Project Everest

CHALLENGE - Malawi Health Assessment

Ella Grier
Ella Grier | Jul 26, 2017 | in Health Consulting

This is a proposal to current and future Malawi Health Teams on executing the assessment phase of the project. Teams may use the comment section to post updates on progression through these stages and insights uncovered as a result. 


The Health Assessment team should investigate as many health-related issues as possible in order to uncover the central areas where impact can be made. An in-depth understanding of key issues, as well as the economic circumstances of potential stakeholders and their access to medical treatment and technologies, will create a strong platform from which ideation can begin.

Engagement with a wide variety of stakeholders is essential to generate a holistic perspective on what key issues are – and what treatments are currently in place. It is important that the team survey a broad demographic, from different socioeconomic classes, in order to gauge how problems and pains vary within and between communities. Engagement with local hospitals, clinics and pharmacies, in the area where teams are working, will provide a different perspective on these problems, as well as metrics on the cost, supply and access to essential health medications, facilities and services. The team should research current organizations dedicated to health-related issues in Malawi, find what capacity they operate in, and assess potential for data sharing or future collaboration. As well as this, universities and various government bodies can provide access to more general data and statistics.

Information can be collected through surveys, as well as interviews and conversations. It’s important that the team continually seek to build sustainable relationships with stakeholders (within communities, healthcare facilities, and organisations) based on honesty and trust, and ensure they manage expectations so that business development can be made easily in the future.


Throughout the empathise stage, data collected should be collated succinctly and survey structures should be refined persistently in order to arrive at a correct and extensive definition of health issues in Blantyre. These definitions should be based on a comprehensive combination of personal accounts and testimonials, as well as stats and data summaries. The team are encouraged to collaborate with the Malawi Assessments during this process, as a holistic approach to concurrently solving multiple areas will be the primary way impact can be made. From this insight, the team will be able to nominate key areas to focus ideation.


In the ideation stage, the team should develop solutions that generate access across a broad range of health issues, to ensure impact is maximized. The team may assess the viability of cloud-based knowledge platforms, health insurance schemes, supply distribution services, as well as collaborative solutions with other Malawi Assessment teams. It is important that empathise and define stages are continually refined throughout the ideation process, to verify that potential social enterprises will be functional and sustainable.

Dolly Phiri Jul 26, 2017

That's awesome, Ella!
Just an update on our progression from Empathy to Define...

The Malawi Health Assessment team started the month at the Empathise stage and has made significant progress toward defining the issues surrounding Health in Blantyre. The team began by learning about Malawian culture, the language and understanding the people before developing a survey. This allowed us to formulate a survey that would be received well by the locals across many villages in Blantyre and would allow us to more thoroughly define the issues communities are facing.

The team developed several surveys targeted to different stakeholders within the healthcare system - community members, health care professionals and pharmacies. For community members, data was collected across a sample of 80 surveys in various rural villages in Nancholi. After collation, the team was able to analyse and identify trends within these rural communities. Quantitative results were supplemented by qualitative insights from interviews with health professionals which allowed for a holistic definition of the issues. These included;

1. Lack of Education

Interviews with healthcare professionals revealed that most illnesses were preventable and easily treated, but there was a lack of education surrounding basic, at home, treatments amongst the community. This meant that they did not understand how to look after themselves, adopt safe drinking water practices and clean around the house to prevent stagnant water which would eventually reduce the risk of developing malaria.

2. Access barriers to health services

The health services provided to the communities are minimal. The clinics are very far away and villagers walk for an average of 1.5hrs to seek medical help. The health facilities also have a problem of high traffic, which increases the stress on doctors, especially as some people visit the clinic for illnesses that can be treated at home or by visiting the pharmacy. We found that this was the case because the medication from the doctor is largely free, as opposed to pharmacies, which charge significant mark-ups on medical supplies.

3. Low socioeconomic status

Across different demographics within and between communities, health issues were generally correlated to socioeconomic status. Low income and education means that individuals are unable to protect themselves from health problems. This lack of resources results in poor hygiene practices, poor quality of drinking water and malnutrition. All of which are factors that contribute to their susceptibility to illness.

4. Sociocultural influences

As a culture, Malawians depend heavily on the public healthcare system. The opinion of a doctor is highly valued and the people often visit the doctor immediately when they feel unwell. This practice means the people are disempowered and not able to autonomously look after their health.

For this point, the team has decided to work towards developing an app to facilitate the diagnostic process, reducing access barriers regarding cost, time and strain on both public and NGO funded facilities. In a hospital context, the service would reduce the patient inflow to allow priority for patients with more serious illnesses. In the context of individual community members, the service would relieve hindrances related to transport and aim to educate users around basic prevention techniques, empowering the communities to take control of their own health.
The team tested out a similar app, YourMD in a local clinic with the assistance of a field guide. The app would ask for the patient’s symptoms and suggest a possible illness, treatment and education on causes and prevention. In this preliminary phase, the health team found that the app would suggest illnesses similar, or associated to, illnesses being diagnosed by the doctor. Discrepancies may have been a result of the app’s western target user, which is not congruent in a developing context. However, with continued use, the app began to adapt and suggest illnesses found in developing countries such as Malaria. In terms of usability, the app was very well received by local field guides, who were helping to facilitate.

The health team would like to hear from the Project Everest community if this is a viable option and if it would be successful in Malawi. Alternative solutions, or ideas of how this concept may be built upon, are welcome.

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Andrew Vild Jul 27, 2017

I'll be sure to add some ideas I have on this space that utilises ideas from TLT (MedEd) and how that ties in with some other existing apps already developed.

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Ella Grier Jul 27, 2017

As a team this month, we've have also been looking into similar tech-based solutions. Ideas from the team are in the works, so watch this space.

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(Account removed) Jul 27, 2017

Another update from the health team here.
Over the past month we have been working in one of the 13 districts surrounding the city of Blantyre called Nancholi. In Nancholi is a local NGO operating called the Nancholi Youth Organisation. They provide a number of services surrounding health including a free health clinic run on Mondays and Tuesdays. George and Watson, the founders of NAYO, have very generously given us almost unrestricted access to their operations including seven months of raw patient diagnosis data collected in handwritten books.

After transferring all the data into Google Sheets and analysing the data, I wrote the attached report which gives a more indepth look at the prevalent illnesses, genders and ages of patients including whether they are new patients or not. Using this data and some background research of Malawi, I have identified the following considerations that need to be addressed when developing a tech based solution to the health care issues facing the communities we have been working in.

63% of patients visiting NAYO are female
This is an important consideration because in Malawi while the overall literacy level is 75%, for females only it is much lower at 59%. When developing a product to address the health issues, we need to know that if it is designed for an individual’s use we should make sure it is compatible with the literacy levels of the nearly two thirds of patients who are female.

Over 50% of patients are under the age of 18
This figure is backed by the statistic that over 50% of the Malawian population is under 18. While this can be a positive for teaching how to use technology or the level on technology literacy in the community, it can also pose challenges when considering the maturity of the younger patients and their willingness to self identify more sensitive health issues.

15% of patients are 2 years old or younger
Patients aged 2 and under have a limited capacity for effectively communicating health issues to parents or health care providers. When developing a tech based solution we should consider how well the program interactions will work for those who can’t verbally communicate well. Will they be able to answer certain questions asked of them? Will they be able to communicate issues that cannot be physically seen? Will care givers be able to identify these issues on their behalf?

64% of patients are travelling from outside Nancholi Village
This statistic highlights the issue of access to health services. Whilst some surrounding villages are nearby, some patients can face a long trek with multiple children in tow. A possible tech solution could focus on a way to bring the required health services closer to the patients. The travel considerations can also act as a deterrent to access health care in a timely manner.

Respiratory issues are the most prevalent
Two of the top three overall diagnoses are respiratory issues. Some of the respiratory issues facing the nancholi communities include respiratory tract infect, acute respiratory tract infection, upper respiratory tract infection and asthma. Future project may want to further investigate the causes and impact of these respiratory issues as some environmental factors have been identified throughout the month, including the frequent burning of rubbish such as soft plastics and large amounts of smoke produced during cooking each meal.

Attached is a report with more in depth data from the patient books. I would love for everyone to take a look and provide any more insights that I may have missed or discuss some of the insights I have found below and how this will impact any health-based business solutions.

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life time 2 months ago

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