Figure 8: Summary of key lessons from Special Study 1

used during the height of the OHSP roll-out. Consideration should, therefore, be given to building on this experience and formalizing it to provide timely systems support at district level. This gap could also explain some of the challenges which OHSP users were facing regarding systems support.44 ● Direct involvement and / or use of the COVID-19 digital solutions has primarily been limited to certain cadres and individuals in health facilities and ports of entry. In several health centres and ports of entry, only one focal person (e.g. HSA) was involved. Similarly, at district level, only the IDSR focal point or DEHO were involved. Those not involved had no access to this data until after it was packaged and presented by PHIM on their website, and through daily updates released by PTF to the general public. While this was considered unsatisfactory, other key informants argue that the unprecedented speed and regularity (sometimes daily) with which data was analyzed and fed back to districts represents a major shift in real-time data transparency and availability. ● Capacity building on the use of OHSP. The Kuunika team built the capacity of MoH staff at district level on the use of the OHSP system, including data capturing, synchronizing and use. However, there is no evidence of sustainable capacity yet built locally (i.e. district or health centres) on the technical side of digital solutions, including their maintenance and scale-up. ● Politics in the digital health space. Kuunika and the Digital Health Division supported MoH leadership and supported the national COVID-19 coordination effort to great effect, successfully aligning resources and designing systems that DHIS2. However, the special study enquiry found that other Implementation Partners continue to promote their own solutions and research tools in the districts, with some evidence that this ‘duplication of effort’ is overwhelming the healthcare workers, and even causing them to abandon government reporting systems. ● Lack of clarity on ownership and maintenance of mobile devices: There is no clear policy on the ownership, responsibility and maintenance of mobile devices used for uploading data at points of care. This can lead to ambiguity about respective responsibilities regarding faulty or lost devices. Additionally, when mobile devices are personalized, this can restrict usage by other officers.

Figure 8 below provides a diagrammatic overview of lessons learnt from Special Study 1.

Figure 8: Summary of key lessons from Special Study 1

44 Other problems were due to device shortages and incompatibilities and funding, which is beyond the remit of district-level IT support,