Project Everest

Customer Segment

[CUSTOMER SEGMENT]: Health Malawi - Senior Clinicians - December 2018

From extensive research into and interviews of clinicians and other medical professionals, deep insights into the experiences of these people were uncovered. This allows the team to understand how we might best serve these segments, and who within them might be our early adopters.


The clinicians engaged operate in public clinics in the Blantyre District. Communities and clinics there are intertwined - clinic initiatives such as educational programs and structured clinical days create community engagement in clinics and determine the relationships of clinicians with members of their respective community.

Health Surveillance Assistants (HSAs) are key to this structure, acting as the bridge between public clinics and patients within the community. Although their work with patients is targeted towards preventative rather than curative treatments, their role is intrinsic to the successful operation of clinics at their most fundamental level. Whilst not our primary customer segment, understanding their role appears key to an effective solution, so insights on their role are included below.

Head Clinicians retain responsibility for day-to-day running of clinics and understand the challenges faced therein. However, it’s essential to understand the perspectives of the clinicians and HSAs who form the medical ‘front line’.

Public and private clinics act fundamentally differently, and a focus on public clinics has been retained. Although both private and public clinics faced similar challenges such as long waiting times, short patient consultations and overloaded work days, it was clear that privately funded clinics take initiative to focus their more considerable resources towards addressing challenges as they see fit, clinic by clinic. For example, LMJ Limbe Diagnostic Clinic, a privately funded clinic in Blantyre, is in the process of funding an extension to increase the clinic’s available space and facilities in order to address overcrowding. As a result, the interests and priorities of private clinics, such as LMJ, generally do not correspond with the challenges the current health project is seeking to address.



A range of primary concerns from healthcare professionals exist, regarding the impact of insufficient healthcare in executing their roles successfully. For example, common issues that transpired included over-capacity in clinics, compromises of professional medical care, limited face-to-face consultation time and limited access to resources. These were defined as persistent problems that challenged Malawian healthcare workers on a day-to-day basis.


Clinicians often feel helpless and overwhelmed that they are unable to sufficiently help the people they feel responsible for helping. For example, developing an ongoing doctor/patient relationship is key to the establishment of trust. However, due to inconsistencies within the healthcare system, many healthcare professionals stated that they feel anxious in not being able to implement continuous care. Furthermore, clinicians and nurses stated that they often feel unsatisfied in their roles due to limited patient contact, medicinal shortages, infrastructure insufficiencies, potentially high cost of care for patients, and the lack of urgency some patients exhibit towards health-related issues.

Healthcare management is a major concern for personnel. Within Limbe Health Clinic and the Makhetha Clinic, HSAs were dissatisfied by the lack of attention given to their clinic and staff. Another issue that emerged included the disregard for their professional work opinions, the perception that higher management is unapproachable, lack of motivation due to an unsatisfactory salary, and the absence of necessary communication related to patient care. For example, at the Limbe Health Clinic, Senior HSAs stated that they are often not notified of medicinal changes such as substance modifications, alterations in volume, and overall medication design. Consequently, this means that HSAs are firstly forced to seek clarification before administering medication and, secondly, are also at risk of wasting medication due to volume changes.

Clinicians’ efforts to improve patient care engendered self fulfilment. For example, many healthcare professionals stated that they were happy to, and actively do, offer after-hours support to patients that need it. Avenues of support include clarifying medication dosages, monitoring patient symptoms after visitation and answering patient questions. When clinicians indicated that they were working after-hours, many stated that their desire to help patients was their motivation. Interviewees also stated that they thrived in a consistently busy environment as it allowed them to feel fulfilled. However, this was also due to many healthcare professionals perceiving their expertise as being of high-demand and exceedingly relied upon by their communities. Additionally, clinicians demonstrated a reluctance to pass the responsibility of their patients to parties they do not trust. This further highlights the personal investment clinicians have in the quality of care their patients receive.


A range of early adopter behaviours have been observed. A major behavioural trend identified during the interviews was that a large proportion of clinics had structures in place so that specific populations of patients visited the clinics on a specified day. This strategy helped to filter patient traffic, whilst also enabling the clinic to provide educational programs which were tailored to the specific population visiting on that day. For example, Zingwangwa Health Centre provided specific clinic days throughout the week for maternal health, antiretroviral therapy (ART), ‘teen club’ and general outpatient department, so that patients in these populations could receive the most efficient healthcare treatment available.

Additionally, another significant behavioural trend identified was that 75% of clinicians interviewed stated that they extended their working hours to alleviate clinic capacity pressure. The working day for a majority of clinicians was from 7:30am until 4:00pm. With the number of patients being treated at various clinics ranging from 200-1000 patients per day, however, many clinicians worked later into the day, extending their hours until all of the patients at the clinic had been treated. This strategy is an early adopter behaviour (exchanging time in an attempt to solve the problem), but it is not sustainable, with many clinicians vocalising that they feel “exhausted” and “disheartened” by the compromise of patient care that occurred regardless.

Clinicians wish to adopt key behaviours, but are inhibited from doing so. These include the desire to be able to hire more clinicians and nurses so that patient waiting times could be decreased and the workload could be more evenly spread throughout the clinic. Many clinicians also believed that an increase in educational programs would be beneficial for patients (especially those in high-risk situations) to improve the health literacy of the communities. Finally, all clinicians identified that with better resources they would be able to spend more time with their patients in consultation hours, and provide a higher quality of care. As summarised eloquently by Dr Asimah from Ndirande Health Clinic, “no matter how good of a doctor you are, without proper time, infrastructure and resources, there’s not much you can do”. The range and depth of interactions Project Everest personnel have had with these professionals shows the degree to which they are willing to communicate their perspectives on and determination to seek progress in the healthcare system.


The Health Consulting team has been extremely humbled by the dedication and compassion demonstrated by each healthcare professional they have had the pleasure of meeting.  Not only are clinicians extremely passionate about providing the highest quality of care to their patients, but they are also incredibly willing to share their expert understandings of the healthcare system. As a result, the team’s understanding of the challenges healthcare professionals face on a day-to-day basis has immensely developed. These insights have been integral to shaping the direction of the project, ensuring it is tailored to best meet the interests of the individuals that constitute Blantyre’s healthcare system.


edited on 24th January 2019, 22:01 by Ella Grier

Ella Grier Dec 13, 2018

Status label added: Customer Segment

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