Phase 3 and the third adaptation point

After the midline evaluation, the Kuunika Project restructured and streamlined its core partnerships leaving LIN and Cooper/Smith as the Lead Agencies, and other partners providing consultancy inputs as needed. As a consequence, Kuunika dropped its involvement in EMR roll-out at the district level.

10 Instead, it responded to MoH’s request to support the new Digital Health Division and implementation of the new National Digital Health Strategy (2020-2025) over Kuunika’s final Sustainability Phase.

Since May 2019, there have been two Presidential elections in Malawi. These have resulted in changes in political leadership and the institutional arrangements for the Digital Health Division. Initially, the new Digital Health Division was located under the Quality Management Directorate, but since early 2020 it has been located under the Directorate of Planning and Policy Development, where it has experienced a period of relative institutional stability.

The first cases of COVID-19 were reported in Malawi in March 2020. The Government of Malawi acted swiftly to introduce containment measures, despite the absence of a coherent pandemic plan.

Recognizing that digital health technology could play a key role in monitoring and containing the pandemic, MoH’s Public Health Institute of Malawi (PHIM) engaged Kuunika to develop a set of digital solutions to support pandemic surveillance and tracking, data analytics, case management and data use for decisionmaking. Along with the 24 staff it supported at the Digital Health Division, the Kuunika team worked with key MoH structures and role-players11to develop a number of COVID-19 digital products. This included, most notably, a DHIS2 mobile-based tool for recording and reporting disease surveillance data that built on UNICEF’s ‘One Health’ Surveillance Platform (OHSP).12 In addition, smart phones and tablet devices were distributed to District Environmental Health Officers (DEHOs), health facilities and ports of entry across all 28 districts to support case-based surveillance, contract registration and follow-up.13 A further set of digital support tools (including a national information dashboard, and systems for COVID-19 vaccination reporting / certificates) were designed to support the functions of the Public Health Emergency Operations Centre at PHIM.

A summary of key verified Kuunika achievements at endline evaluation is shown in Table 2 below. We note that several of these achievements relate to the strategically important objective of advancing the digital health architecture based on an Open Health Information Exchange (HIE) framework.

10 This was also driven by a shift in CDC’s EMR investment from BHT to the Elizabeth Glaser Pediatirc AIDS Foundation (EGPAF) 11 These included: MoH senior management teams, the Health Cluster, the President’s Task Force, the National Task Force on COVID-19 vaccines and Disaster and Risk and Recovery Management 12 UNICEF initiated OHSP development with LIN in 2019 to support integration of surveillance data on human health, animal health and ecosystem health. 13 This activity was assisted by other partners, such as ONSE, CHAI, PIH, Last Mile Health