Health Surveillance Assistant (HSA) Backpack

Health Surveillance Assistant (HSA) Backpack

Organization type: 
nonprofit/ngo/citizen sector
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Community health workers are playing a growing role in providing healthcare services in the developing world. We are working with local hospitals and NGOs in Malawi to bring quality healthcare to the last mile in Malawi by equipping the Ministry of Health’s Health Surveillance Assistants with portable pack of targeted tools to deliver diagnostic services, treatment, and preventive care in rural communities. While the pack has been designed for use in Malawi, the tools in the pack can be tailored to meet specific regional health needs and community health worker responsibilities. In addition, we are incorporating mobile technology into the packs to improve communication around outcomes tracking, patient referrals, and restocking of the packs.

About Project

Solution: What is the proposed solution? Please be specific!

In the developing world, many people in rural areas live far from centralized health facilities, and health professionals are often concentrated in urban areas. Many developing countries have a severe shortage of trained physicians and nurses; in Malawi, for example, the World Health Organization estimates that there are only .2 physicians and 2.8 nurses and midwives per 10,000 people. Community health workers are playing an increasing role in delivering care at the last mile, and serving as a bridge to healthcare facilities. However, they often lack appropriate support and equipment. Our community health outreach pack equips community health workers with a comprehensive set of tools to provide diagnosis, treatment, and prevention services; the tools have been refined with input from community health outreach nurses in rural Malawi. In addition, results from an early field test of the pack suggest that the pack lends community health workers legitimacy in their communities, and that this increases the likelihood that patients will seek care from them. To produce an integrated innovation, we are working with partners to incorporate handsets and SMS technology into the packs. In particular, SMS applications can be used to facilitate communication around health service delivery, outcomes tracking, and restocking of the packs.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

We have developed a pack containing tools for diagnosis, treatment and prevention that enables trained community health workers to deliver safe and effective care in rural settings. The pack was designed to enable providers to care for patients according to World Health Organization and Ministry of Health guidelines in Malawi. However, the packs can be tailored to meet the needs of any region in the world. We field tested the packs in Malawi in 2009; in spring 2010, 14 improved packs were piloted over one year. Based on feedback, Rice added commonly used medications, a scale, a water bottle and cups so that officers can observe patients taking their medications, and consumables. The current pack also addresses the specific responsibilities of the Malawi Ministry of Health’s Health Surveillance Assistants with tools to deliver safe immunizations, including a cold vaccine box and a sharps disposal box, and streamlined wound dressing and home‐based primary care materials. With low‐volume production, the cost of a fully‐stocked HSA pack is estimated to be $250-300; a rough estimate of restocking costs is approximately $30 every week. We estimate that each pack contains supplies for 100 patient visits, or two weeks of use.
About You
Rice 360: Institute for Global Health Technologies
About You
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About Your Organization
Organization Name

Rice 360: Institute for Global Health Technologies

Organization Phone


Organization Address

Rice University, 6100 Main Street, Houston, Texas 77005

Organization Country

, TX

Country where this project is creating social impact
How long has your organization been operating?

1‐5 years

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What stage is your project in?

Operating for 1‐5 years

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

According to the World Bank, Malawi’s GNI per capita is $330; life expectancy is only 47 years. In addition, the World Health Organization estimates that there are only .2 physicians and 2.8 nurses and midwives per 10,000 people. Malawi’s Ministry of Health uses Health Surveillance Assistants (HSAs) to promote community –based health care. There are an estimated 11,000 HSAs in Malawi. Training has been standardized for the HSAs by the MOH. However, HSAs often do not have the tools or support to deliver these critical health services to the last mile.

Our packs have been field-tested over approximately 2 years at St. Gabriel’s Hospital in Namitete, Malawi, located in a highly rural area outside Lilongwe, Malawi. St. Gabriel’s is a district hospital with a catchment area of 100 miles and more than 250,000 patients. Patients often travel by foot or bicycle to reach the hospital; as a result, St. Gabriel’s has an active community outreach program. Community health outreach nurses from St. Gabriel’s travel into poor rural communities to deliver basic health services and referral services to patients. Interviews with these community health workers are in a video included in this submission.

Share the story of the founder and what inspired the founder to start this project

A team of Rice University undergraduates in the Beyond Traditional Borders program were offered the global health technology design challenge of creating a portable kit for community health outreach nurses in Malawi. One of the students on the team, Elizabeth, had volunteered at St. Gabriel’s Hospital. She is extremely dedicated to the St. Gabriel’s community and considers it her “family”. Working with her team and physicians at St. Gabriel’s, she designed a prototype of the backpack and traveled to Malawi in summer 2009 to gather feedback on the packs from the community health outreach nurses at St. Gabriel’s. Elizabeth then produced and delivered 12 refined packs to St. Gabriel’s in January 2010. Last summer, she returned to St. Gabriel’s and gathered additional feedback that helped to refine the packs specifically for use by the Malawi Ministry of Health’s Health Surveillance Assistants. In addition, she helped to open up the opportunity for scale up of the pack at St. Gabriel’s hospital, as well as at another district hospital in Malawi. She started medical school this fall and will pursue a career in global health so that she can continue to lead in providing care for underserved populations in the developing world.

Social Impact
Please describe how your project has been successful and how that success is measured

We measure success in terms of how many patients receive improved access to healthcare as a result of the pack, and how well the pack equips community health outreach nurses to provide diagnostic, treatment, and preventive services in remote rural communities. We estimate that since January 2010, the packs have been used by community health workers based at St. Gabriel’s Hospital to provide care to an estimated 120 patients per week living in rural communities. Feedback suggests that these patients have improved access to basic diagnostics, treatment, and prevention. In addition, community health workers have said that the pack lends them legitimacy as qualified healthcare providers in their communities.

As we move forward, we will also measure success in terms of the number of new partnerships formed to facilitate country-wide scale up, the number of new packs distributed in Malawi, and the number of HSAs trained to use the packs. In addition, as we measure the impact of the integration of mobile SMS technology into the packs, we will look at the number and accuracy of patient referrals, and the accuracy and efficiency of restocking the packs and supply chain management.

How many people have been impacted by your project?

1,001- 10,000

How many people could be impacted by your project in the next three years?

More than 10,000

Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact

Increase number of packs and handsets in use at St. Gabriel’s and develop and implement training program for HSAs to accompany packs and handsets.

Task 1

Produce 10 new packs for use by HSAs at St. Gabriel’s Hospital

Task 2

Provide 10 new handsets to HSAs at St. Gabriel’s

Task 3

Train new HSAs at St. Gabriel’s to use the packs and handsets

Identify your 12-month impact milestone

Disseminate packs and handsets at additional target sites in Malawi, advance countrywide scale up, and evaluate and refine the packs and handsets

Task 1

Formalize partnerships to identify with new sites and send packs to one new partner

Task 2

Evaluate the use of the packs and handsets in the field, and refine these technologies for optimal effectiveness

Task 3

Establish a strong and sustainable supply chain for the packs using SMS applications and local supply partners

How will your project evolve over the next three years?

We will strive to optimize the packs, develop and refine training materials, and achieve countrywide scale up of the packs in Malawi. We will integrate mobile SMS technology and training in this technology into the packs enable regular communication between HSAs and centralized health facilities to improve patient referral services and supply chain practices. We will develop a system that engages HSAs in the assembly and maintenance of the packs and leverages local suppliers to ensure the packs are locally sustainable.

What barriers might hinder the success of your project and how do you plan to overcome them?

Funding to scale up the packs may be a challenge. We are aggressively pursuing fundraising opportunities for the packs, including through grant-making organizations and other implementing partners. In addition, we are designing a fundraising campaign around the packs to attract private philanthropy. One of our goals for the packs is to increase their sustainability through the use of local suppliers for the packs consumables. We have identified local suppliers in Malawi for some of the reusable items in the pack; however, the uninterrupted availability of supplies may be a challenge. We are working to implement mobile technology into the packs with the goal of improving supply chain management.

Tell us about your partnerships

Since 2009, we have partnered with St. Gabriel’s Hospital to develop, implement, and refine the HSA packs. St. Gabriel’s has been instrumental in advancing the design of the packs. Last summer, we began conversations with other hospitals in Malawi that have community health outreach programs; these hospitals represent additional opportunities to scale up distribution of the pack and evaluate its use in the field. Also last summer, we began conversations with a non-governmental organization and the Ministry of Health in Malawi; this NGO and the Ministry of Health are potential partners to scale up the implementation of the packs and to develop and implement training programs around the packs.

We are also beginning to work with an NGO in Malawi that uses mobile technology to improve access to health services in remote communities. The NGO has successfully implemented SMS technology into the community health outreach program at St. Gabriel’s Hospital and has a strong track record of successful project development in Malawi, working with the Ministry of Health, CHAM, Baobob Health, and many local and international NGOs. Our local partnerships continue to be critical to the successful development, expansion, and scale up of the packs.

Explain your selections

The development and improvement of the HSA packs has been supported by the Howard Hughes Medical Institute through its Undergraduate Science Education Program. HHMI has provided support for the Beyond Traditional Borders program, in which students develop and implement global health technologies of their own design. Staff and faculty support to guide the development, implementation, and refinement of the packs has come from the institutional support of Rice University. Student internships in Malawi to evaluate the packs in the field have been supported through a combination of HHMI and private philanthropy. In-kind support has been provided by St. Gabriel’s Hospital in Namitete.

How do you plan to strengthen your project in the next three years?

Over the next three years, we will partner with new hospitals in Malawi providing community health outreach care; we have already identified one new hospital in Malawi for immediate scale up of the packs. In addition, we have initiated conversations with an NGO that has a strong community health outreach program in Malawi in partnership with the Ministry of Health around scaling up distribution of the packs and training of HSAs in the use of the packs. These partnerships will provide additional opportunities to distribute and evaluate the pack, and to develop training programs.

We will incorporate mobile technology, and training in this technology, into the packs. We have begun conversations with an NGO based in Malawi that provides handsets with SMS applications to community health workers there. The applications facilitate stock monitoring and outcomes tracking to improve supply chain management and the effectiveness of the packs. We will work with hospitals and the Ministry of Health to evaluate this technology, and develop an efficient accurate data-driven supply chain. To ensure that the packs are sustainable, we will establish a system for HSAs to assemble and maintain the packs and identify local suppliers for reusable components.

Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.


Lack of physical access to care/lack of facilities


Limited diagnosis/detection of diseases


Limited access to preventative tools or resources

Please describe how your innovation specifically tackles the barriers listed above.

The HSA pack gives trained HSAs the equipment they need to provide diagnosis, treatment, and preventative services at the last mile. The pack is easily portable and can be transported over difficult terrain. It does not require power so can work in settings without electricity. We are exploring opportunities to integrate mobile technology into the pack; such SMS technology would enable regular communication between HSAs and centralized health facilities to support HSAs as they provide diagnostic and preventive care and refer patients when necessary. In addition, SMS technology would help to create a reliable, efficient supply chain to ensure that HSAs have access to the tools they need to provide quality health services.

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.



Leveraged technology


Enhanced existing impact through addition of complementary services

Please describe which of your growth activities are current or planned for the immediate future.

We are pursuing opportunities to scale up distribution of the packs from St. Gabriel’s to hospitals across Malawi; we identified one hospital for immediate scale up and other potential collaborators for long-term scale up. We are also developing a pipeline of new health technologies that do not compromise quality of care; these tools will help decrease the cost of the packs. We have started conversations with a mobile technology NGO based in Malawi to integrate mobile handsets and SMS applications into the packs to help HSAs communicate with centralized facilities for referrals, health outcomes tracking, and restocking and inventory management.

Do you collaborate with any of the following: (Check all that apply)

Government, Technology providers, NGOs/Nonprofits.

If yes, how have these collaborations helped your innovation to succeed?

Healthcare providers in the developing world help us identify need, develop technologies in response to that need, and implement and refine the technologies for optimal effectiveness. For the packs, we collaborated with healthcare providers at St. Gabriel’s Hospital in Malawi. Our organization also collaborates with non-governmental organizations working in global health and ministries of health in the developing world. We are pursuing partnerships with these kinds of organizations around scale up of the Health Surveillance Assistant packs; we have initiated conversations with non-governmental organizations and the Ministry of Health in Malawi to distribute the packs and train Health Surveillance Assistants.