Consultant: Patient and Caregiver Perspective and Care Navigation

1. Background

As part of a maternal and newborn health collaborative care initiative in Malawi, D-tree seeks to demonstrate that strengthening the care pathway between community and facility levels can improve health outcomes and patient experiences, while reducing costs to the health system. Collaborative care refers to a model in which community health workers (HSAs) and facility-based providers work in an intentional, coordinated way to manage care for the same patients across the continuum–moving beyond one-directional referrals to a system where information, responsibility, and follow-up are shared bi-directionally across levels. Rather than treating community and facility care as separate, a collaborative care model is designed so that each level builds on the other's work, enabling continuity, reducing gaps, and improving the overall quality of care a patient receives. 

A core objective of this initiative is to ensure the model is grounded in the real experiences and perspectives of the women and caregivers it aims to serve. Understanding patient and caregiver perspectives–including barriers to care-seeking, experiences with referral systems, trust in health providers, and satisfaction with care–is essential to designing an intervention that improves health outcomes in a way that is responsive, respectful, and accessible. D-tree is therefore seeking a patient experience expert to lead human-centered design work with women and caregivers: understanding their current experience navigating maternal and newborn care, identifying where it falls short, and collaborating with D-tree to design patient and caregiver-facing interactions, workflows, and communication that meaningfully improve upon the status quo. D-tree will lead the final translation of design insights into digital tools, protocols, and training content.

Note: D-tree is in the process of selecting a specific clinical focus area within maternal and newborn health–for example, care for women with high-risk pregnancies or management of premature or low birthweight newborns–for this collaborative care initiative in Malawi. Through strategic engagement MOH and other stakeholders, we will select the specific focus area prior to the consultant beginning their work. This SOW references maternal and newborn health broadly as a placeholder, but the consultant's work will be scoped to the selected focus area once confirmed.

2. Objective

To provide expertise in patient experience research and human-centered design, generating the insights D-tree needs to design patient and caregiver-responsive components of the intervention. This includes documenting the current care experience, identifying priority gaps to resolve, and collaboratively designing what improved patient and caregiver interactions should look like at each point of the care journey–so that the intervention's design choices are grounded in real perspectives and clearly linked to a better experience.

3. What We Need From the Patient Experience Expert

The patient experience expert provides specialized patient-centered inquiry and design skills.

A. Measurement Approach

Identify how patient experience should be measured, both for this design work and in anticipation of a future evaluation.

• What validated or adaptable tools exist for measuring patient/caregiver experience in LMIC primary care and community health settings, particularly in maternal and newborn health? What dimensions do they typically measure (e.g., satisfaction, perceived quality of communication, ease of navigation, trust, wait times, respectful treatment, continuity of care)? Which are most relevant to a community-to-facility care continuum?
• Which dimensions are most important given the intervention's focus on coordination and continuity across HSAs and facility providers across antenatal, delivery, and postnatal care?
• How do we ensure that patient experience measures capture meaningful variation and are not subject to social desirability bias, particularly in a context where women may be reluctant to criticize health workers?

B. Understanding the Current Patient and Caregiver Experience

Document the current state of the patient and caregiver experience in navigating maternal and newborn care in Malawi. This is not a formal baseline–a baseline evaluation is anticipated in 2027–but a design-oriented assessment that captures how women currently experience the system, where the biggest pain points are, and what matters most to them. The findings should be documented clearly enough to show how each proposed design choice addresses a specific gap in the current experience at each level of care and why it should lead to a measurable improvement in health and in the collaboration across community and facility teams.

• What are the key barriers and facilitators that women face when seeking, accessing, and completing maternal and newborn care in the current system across different levels of care?
• What is the patient and caregiver experience of the referral process–from community-level HSA assessment through facility visit and follow-up? Where are the main friction points?
• Beyond referral, what do women experience as gaps in coordinated care as they move between HSAs and facility providers? Do women feel that different providers are working together and building on each other's wor–or does the experience feel fragmented, repetitive, or contradictory?
• What type of communication from health workers at each point of care–HSA assessment, referral, facility visit, and post-facility follow-up–would make the experience feel seamless and connected? What information gaps or moments of having to "start over" are most frustrating?
• After a facility visit, what follow-up at community level would be most helpful? What do women need in terms of information, reassurance, monitoring support, or guidance on danger signs? What feels supportive vs. intrusive?
• How do women perceive and trust HSAs vs. facility-based providers? How does this affect care-seeking behavior and adherence, particularly for high-risk pregnancies and the immediate postpartum period?
• Are there specific cultural, gender, or socioeconomic factors in the Malawi context that shape the care experience for pregnant women and mothers of newborns?
• What does a "good" experience look like from the woman or caregiver's perspective?

C. Designing Improved Patient/Caregiver Interactions and Workflows

Working collaboratively with D-tree, use the findings from Section B to practically design what better patient/caregiver-facing interactions should look like at each point of the care journey. The goal is to move from "here's what's broken" to "here's what we'd design instead and why it would be better."

For each priority gap identified, what should the improved patient/caregiver interaction look like in practice? For example:

• What should an HSA say (and how) when explaining a referral to a pregnant woman or new mother–what information, in what format, with what tone?
• What should happen when a woman arrives at a facility with a referral from an HSA–how should the handoff feel from the woman or caregiver’s perspective?
• What should facility providers communicate to women about diagnosis, treatment, risks, and next steps–and how should this connect back to the HSA?
• What should the HSA's follow-up visit look and feel like after a facility visit–what does the woman need at that point?
• Where should patient/caregiver-facing communication and counseling be standardized (e.g., scripts, visual aids, key messages) vs. left flexible for health workers to adapt?
• What feedback mechanisms could allow women to report on their experience, and are these feasible in the Malawi context?
• How should the proposed design choices be documented to make the link between current gaps and proposed improvements clear and traceable–for D-tree's internal design process and for the future evaluation?

D. Informing Future Evaluation Design

A formal baseline evaluation is anticipated in 2027, ahead of piloting the collaborative care model. While the patient experience expert will not be expected to collaborate directly with an evaluation partner at this stage, their input will be valuable in anticipating what a rigorous evaluation of this intervention would require. The expert should provide upfront guidance to D-tree on:

• Which patient experience measurement tools and frameworks are most appropriate for the Malawi context, and how they could be adapted for use in a future evaluation baseline and endline
• What qualitative methods are most appropriate for capturing the depth of patient/caregiver experience within a future evaluation (e.g., in-depth interviews, journey mapping, photo-voice) and recommended sampling strategies
• How the findings from this design work can inform D-tree's thinking about the evaluation approach–including which dimensions showed the most variation and where the intervention is most likely to demonstrate measurable change
• How patient experience measures should be integrated alongside health outcome and cost-effectiveness measures in an overall evaluation framework

4. Deliverables

• Recommended patient experience measurement approach– including selected/adapted tools, priority dimensions, and guidance on mitigating social desirability bias–for use in both the design work and as input for future evaluation planning
• Current state documentation: a clear picture of how women and caregivers currently experience maternal and newborn care in Malawi across community and facility levels, where the biggest gaps are, and what matters most to them
• Proposed patient/caregiver interaction designs for each key point of the care journey (HSA assessment, referral, facility visit, follow-up), with a clear link from each current gap to the proposed improvement and rationale for why it should lead to a better experience
• Participation in up to 3 working sessions with D-tree, including at least one joint session with the clinical expert to align patient/caregiver-reported gaps with clinical care pathway design
• Advisory input to D-tree on patient experience measurement tools, qualitative methods, and how findings should inform future evaluation design

5. Expert Profile

• Advanced degree in public health, medical anthropology, health services research, social science, or related field
• Demonstrated experience designing and conducting patient/caregiver experience research in LMIC health settings
• Expertise in qualitative and mixed-methods research approaches, including participatory and human-centered design methods
• Familiarity with patient experience measurement frameworks and validated tools applicable to primary care and community health
• Experience working in maternal, neonatal, or reproductive health programming preferred
• Experience in Malawi or similar Sub-Saharan African contexts preferred

6. Level of Effort and Timeline

Estimated 12-15 days from June-July 2026. Engagement will include remote consultations, fieldwork in Malawi (approximately 5-7 days), and documentation/report writing.

7. Budget Requirements

The consultant will submit a proposed budget as part of the application, which will be reviewed and approved by D-tree. Please include a simple budget of your daily rate (if a group is applying, please list each individual and their individual daily rates) and the number of days. If applicable, any other anticipated costs should be specified. D-tree will cover costs of fieldwork directly–these costs should not be included in the proposed budget. 

8. Application

To apply for this role, please submit your application through this link.

• Upload your CV in the CV section
• Upload your cover letter and budget in the Cover Letter section

Please note that by applying to this position, you consent to your name being checked against a terrorist watch list prior to any consultancy engagement. Deadline for submitting applications: May 15, 2026.