Figure 1: Schematic timeline of the Kuunika Project

Figure 1: Schematic timeline of the Kuunika Project

In keeping with Kuunika’s responsive project design, project roll-out was characterised by three key adaptation points. These were: i) a pivot to ‘unlocking defined key capabilities’ in HIV services in 2018; ii) [after the independent midline evaluation in 2019], a significant reconfiguration of the consortium,

1 followed by Kuunika being appointed as the prime implementer for the Ministry of Health’s new National Digital Health Division;2 iii) a pivot to support the national response to the COVID-19 pandemic through support for new customised digital platforms, data analytics and ‘knowledge translation’.

A responsive evaluation approach

The endline evaluation and special studies have sought to flex to the ‘strategic tacking’ of the Kuunika Project roll-out to assess project progress (from multiple stakeholder perspectives), and to identify lessons and recommendations for future program design.

The 2019 midline evaluation report documented a number of evidence-based achievements, as well as challenges in the early phases of the project. For example, key achievements included good progress in design and implementation of a Health Management Information System (HMIS) smartphone application (app), along with training in linking the new app and digital services to health workers’ routine work needs and procedures. It was also clear that the focus on ‘user capabilities’ was beginning to strengthen Kuunika’s implementation approach. However, there were growing concerns about the limitations of the EMR technology being rolled out in target districts, weak progress in improving HIV data quality and use, and wider concerns about the overall fragmentation of health information system (often driven by siloed donor priorities).

Evidence synthesis from across all data sources at the endline evaluation points to useful learning and effective course correction by the Kuunika team. Since 2019, Kuunika’s Phase 3 Sustainability Phase has largely focused on technical assistance to the National Digital Health Division (DHD). The latter has included secondment of Kuunika staff to the Division (to make up a DHD staff complement of 24 staff members) and technical / convening support for development of Malawi’s new Digital Health Strategy, 2020-2025. Figure 2 below provides an overview of some key achievements found at endline. We note that many of these achievements relate to the strategically important objective of advancing the digital health architecture based on an Open Health Information Exchange (HIE) framework.

1 This reconfiguration resulted in LIN and Cooper / Smith becoming the Kuunika Project’s Lead Agencies. 2 This was in keeping with Kuunika’s plan for sustainability in Phase 3.