3.3 Pre-COVID Digital Progress in the Health Sector in Malawi

Depending on the maturity of the technology, the provision of health care through remote consultation came to be much more prevalent much more quickly, and as a result, the approach to digital tools in health systems appears to be undergoing a substantial and rapid shift. The global pandemic, plus the situation of much of the technology, appears to have effectively promoted the uptake of digital systems even in those national health systems which have proved to be particularly resistant to the digital transition.1516 Most of these digital solutions and innovative technologies have been specifically proposed for the diagnosis of COVID-19.. Fewer address lifestyle empowerment or patient engagement17 . Alsunaidi, S. et al. (2021) argues that controlling this kind of a pandemic requires understanding of several aspects and behaviour, which can only be done by collecting, analyzing and interpreting related big data.18 The digital solutions have become crucial tools for healthcare workers and policy makers in the sector as they seek to be on top of an evolving situation and effectively monitor and respond to the pandemic. Digital technologies have enabled authorities and stakeholders in the health sector to realize the importance of availability and sharing of comprehensive health data to effectively address the pandemic.19 There is generally a hope that ‘the Recovery will be Digital’ enabling the process of digitizing health data to proceed post-COVID at a new speed and scale.20

3.3 Pre-COVID Digital Progress in the Health Sector in Malawi

The previous 10 years before COVID saw a plethora of digital legislation, policies and strategies in Malawi, and the presence of many international donors and NGOs both supported and necessitated this. Kuunika’s focus on supporting one dedicated digital department within the MoH and maintaining the principle of interoperability in all digital developments had been important in promoting a culture of government-led standardised systems within the health sector. As outlined above, the Kuunika Project initially aimed to establish a strong base of high-quality, routinely-available data and a culture of data use in the Malawi health sector, using HIV as a first use case. Through the MoH, the Project has sought to strengthen the data systems architecture, while simultaneously evaluating targeted methods to increase data use for decision-making at facility, district and central levels.21 When COVID struck, Kuunika had made significant progress but was also experiencing challenges, both internal and external. Achievements included the set-up and functioning of the Digital Health Division, contributions to the National Digital Health Strategy and the Digital Health Sustainability Paper, and aid effectiveness e.g. through the joint HIS Investment Fund, several Data Use initiatives and the Master Health Facility Register. Challenges included a fragmented digital health investment environment, lack of joint planning between MoH and partners, and IT infrastructure issues across the country. Nevertheless, although progress in the early years was slow, it did provide the Kuunika team with a firm foundation of operational experience and lessons. These, in turn, enabled the significant contributions to the digital response to COVID.

15 The digital revolution | The King's Fund 16 Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature - PubMed (nih.gov) 17 ibid

18 Alsunaidi, S. et al. 2021. P.1 19 Horgan, D. et al. Ibid, p.2 20 The-next-normal-the-recovery-will-be-digital.pdf (mckinsey.com) 21 Kuunika. (2019). Press Statement for the Kuunika Core Package Launch. Retrieved from: https://www.kuunika.org/?p=3340