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How to understand public healthcare challenges

The Skoll Centre’s Apprenticing with a Problem awards support individuals to engage in experiential learning and deep immersion around the challenges that they seek to tackle.

Oxford MBA alumna, Melissa McCoy, is a 2016-17 awardee whose apprenticeship took her to South Africa to learn about the real challenges faced in the healthcare system, from those who experience it first-hand.

About two years ago, I started trying to solve South African public healthcare challenges before setting foot in the country. For my Oxford MSc Computer Science thesis project, I built a low bandwidth-optimised online telehealth platform and a machine-learning based triage tool for South African patients to solve issues of doctor scarcity and misdistribution. While this sounds logical, I jumped into creating a solution before truly understanding the problem space.

The Skoll Centre’s Global Challenge competition, which resulted in an Apprenticing with a Problem grant, was a huge blessing. It gave me the resources and thought space to understand South African healthcare challenges from several angles and ensure I was tackling the problems in the right way.

The resulting research that my team and I completed focused on visiting 15 healthcare facilities, spanning several characteristic types:

  1. Primary, secondary, and tertiary levels of healthcare
  2. Gauteng, Western Cape, North West, and Mpumalanga provinces
  3. Remote rural, rural, and urban geographies.

The research also focused on speaking with four types of stakeholders (doctors, nurses, facility managers, ICT professionals) that represent the various healthcare system perspectives.

While our findings around the problem space were extremely valuable (and are fully detailed in our report), we also took away some surprising insights:

  1. Willingness to embrace change: Contrary to our initial beliefs, people in the public healthcare system in South Africa do not enjoy the status quo. They are cognisant of the challenges and inefficiencies in the system. They also believe that while there is a lot that rests on the powers that be, there is a lot that they can do themselves to bring about change. Our visits were viewed with optimism and most facilities were hopeful and confident that our suggestions would be beneficial for them. A system that is not cynical and is open to feedback is bound to see progress in due course of time. The positive attitude of practitioners and the administration alike towards embracing technological improvements was a huge motivational factor for us.
  2. Bottom-up, Organic Tech Solutions: While many facilities lacked digital infrastructure to allow for referrals and sharing information, healthcare facilities & professionals devised their own ways to facilitate these processes. Doctors had created WhatsApp groups to discuss difficult patient cases. Nurses had equally formed networks among themselves and would send SMS messages to each other to communicate bed occupancy and information about referred patients.
  3. Learning from field interviews is hard: We came into the research with several pre-conceived ideas around the core problems and the appropriate solutions to solve them. We wanted to validate if our hypotheses were correct without biasing interviewees in the process. In Rob Fitzpatrick’s book, The Mom Test (which we referenced often), he summarises the challenges of this process well: ‘Trying to learn from field conversations is like excavating a delicate archaeological site. While each blow with your shovel gets you closer to the truth, you’re liable to smash it into a million little pieces if you use too blunt an instrument. I see a lot of teams using a bulldozer and crate of dynamite for their excavation. They use heavy-handed questions like “do you think it’s a good idea” and shatter their prize. At the other end of the spectrum, some founders are using a toothbrush to unearth a city, flinching away from digging deep and finding out whether anything of value is actually buried down there.’ We botched at least a dozen conversations with stakeholder, by either introducing our concept of interest too early or never bringing it up and getting their true thoughts. This was a skill we gradually improved upon with every interaction.

Overall, the exploration was invaluable and one-of-a-kind. It set the stage for how our company, ConnectMed, planned to work with the South African public healthcare system, as well as how we now think about engaging the Kenyan system.

Melissa recently completed her MSc Computer Science and MBA at University of Oxford on a Rhodes Scholarship and is now working on a Africa-focused digital health venture, ConnectMed, in South Africa and Kenya. She previously worked in the Americas and Africa as an engineer, entrepreneur, and consultant.

Follow @melissa_mccoy

Download Melissa’s Apprenticing with a Problem report.

Read more about Apprenticing with a Problem on the Skoll Centre website.