Project Everest


[PROBLEM]: Malawi’s Healthcare System; HSA & Clinician roles, Patient and Data Processes - Health Malawi July 2019



The Health Consulting Team have been researching and analysing information gathered from interviews with healthcare professionals regarding the key challenges that exist within the Malawian Healthcare System. These challenges primarily stem from inadequate access to healthcare services in both rural and urban areas. The core of these issues derive from three main factors which include a lack of resources, congestion and overcrowding in healthcare facilities and inefficient patient data collection, storage and management processes.

In December 2018, the Health Consulting Team conducted interviews with Heads of Clinics in Blantyre in order to validate the customer segment. Through conducting these interviews, the team generated invaluable insights with regard to the healthcare challenges clinicians confront and their associated emotions.

From these insights, the January 2019 Health Consulting Team were able to construct a problem-centric message that encapsulated the challenges identified by Heads of Clinics which formed the basis of offer testing. The purpose of conducting offer testing experiments was to assess whether identified problems have been accurately defined; and if they have been, the level of engagement clinicians demonstrate with the problem.

In February 2019, a second iteration of the offer test was conducted; The problem centric message was expressed as “do you feel frustrated from a lack of quality consultation time with patients?”. From conducting offer testing, the health team validated that clinicians identify with feeling frustrated as a result of inadequate consultation time with patients and they demonstrate a high level of engagement with this problem. 

The July 2019 team worked within the three components of the problem space; identifying existing key knowledge gaps regarding how a patient and their data moves through the Malawian Healthcare System. This drove the July Team to largely focus on patient processes and data collection processes and systems. The team concentrated on the community and facility level of the healthcare system; conducting interviews with clinicians and HSAs (Health Surveillance Assistants) in order to inform these knowledge gaps. 

In order to comprehensively address these knowledge gaps, the team built a patient process map which visually represents patient process and patient data flows from the community, to facility, to district level. This enabled the team to identify key areas where inefficient data processes and overburdening occurs within the healthcare system. A thorough understanding of patient and data processes through the healthcare system is imperative as the health project moves towards MVP development. 


Through the meetings conducted with Heads of Clinics, Clinicians, HSA officers, CCM trained HSAs and HSAs, particular processes and problem areas within patient and data processes have been identified:

- Patients first point of contact: 

  • Approximately one third of patients meet with HSAs in their community before consulting clinicians
  • HSAs become aware of patients they need to attend to in a day through word of mouth in the community, through recording patient addresses in paper registers or through patients attending HSA-run community clinics on allocated days

- HSA roles:

  • An HSA sees approximately 80-100 patients a day; they are overburdened and often do not have sufficient time to spend with patients  
  • Their catchment area is suggested to fall within a 1.5km radius from their allocated clinic, but, in reality, the catchment area they serve is often much wider
  • The challenges this presents in exacerbated by: a lack of funding and resources allocated to HSAs, limited access to transport and the time consuming nature of their roles in following up with and consulting patients 
  • HSAs are expected to provide preventative healthcare to adults and under 5s in their communities: they often experience shortages in medication and supplies to execute on this aspect of their roles

- CCM trained HSA roles:

  • Few HSAs have been trained in CCM (Community Case Management) as a result of limited funding 
  • CCM trained HSAs lack sufficient support in their roles: they often do not have access to essential resources such as smartphones, patient referral books or medical supplies 
  • CCMs receive extra training (beyond initial training received by HSAs) and are expected to take on extra responsibilities in treating, referring and following up with patients: 
  • They receive limited support after receiving this further training 
  • They do not have the support of a network of CCM trained HSAs 


- HSA data storage systems

  • HSAs record their patient data manually in paper registers at community clinics or in tandem with community/house visits 
  • Each month, large quantities of patient data is lost or damaged from paper registers
  • This impedes the efficiency and quality of monthly patient data reviews/aggregate data collection 


- HSA to clinic referrals 

  • HSAs refer their patients verbally with the time and date to attend the clinic for consultation
  • CCM trained HSAs are expected to refer patients via paper forms
  • Patient data is not directly transferred from the HSA to the clinician; it is the responsibility of patients to repeat their symptoms/history to clinicians. 
  • Patients do not always adhere to the recommended referral due to factors such as access to transportation and long waiting times 

- Clinic data storage and transfer 

  • There is not an adopted system or consistent process for patient data transfers between clinics 
  • Patient history is recorded in physical copies of Patient Health Passports; patients are identified by the patient ID/barcode on the Passport. The electronic record of this data is accessible by each clinic, but not transferable between clinics 

Link to January Results Post: 

.Link to February Results Post:

Link to July Results Post:


The results from December 2018, January and February 2019 offer experiments validated that the customer segment, Heads of Clinics, clearly identify with the problem as it is defined; specifically, that they feel overwhelmed and overburdened in their roles and want to be able to spend more time with patients. In July 2019, the Health Team’s contact with healthcare professionals enabled existing knowledge gaps to be addressed; providing a more comprehensive and detailed understanding of patient data flows from the community to facility level and from facility to district level, the patient referral process, relationships between HSAs and Clinicians and their respective roles.

The challenges which exist within these processes have been clearly defined and understood by the team, enabling the project to proceed to utility testing and to develop an MVP that sufficiently addresses these various problem spaces.


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edited on 24th July 2019, 19:07 by Isabella Strapp

Grace Blackford 6 months ago

Status label added: Problem

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