

For the service provider, the service means higher degree of responsibility for the products full life cycle, early involvement of diabetic in the design of service and design of a close loop system.

Why this service?

The home care model concept has the potential to bring about such changes which can accelerate the healthcare industry to shift towards more sustainable practices and societies. According to some authors, the concept might be promising for commercial companies, government, and customers

Understanding this system will provide an opportunity to bring a better lifestyle for diabetic. The current health care practice in India is not very well organized. The cost of healthcare is unbearable by a common man and the government services are so chaotic and unhygienic. They are not really managed; the service they provide is not really dependable. So by supporting such kind of private healthcare institutes government can assure a clean and hygienic health care practice. The concept of a product service system facilitates innovation at a more than incremental level and has potential to bring financial benefits.

This service can be an extension for some healthcare companies for their existing offers for the patients. Others can see it as a new business opportunity.

Usually such companies are forerunners and see the opportunity of being first on the market as a basis for survival.

There are different benefits for product manufacturing companies, heath workers and health practitioners by getting associated with the service.

Product component

Attach addition value to product.

Simplify the usage of the product so as to understand by the common user.

Make the product economically viable and easily in reach of user.

Service component

Health workers can locate the area and take charge. Visit the diabetic at regular interval. The job of health worker is clearly defined, and that is to guide the diabetic to self manage his BGL. Explain the benefits regular exercise and diet control. Keep a track of their BGL readings and forward it to the concern heath practitioner. If serious symptoms observed she can suggest the diabetic to visit the concern health practitioner.

The role of health practitioner is to monitor the diabetic condition and prescribe the required mediation. He will be involved in educating the rural sector in conjunction with health workers and attend regular camps.

The overall set up will be organized and by the healthcare team and will be connected through a web based interface.

Government and society component

Understanding diabetes home care model (DHM) can therefore help to formulate policies that promotes sustainable pattern of consumption and sustainable lifestyle. DHM have the potential to offer a new way of understanding and influencing all the stakeholder relationships and viewing product networks, which again may facilitate development of more efficient policies (Mont.o.k)

At the same time, it is expected that the promotion of added services or substitute of products and alternative schemes of product-service use can assist in the creation of new job.

Benefits

Diabetics can be benefited by this service because they receive product support and prospect for schemes to for variety of products. It will not be mandatory to go for the same product as their will be a greater diversity of choices in the market for those who can afford.

The service components, being flexible by nature the, induces new combination of products and services, better able to respond to changing needs and conditions. The products given to the diabetics are can be under the ownership of the producer and so the user will not have to worry about its servicing part.

The service system changes the price cost systems of the present economy because “the cost of production are only a very small part of the costs involved in making a product available to customer.” Diabetics pay not for material goods but for intangible services. This can amplify the technical development of dematerialization, which is already an ongoing process.

As products are essential part of this service, successful development of a product service system requires that manufacturers and service providers extend their involvement and responsibility to phases in the life cycle, which are usually outside the traditional buyer-seller relationship, such as take back, recovery, reuse and remanufacturing. Usual responsibilities for products are extended through the additional or deepened responsibility for service, including the responsibility for proper organization of take back arrangements and systems for reuse, remanufacturing and recycling and for educating consumers about efficient product use. The reduced technology and material requires a stronger co-operation with suppliers and expertise of the field.

The relationship between the healthcare team and the diabetic plays key role if the product service system are to be designed effectively. Some healthcare institutions have already started working in the area of diabetes and building up close relationship with the diabetics.

The organization who wants to adopt this service will need to change its traditional structure. The extended involvement of the organization with other stakeholders and actors in the service chain may create a demand for intermediates. A web based service can act as the binding element or will act as a common thread. A new network may need to establish in order to develop the system. This can be research network which will investigate through qualitative and quantitative method the actual number of diabetics in the sector, regional and sectoral network can help locating diabetics which are unidentified, through the means of health camps, advertisement and campaigns.

Design particularities

There are few existing examples of design projects, where entire product service system is being designed. The design methodologies of the entire DHM probably differ from the regular product design method.

• Designing DHM requires close interaction of all actors with in the life cycle of a product service. Through interaction between the service and the product manufacturer, is more likely to permit the clear transmission of the economic incentives, allowing service activities to drive manufacturing or design changes.

• The servicing and maintenance part of product should be well designed

• Alternative scenarios of service considering different aspects and possibilities to be priorly thought of.

• The scenarios to be shown to the user of the service, providing information on economic and environmental offers.

• Health workers are to be trained regarding the topic of self management, diabetic care and other required knowledge.

Barriers

The concept of PSS is still in the development phase, but it has already been suggested all possible scenarios of moving towards more sustainable production and consumption system. Hence it’s therefore important to examine all convincible barriers to its development, application and continuous betterment.

• As the service is dealing designing both the product and service system it’s difficult to develop the scenarios of alternative product use.

• As we have an identified sector to work on the risk of acceptance of the service and convincing the service to the society reduces to an extent.

• The designing of service with product support considering the environmental and sustainable issues can be lengthening and can create dilemmas

• The user of the service might not be very enthusiastic about the ownerless service, or the target area might not turn beneficial.

• Product testing should be done before implementing the service as product failure can also lead to the failure of service.

• All components of the service need to be intact and well designed as the success /failure of service is the responsibility of each and every stakeholder.

Conclusion

There are many examples of service design can be found in various fields like eco design, product customization, recycling , healthcare, public services etc. but we can find very few complete examples which are successful in completing the loop. Hence service has to be design carefully considering each stake holders responsibilities and viabilities. Even we should have to think of the uncertainties which can fall into place time to time. Need to project future scenarios and work on those lines which will help in presuming the threat lying ahead. Readiness to accept the service by the user should be estimated by a participatory research to evaluate a competitiveness of the service and its profitability for the user. Research should be carried out in all various aspects; parallel model can be studied if required. Result of research and gather information will govern the future design directions.

Bibliography.

Social research methods, Lawrence Newman.

How to do research project. Colin Robinson.

M. Bhaskara Rao, Manja Prasek, Zeljko metelko, organization of diabetes health care in Indian rural areas, 2002

Mike Graves and Naresh Kumar Reddy, Electronic Support for Rural Health-care Worker.

WHO Technical Report Series 646, 1980. WHO Expert committee on diabetes mellitus: second report

Liam fennessy, Soumitri Varadarajan, Helen McLean, Working with communities: a case study of design for diabetes, 2007

Mont o.k, clarifying the concept of product-service system, Lund University.

Stahel WR, the limits to certainty: Facing risk in the new service economy, kluwer academic publishers, Dordrecht, 1989

Goedkoop MJ, van halen cjg, te riele hrm, rommens pjm, product service systems, ecological and economical basis, 1999

Rao Pv., http://diabetes-india.com

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diabetes care model for India

PROJECT PROPOSAL

Keywords:

Diabetes, Product service system, Social Innovation, Diabetics,

Chronic diseases, Self management, Rural India.

Abstract:

“Designing a Product Service System for diabetics in India to self manage their conditions, mainly focused upon in particular the areas of data management, education, prevention, lifestyle change, and communication between diabetics, doctors, and health workers.”

Introduction

India second largest populous country in the world and out of which more than 70% of population resides in rural India. India is predominantly an agricultural nation, the literacy rate in India as a whole is still very low. And as its an highly populated country the its obvious to have a higher rate of diabetics. There are thousands of villages in India where people have to walk or travel by bullock cart for miles together just to obtain even a simple medical aid. There are no proper lavatory facilities, which are essential for diabetes patients. Remedies for diabetes prescribed by native medical men include neem tree leaves, bitter gourd juice, honey etc.

From above description it shows that there are many more problems and challenges are there related to diabetic health care in India. A community approach is necessary for planning and implementing prevention and control programs for non communicable diseases like diabetes with common underlying risk factors.

WHO estimates that there are 32 million diabetics in India, diabetes was responsible for more than 125,000 deaths in 2000 and up to 75 % of them were unknown of the fact that they are diabetic. Studies has proved that rising prevalence of non insulin dependent diabetes (NIDDM), which affects Indian earlier than west. Diabetes retinopathy the common cause of blindness in urban, middle class Indian is on the rise, although it is not at high risk. Diabetes is also the most significant cause of end stage kidney diseases. The cost of drugs for diabetes, already high for the average Indian, is expected to go up in the near future.

Diabetes health care in India

The practical management of diabetes in developing countries is often made difficult by the scarcity of health care workers, monitoring equipments and even drugs supply, especially in rural areas. Lack in general awareness of the disease due to in adequate or even absent diabetes education undoubtedly contributes to delayed presentation and misses diagnosis.

The development of diabetic complications is closely related to glycemic control, to accessibility to patient care, and to patient compliance with a rigid dietary regimen and lifestyle. These can be influenced by number of including age, co morbidity, socioeconomic status, and social health care support.

Hence the risk of development of long term complications could be avoided by improving the quality of diabetes care for patients by establishment of public health care system.

The cost of diabetes care is so high that government can not afford the medication cost. The annual estimated cost of care of one insulated treated person attending diabetes care in madras was more than Rs 25,000/-.

Out of 32 million diabetics in India, 20% that is around 7 million diabetics require insulin treatment. The government is unable to provide proper health care, so most of the people depend on private hospitals for better care. There are number of voluntary organization and private clinics and outpatient services to pay the individual attention, patient education towards diabetes.

Current Healthcare Associations active in India

Diabetes association of India was founded in Mumbai in 1955, the aims and objectives of this association are as follows:

• Study of the causes and treatment of diabetes.

• Promoting of patients education through various media such as lectures, discussions and publications.

• Promoting plans for early detection of diabetes.

There are 25 branches distributed all over India. The association works in co-ordination with WHO. The association takes active part, in international congresses on diabetes and organizes national congress on diabetes every three years.

Some other institutes like,

AIIMS- All India Institute of Medical Sciences.

Apollo hospitals are also actively connected with the Association.

Problems of Diabetes in Rural India

The rural sector is suffering from poor socio economic conditions, low health awareness and limited access to medical facilities. Within these circumstances rural diabetics are always diagnosed with severe level. Hence it shows that implications for the provision of healthcare service throughout the Indian subcontinent are clearly essential. These includes both the finances make comprehensive and acceptable diabetes care service to the people, and more important the consideration of capacity of people to afford this service. Indian government spends 1.2% of its annual budget on health and money routinely allotted to no communicable diseases and especially diabetes is sparse.

Approach:

For planning health care of Diabetes for a District in India, we will take a sample district Kandhamal from state Orissa.

The Dream Land of Nature

The district Kandhamal a part of erstwhile district of Boudh-Kandhamal came to existence on 1st April, 1993 as a result of reorganization of the district of Orissa. The district is a land of scenic beauties, water falls, and natural springs, hill tracts, perched with history antiquities. The District is otherwise peaceful but on 25th December 2007, it attracted attention due to Christians and Hindus and Kandha tribe and Pana caste people. This is the land where Kandha tribes are the principal inhabitants. The district headquarter is Phulbani located in the central part of the district. Administratively it constitute with 2 sub-divisions, 12 CDB, 2 ULB, 153 GPs and 2515 villages. Physiographical the entire district lies with high altitude zone with inter spreading inaccessible terrain of hilly ranges and narrow valley tracts which guides the socio-economic conditions of people and development of the district. More than 50% of population constitutes ST community of aboriginal tribal races. Overall, the district is rank as a backward district in the state of Orissa (India).

The population of the district is 6,90,000 (projected count on the basis of 2001 census) out of which 50,000 is urban population and 6, 40,000comes under rural sector. The literacy rate is 43% and the male to female ratio is 60% to 40% respectively.

There is one district headquarters hospital in phulbani, and four government hospitals in different tehsil place. The state is divided into two sub divisions namely Kandhamal and Baliguda and 12 C D blocks and 153 Gram Panchayats.

Map of kandhamal district Tehsil in kandhamal

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Planning of Diabetes Health care

The ever increasing numbers of diabetics alarmingly stretch the disease burden beyond the limits of health care provisions. A primary care clinician with certain with certain expertise in diabetes can barely look after some 30 persons a day by appending 10 min with each and provide minimal care to 1000 diabetics in a month.

To meet diabetic’s requirement and ensure and ensure easy approach to the health center, it has to be set in the center of the chosen place to reach the patients from the periphery and to allow for transportation of patients by ambulance in emergency to the regional diabetes health care center, which can be located at the four tehsil zones.

Hence the risk of development or progression of long term complications could be avoided by improving the quality of diabetes care for patients by establishment of a community health care system.

The healthcare for diabetes provides an excellent example of a chronic disease where primary health care must play a key role. The personnel involved at local and referral levels are physicians, nurses and midwives, community workers, who should ideally work as a team. After a period of training, community health workers have a valuable part to play in the health care team.

• The training should enable them to detect new cases.

• To test urine or blood for glucose, to identify specific problems.

• To give advice, and to know when and where to seek advice themselves.

• They should also be able to prescribe follow up care and to provide accurate information to the patient and his family relevant to patient needs.

The primary health center should be staffed with a physician, a nurse and some health auxiliaries. In addition to its health functions, it serves as an educational institution for both the staff and patients, as a center for dissemination of printed information such as diet sheets and as a place where patient’s records are kept. It aims to offer continuous comprehensive and coordinated care. The diabetic care health care centre in different zones will be equipped with OPD, inpatient ward and a care unit with a small administrative wing.

Responsibilities

Diabetes Home Care Team

This is a group of expertise which will be located in four different zones of Kandhamal district and will take care of the rural and urban diabetics come under the zone.

The set up of the home care model will consist of a diabetic physician, health workers @ 30 diabetics/ week. Small administrative wing to keep the records and check the digital records coming from various sub units located in the zone and process that data to the respective heath practitioner in the field.

The team will be associated with general health consultants like dietitian, Endocrinologist, physiotherapist, ophthalmologist, dentist, podiatrist etc. so as to direct the patients to the respective consultants for the treatment as per schedule.

Health care worker

Diabetes health care worker play an important role in the community health care systems. They work as assistant to the physician to give patient more detailed information and instructions about diabetes. The diabetic has to deal with special problems every day, including how to plan their meals with various foods, do different kinds of exercises, deal with hypoglycemic events, and seek doctor’s help and so on. A visit to general physician will not cover all information mentioned above, while a health worker in the field can make general information more and more in detailed and personalized to fit the patient’s daily life. The diabetes health worker can also work as diabetes educator to provide information and aware them with new symptoms.

There is a need of comprehensive plan for diabetic education; a person once diagnosed with diabetes has to live with the disease. All the more, this disease affects several aspects of the victim’s life, such as diet, lifestyle, physical well being, mental state, economic conditions, sexual and marital life, etc. so in any discussion regarding diabetes not only patient but also his family should take active participation.

The education plan should go through three phases, are

• Primary or initial education.

• Secondary or in depth education

• Tertiary or continuing education.

Diabetes education and treatment camps:

The camps will be conducted in periphery of different zones, once or twice a month. It can be worked out in collaboration with social organization or NGO’s to screen the diabetics in each zone. Advertisement or posters should be displayed for urban people while for villages village heads, schools, postal department should be involved. It would be very convenient to organize these camps in to school campus or any public open space. Local newspaper, television advertisement, radio announcement will be good way of publicity.

The diabetics in the camp should receive comprehensive treatment including education regarding the basic education regarding diabetes, diet modification, exercise, medications. Name and addresses should be recorded at same time and registration can also be happen the same time. Those who are not registered at the same time can be followed up with health care workers and convince them the importance of their involvement in the service.

Some Strategies

Our aim is to approach the problem of diabetes with a view to prevent and control it, with the help of appropriate diabetes health care system. While designing the system following aspects should essentially be considered.

• A web based service which will be more helpful and convenient for the diabetics residing in urban sector. This service will be a user pay service and the user will have free access to the basic informative web support, but has to subscribe for full service by paying yearly subscription. This will provide consultant support in respect to the diagnosis and necessary product support. Once the service is subscribed then the diabetic will get all the required product support and online feedback account. This will provide him the required day to day feed back in respect to diet, exercise and everyday tips for BGL management. They will get additional facilities like chat rooms and blog room where they can learn and share there views. This will help them to come out of their depression and form a community and make friends. They can chat directly to doctors and write directly through blog to get feedback from various expertises from all over the world.

• The rural sector will be mostly managed by the health workers, each zone will be having a central health care unit, which will take care of the online data of the zone and provide health worker support for the zone.

• The zone will be divided in sub zones and a particular area will be given to the health workers where he/she can take care of 30 diabetics, at the rate of 5 diabetics per day. So if we consider 3% is the diabetic population in the state then the number comes around 21,000 approx. out of these 2000 will be residing in developed cities, which can have direct access to internet. Where as rest of the 19, 000 people has to be taken care by the health workers.

• The diabetics can visit to doctors every month and the regular day to day management can be governed online. Those who don’t have access to web as in rural and remote areas can be managed by health workers on mobile healthcare.

• Heath care worker needs to carry a carer’s kit which will have enough space to carry necessary space to keep products and medicines for demonstrations, a small display screen for data review, internet connection device if required, small handouts and manuals for diet and exercise guide.

• The benefit of subscribing the service can be explained to the user by showing the long term returns and the use services in critical conditions in longer run.

Expected outcome

The design project will have a physical design outcome with the potential of it being web enabled. A well thought and practically designed health care service. The end deliverable will be a range of multiple operating systems for diabetics that will keep the updated records and directly communicated to concern doctors. Essential product design, development and support for the community.

Submitted by:

Student

Vazir Nadaph

P.G.D.P.D

Product Design,

National Institute Of Design. India

RMIT University. Australia

S3216510@student.rmit.edu.au

vazir@nid.edu

vazir.nadaph@gmail.com

Contact:

+61- 0431 935 105