1 INTRODUCTION

This report on Special Study 2 is one of three ‘deep dive’ studies for the final evaluation of the Kuunika Project in Malawi. The study focuses on the how the programme engaged with the Government of Malawi’s pandemic response as the latter evolved.

The Kuunika Project: Data for Action is funded by the Bill & Melinda Gates Foundation (BMGF). It commenced in 2016 and was implemented in partnership with the Government of Malawi (GoM). The Kuunika Project aimed to establish a strong base of high-quality, routinely-available data and a culture of data use in the health sector, using the HIV/AIDS programme as a first use case. There was a particular focus on addressing the range of technological innovations, knowledge translation, and health system strengthening needs of the Ministry of Health (MoH) in Malawi. BMGF contracted Mott MacDonald to provide independent evaluation services to the Kuunika Project over the course of programme implementation (2016-2021). These evaluation services have included baseline, midline and endline evaluations. This Special Study (1) is one of three ‘deep dive’ special studies being conducted as part of Mott MacDonald’s final, endline evaluation. The study set out to assess how Kuunika engaged with the pandemic as it and the Government response evolved, and to explore if it took advantage of the impetus provided by the crisis to promote uptake across a national health system which has proved to be particularly resistant to the digital transition in recent years.2 The specific objectives of the study are: • to identify and analyse evidence (including quantified evidence, where available) for a permanent, COVID19 pandemic-driven ‘surge’ in demand for, and use in decision-making of, digital data in the Malawi health sector;

• to explore the role of Kuunika in initiating, directing and sustaining the digital surge; • to identify which aspects of Kuunika project design, activities and implementation were most important in: - supporting the immediate monitoring response (retrospective) and - (potentially) sustaining the digital surge (prospective); • to identify other (non-Kuunika) key contextual determinants promoting or limiting the sustainability of the post-Covid digital data surge in Malawi’s health sector; and • to draw out lessons and recommendations for the design and sequencing of new digital health sector programmes that can sustain and build on the ‘digital surge’ and promote adoption in national health systems that have hitherto been resistant. This Special Study Report begins with an overview of the Kuunika Project. Chapter 3 presents the Covid context. a review of key literature and the conceptual frameworks used to determine the potential impacts Kuunika may have had on any digital surge in the health sector. Chapter 4describes the study methodology, including data collection methods. Chapter 5 presents a synthesis of evidence-based findings from the study enquiry – these findings are presented systematically against each of the study objectives. The final

2 Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of

Early Scientific Literature - PubMed (nih.gov)

chapter of this report (Chapter 6) presents a summary of lessons arising from the study findings, along with our conclusion and recommendations for key stakeholders. The Annexes to this report provide the analytical frameworks in detail and more background information.