Project Everest

Experiment Results

[EXPERIMENT RESULTS] Problem - Patient and Data Process Mapping - Health Malawi July 2019

Reference to Experiment Post:

Experiment Post:

 This experiment was designed in order to gain a thorough understanding of the Malawian healthcare system by mapping patient processes and data flows. Creating this map would enable future months to design a solution which addresses problems for various stakeholders and at various stages of the healthcare process. 

 In order to create this map, the team needed to fill the knowledge gaps around the relationships between patients, HSAs, and clinicians, as well as how data is stored and transferred by and between these three parties. Finding the necessary information consisted of conducting a series of interviews with head clinicians, HSAs, and HSA officers.

 Lean Phase: Problem

 Assumption: The team will be able to gather enough information to build a comprehensive patient process map and bridge knowledge gaps within the understanding of the Malawian health care system.

 Results:  The success metric was achieved for this experiment; to successfully create a map of patient processes with all previous knowledge gaps identified and filled (See Patient Process Map Attached). 

Throughout the experiment the team conducted interviews with healthcare professionals at the following facilities

- Dr Atusaye, Zingwangwa Head of Clinic, 09/07/19

- Lydia Mkumba, Zingwangwa Senior Clinician, 09/07/19

- Martin Maluwo, Limbe Clinic HSA & Washun Thomas, Limbe Clinic HSA Officer, 11/07/19

- Madalisto Kandaya, Makhetha Clinic HSA officer & additional HSAs, 15/07/19

These meetings were invaluable in helping the team to understand the workings of the Malawian healthcare system, particularly the roles of HSAs and patient data flows within this system:

  • First Point of Contact:

Patients and HSAs have a strong and trusting relationship. As a result of this, patients are more likely to visit HSAs as a first point of contact, and seek treatment from HSAs in the community over being referred to a clinician. 

  • HSA Triage:

At clinics, HSAs triage their patients manually, though some clinics use the Chipatala Robot system; a manual triage system which involves allocating patients a red, orange or green light to determine their severity and triage order.

The Chipatala Robot system is most often used for triaging children and is not wide spread or frequent in its use as patients find it confusing.

  • HSA Roles:

On an average day HSAs see an estimated 80-100 patients, spending around 30% of their time in clinics and 70% in the field. Under their role, they are expected to reach patients in a 1.5km radius from their clinic, but many go further than this, which can be difficult due to limited transportation. 

HSAs have more freedom in treating children than adults, and they have limited access to medication. HSAs only provide preventative medications to adults. 

  • CCM Roles:

HSAs can undergo an additional 7 days training in Community Case Management. This provides them with more time working in the community, as well as more equipment to use. They also have more responsibilities which fall under their roles, including transferring patient data to the DHO. CCMs see an average of 28-30 patients per day, and spend around 15 minutes with each of them. They also see an additional 50-75 patients through workshops in topics such as family planning. 

Of the 38 HSAs at Limbe Clinic, 9-10 are trained in CCM, and of the 18 at Makhetha Clinic, 6 are CCM trained. There is a high level of interest amongst HSAs in becoming CCM trained, however there is a limited amount of funding allocated to the training and so the breadth of CCM trained HSAs is restricted.

  • HSA Data Storage:

HSAs record their patient data manually, including records of medication stock and usage. Most types of data recording are limited; recording seems to be restricted to high priority cases such as tuberculosis. HSAs trained in CCM are expected to be more consistent in their data collection and recording processes.

HSAs conduct regular data reviews, though the regularity depends on the clinic (weekly, monthly, or quarterly). This is done in order to establish prevalence of diseases, patterns in symptoms and what has or has not been successful in the month and what needs to be adjusted for the following month.

These data reviews can be difficult to complete due to the amount of data that goes missing or is damaged from paper registers. 

  • HSA/Clinic Referrals:

HSAs refer patients to clinicians when the severity of their condition exceeds the limits of HSA training. This referral is often done verbally, with the HSA giving the patient a date and time which they should go to the clinic. Sometimes it is done on a carbon paper form, particularly by HSAs trained in CCM.

Patient data isn’t transferred from the HSA to the clinician other than through the referral process, and it is the responsibility of patients to repeat their symptoms to clinicians. 

HSAs check their referral book twice a week and follow up on patients who they have referred to clinicians. Patients do not always adhere to the recommended referral and attend the clinic due to transportation issues or long waiting times.

The relationships which exist between HSAs and clinicians varies depending on the clinic and approach adopted by the Head of Clinic. There is often a drive to establishing a strong and trusting relationship and for many clinicians this involves establishing greater face to face time and contact with HSAs

  • Clinic Data Storage and Transfer:

Clinics don’t refer patients to other clinics, and their data communication process is very limited. However, clinics are currently working towards using the BAOBAB system to connect clinic data. This will enable patients to scan their health passports at clinics which they haven’t been to before and enable clinicians to access previous medical data. This advancement will present a huge benefit for clinicians, as this new system will minimise the amount of data and patient history lost as a result of patients moving between clinics.

  • Clinic & HSA / Hospital Referrals and Data Transfer:

When an HSA or a clinician identifies that a patient requires emergency treatment, they refer them to the hospital. The only contact between HSAs and clinicians and the hospital is this referral. Clinicians and HSAs only call ambulances in the most severe cases to take the patient to the hospital.

 Validated Learning: As a result of this experiment the Health Team were able to gain a comprehensive understanding of the way in which patient and data processes through the Malawian healthcare system work. The team’s previous knowledge gaps around the roles of HSAs, referral processes, and data transfer and storage methods from community to facility to district level were identified and addressed. 

 Next Move: The team are able to proceed to utility testing with HSAs and clinicians. The purpose will be to build on the information obtained and proceed towards building an MVP that is suitable for the problem space, adequately addresses pain points and provides value in patient and data processes.

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edited on 24th July 2019, 07:07 by Isabella Strapp

Grace Blackford 1 month ago

Status label added: Experiment Results

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