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‘Design with the user’ is a guiding principle for creating digital solutions to solve systemic developmental challenges. According to this principle, digital solutions are more likely to be effective if the intended users are involved in the design process, thereby rooting design thinking in a human-centric approach that seeks to understand their characteristics, needs and challenges. However, few examples exist for human-centred design (HCD) processes being successfully applied in low-and-middle-income countries to create digital health interventions that achieve both scale and sustainability. This paper describes the application of a five-stage HCD process to develop a suite of mobile solutions to improve reproductive, maternal, neonatal and child health in Bihar, India, and discusses lessons learnt. Two of the solutions were later adopted by the government and scaled to 10 million subscribers and more than 300 000 front-line health workers (FLHWs) in 13 states. The socio-ecological model, which considers the interplay between individual, interpersonal, organisational, community and public policy factors, provides a conceptual framework for understanding key learnings from the HCD process. At the organisational level, we found that demand generation was constrained by deficiencies in the public health system, while at the community level, gender norms were a barrier to changing health practices. At the interpersonal level, mobile health solutions for mothers also had to address fathers, because they controlled women’s access to mobile phones. At the individual level, FLHWs had limited time to build their skills and needed more flexible, home-based learning opportunities; most FLHWs had access to mobile phones, but devices were overwhelmingly basic and digital skills limited; voice technology was required to maximise reach among low literate women and an authoritative yet empathetic narrator was required to humanise the digital experience, lend credibility and create engagement.

IntroductionKilkari is the largest maternal messaging programme of its kind globally. Between its initiation in 2012 in Bihar and its transition to the government in 2019, Kilkari was scaled to 13 states across India and reached over 10 million new and expectant mothers and their families. This study aims to determine the cost-effectiveness of exposure to Kilkari as compared with no exposure across 13 states in India.MethodsThe study was conducted from a programme perspective using an analytic time horizon aligned with national scale-up efforts from December 2014 to April 2019. Economic costs were derived from the financial records of implementing partners. Data on incremental changes in the practice of reproductive maternal newborn and child health (RMNCH) outcomes were drawn from an individually randomised controlled trial in Madhya Pradesh and inputted into the Lives Saved Tool to yield estimates of maternal and child lives saved. One-way and probabilistic sensitivity analyses were carried out to assess uncertainty.ResultsInflation adjusted programme costs were US$8.4 million for the period of December 2014–April 2019, corresponding to an average cost of US$264 298 per year of implementation in each state. An estimated 13 842 lives were saved across 13 states, 96% among children and 4% among mothers. The cost per life saved ranged by year of implementation and with the addition of new states from US$392 ($385–$393) to US$953 ($889–$1092). Key drivers included call costs and incremental changes in coverage for key RMNCH practices.ConclusionKilkari is highly cost-effective using a threshold of India’s national gross domestic product of US$1998. Study findings provide important evidence on the cost-effectiveness of a national maternal messaging programme in India.Trial registrationNCT03576157.

BackgroundDirect-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.MethodsWe conducted an individually randomised controlled trial in four districts of Madhya Pradesh, India. Study participants included Hindi speaking women 4–7 months pregnant (n=5095) with access to a mobile phone and their husbands (n=3842). Women were randomised to either an intervention group where they received up to 72 Kilkari messages or a control group where they received none. Intention-to-treat (ITT) and instrumental variable (IV) analyses are presented.ResultsAn average of 65% of the 2695 women randomised to receive Kilkari listened to ≥50% of the cumulative content of calls answered. Kilkari was not observed to have a significant impact on the primary outcome of exclusive breast feeding (ITT, relative risk (RR): 1.04, 95% CI 0.88 to 1.23, p=0.64; IV, RR: 1.10, 95% CI 0.67 to 1.81, p=0.71). Across study arms, Kilkari was associated with a 3.7% higher use of modern reversible contraceptives (RR: 1.12, 95% CI 1.03 to 1.21, p=0.007), and a 2.0% lower proportion of men or women sterilised since the birth of the child (RR: 0.85, 95% CI 0.74 to 0.97, p=0.016). Higher reversible method use was driven by increases in condom use and greatest among those women exposed to Kilkari with any male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). Immunisation at 10 weeks was higher among the children of Kilkari listeners (2.8% higher; RR: 1.03, 95% CI 1.00 to 1.06, p=0.048). Significant differences were not observed for other maternal, newborn and child health outcomes assessed.ConclusionStudy findings provide evidence to date on the effectiveness of the largest mobile health messaging programme in the world.Trial registration numberTrial registration clinicaltrials.gov; ID 90075552, NCT03576157.

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What does it mean to respond to the Anthropocenes, plural, when doing science education? Specifically, can we critically engage with the Anthropocene, singular, without responding to the multiplicity in which Indigenous land and its many facets within the global community were at risk of destruction from Man? In this work, we contemplate the urgency of the inclusion of Indigenous philosophies and ways-of-knowing within the arching body politic, giving space to these practices that have been otherwise silenced within and beyond Western colonial frames. We argue that if the ways of thinking and practicing science and science education continue to stem from settler colonialism, capitalism, and toxicity, having previously and continually been responsible for the erasure of Indigeneity, the response within the Anthropocene will be multitudinously harmful. Here, we turn to Dakota scholar, Kim Tallbear, (Native American DNA: Tribal belonging and the false promise of genetic belonging, University of Minnesota Press, 2013) and her work in the intersections of identity, science, settler relations, and Indigeneity with the use of provocative imagery to the innate feeling of and within the Anthropocene(s).

Between 2011 and 2019, an integrated communication programme to address reproductive, maternal, neonatal and child health was implemented in the Indian state of Bihar. Along with mass media, community events and listening groups, four mobile health services were co-designed with the government of Bihar. These wereMobile Academy—a training course for frontline health workers (FLHWs) supporting them as the last mile of the health system;Mobile Kunji—a job aid to support FLHWs’ interactions with families;Kilkari—a maternal messaging service delivering information directly to families’ mobile phones, encouraging families to seek public health services through their FLHWs; andGupShup Potli—mobile audio stimulus used by FLHWs in community events. WhileMobile KunjiandGupShup Potliscaled to other states (two and one, respectively), neither was adopted nationally. The Government of India adoptedKilkariandMobile Academyand scaled to 12 additional states by 2019. In this article, we describe the programme’s overarching person-centred theory of change, reflect on how the mHealth services supported integration with the health system and discuss implications for the role of health communication solutions in supporting families to navigate healthcare systems. Evaluations ofKunji, AcademyandGupShup Potliwere conducted in Bihar between 2013 and 2017. Between 2018-2020, an independent evaluation was conducted involving a randomised controlled trial forKilkariin Madhya Pradesh; qualitative research onKilkariandAcademyand secondary analyses of call record data. While the findings from these evaluations are described elsewhere, this article collates key findings for all the services and offers implications for the role digital and non-digital communication solutions can play in supporting joined-up healthcare and improving health outcomes.

Kilkari is one of the largest maternal mobile messaging programmes in the world. It makes weekly prerecorded calls to new and expectant mothers and their families from the fourth month of pregnancy until 1-year post partum. The programme delivers reproductive, maternal, neonatal and child health information directly to subscribers’ phones. However, little is known about the reach of Kilkari among different subgroups in the population, or the differentiated benefits of the programme among these subgroups. In this analysis, we assess differentials in eligibility, enrolment, reach, exposure and impact across well-known proxies of socioeconomic position—that is, education, caste and wealth. Data are drawn from a randomised controlled trial (RCT) in Madhya Pradesh, India, including call data records from Kilkari subscribers in the RCT intervention arm, and the National Family Health Survey-4, 2015. The analysis identifies that disparities in household phone ownership and women’s access to phones create inequities in the population eligible to receive Kilkari, and that among enrolled Kilkari subscribers, marginalised caste groups and those without education are under-represented. An analysis of who is left behind by such interventions and how to reach those groups through alternative communication channels and platforms should be undertaken at the intervention design phase to set reasonable expectations of impact. Results suggest that exposure to Kilkari has improved levels of some health behaviours across marginalised groups but has not completely closed pre-existing gaps in indicators such as wealth and education.

There has been exponential growth in the numbers of ‘digital development’ programmes seeking to leverage technology to solve systemic challenges. However, despite promising results and a shift from pilots to scale-ups, many have failed to realise their full potential. This paper reflects on lessons learnt from scaling and transitioning one of the largest mobile health programmes in the world to the Indian government. The complementary suite of services was designed by BBC Media Action to strengthen families’ reproductive, maternal, neonatal and child health behaviours. Mobile Academy was a training course to refresh frontline health workers’ (FLHWs) knowledge and improve their interpersonal communication skills. Mobile Kunji was a job aid to support FLHWs’ interactions with families. Kilkari delivered weekly audio information to families’ phones to reinforce FLHWs’ counselling. As of April 2019, when Mobile Academy and Kilkari were transitioned to the government, 206 000 FLHWs had graduated and Kilkari had reached 10 million subscribers. Lessons learnt include the following: (1) private sector business models are challenging in low-resource settings; (2) you may pilot ‘apples’ but scale ‘oranges’; (3) trade-offs are required between ideal solution design and affordability; (4) programme components should be reassessed before scaling; (5) operational viability at scale is a prerequisite for sustainability; (6) consider the true cost of open-source software; (7) taking informed consent in low-resource settings is challenging; (8) big data offer promise, but social norms and SIM change constrain use; (9) successful government engagements require significant capacity; (10) define governance structures and roadmaps up front.

The present paper is the third of a series of papers devoted to the study of h - p spectral element methods for three dimensional elliptic problems on non-smooth domains using parallel computers. In this paper we provide error estimates, preconditioners and numerical results. The spectral element functions are fully non-conforming. We propose preconditioners on non-smooth domains which can be diagonalized using separation of variables technique. Optimal error estimates in terms of number of layers in the geometrical mesh and in terms of number of degrees of freedom are obtained. The method is easy to implement on a parallel computer and we briefly outline computational techniques. We give results of numerical simulations to confirm the theoretical estimates. Theoretical results have been also validated by computational experiments which are published independently in Dutt et al. (2014).

Food forms one of the basic elements of our existence. The dissection of food at a gross, medium and subtle level reveals its impact that touches human existence at every possible level. The study of this ancient wisdom of India is best understood through upanishads or through living examples of this belief system. A deeper look at this topic revealed “We are what we eat”. The impact of food at a physical, intellectual, emotional and energy level shows its intertwined relationship that impacts the elements of leadership. Leadership is a concept that has been written and discussed about through theories, models, styles, definitions etc. From this vast literature of Leadership, a basic aspect that would be common across various perspectives has been taken. These elements form the part of the leadership ability impacted through an individual's physical, intellectual and emotional stature. It is these levels that are impacted by one’s intake through five senses and one of the senses relating to taste gets formed by one’s food intake. Thus, the paper introduces the two concepts Food and Leadership. The paper attempts to study the unique relationship of the two concepts through three references - ethnographic study of the gurukuls, case study of natural leadership on Tine Mena and the Chandogya upanishad view along with a summarized version of Bhagavad Gita. The views expressed in the paper are at an elementary stage and further studies can be made in order to study the data statistically. Towards the end a few opportunities for further research have been shared that can add value to this preliminary thought.

The concept of swadharma is ancient but its application holds modern relevance. The ancient wisdom of Bhagavad Gita engulfs thought provoking ideas on the concept of swadharma. The concept without any formal rules or guidance procedures is intertwined in the lifestyle of a human civilization through the framework of varna vyavastha and ashrama vyavastha. These terminologies have been explained in the paper based on the study of commentaries and translations of Bhagavad Gita. In order to view the visible results of swadharma an additional dimension has been studied. This is done by studying the inter-relationship between swadharma and leadership. The findings are based on secondary data sources that provide an overview of the topic. The paper concludes by stating avenues for future research in terms of variables closely associated with swadharma and leadership. Also, the additional areas of study have been suggested that can provide with primary data sources.

This is the first of a series of papers devoted to the study of h-p spectral element methods for solving three dimensional elliptic boundary value problems on non-smooth domains using parallel computers. In three dimensions there are three different types of singularities namely; the vertex, the edge and the vertex-edge singularities. In addition, the solution is anisotropic in the neighbourhoods of the edges and vertex-edges. To overcome the singularities which arise in the neighbourhoods of vertices, vertex-edges and edges, we use local systems of coordinates. These local coordinates are modified versions of spherical and cylindrical coordinate systems in their respective neighbourhoods. Away from these neighbourhoods standard Cartesian coordinates are used. In each of these neighbourhoods we use a geometrical mesh which becomes finer near the corners and edges. The geometrical mesh becomes a quasi-uniform mesh in the new system of coordinates. We then derive differentiability estimates in these new set of variables and state our main stability estimate theorem using a non-conforming h-p spectral element method whose proof is given in a separate paper.

A researcher is the most crucial constituent in any research and re-search under Communities of Practice, specifically for research domain concerning the social aspect of human existence. This chapter presents a collaborative auto-ethnography of researchers’ preparation for undertaking indigenous fundamental research. The chapter has three major sections ‘why researcher preparation?’ followed by ‘how it was achieved (process of researcher preparation)’ and finally describes ‘the way ahead’. The researchers had a common interest and common philosophical orientation, so the researcher preparation activities were conducted in a ‘community’ formed by the researchers. This community involved the authors who ‘interacted’ and ‘experienced’ the indigenous phenomenon. The account could help other researcher(s) in forming a community with varied areas of interest, but with similar philosophical approach.

In this paper a nonconforming spectral element method is discussed for the elliptic partial differential equations with periodic boundary conditions. The formulation is based on the minimization of a functional by the least squares method. The periodic boundary conditions are added in the weak form in the formulation of the functional and the normal structure of resulting coefficient matrix is retained. To obtain the conforming solution a set of corrections are made and the error is estimated in H 1 norm.

This paper is devoted to the study of non-conforming h - p spectral element methods for three dimensional elliptic problems on non-smooth domains using parallel computers. To overcome the singularities which arise in the neighbourhoods of vertices, edges and vertex-edges we use local systems of coordinates together with geometric meshes which become finer near corners and edges. We provide estimates for the error and the computational complexity of our method and present results of numerical simulations that have been performed to validate the theoretical estimates obtained in 22].

In recent times, researchers' interest in understanding the nature of leadership's relationship to spirituality has been fuelled by a striking commonality among successful leaders with regards to t...