Table 6: Summary of Issues for not using OHSP

shows 12 health facilities using OHSP against a total of 16. However, no health facility in Blantyre and Machinga are using the OHSP system. Reports from these health facilities are compiled manually and then submitted to the DEHO or District IDSR focal person through either an ambulance vehicle or WhatsApp. This is a major issue and explains gaps in data from these districts in the OHSP server at PHIM. Data which PHIM receives come directly from the district level person mainly through WhatsApp or email. The table further shows that even where OHSP is being used, there is a corresponding use of parallel system – paper and WhatsApp. In addition, various issues have prevented those who do have a mobile device from using it for OHSP:

Table 6: Summary of Issues for not using OHSP

District Location Health Facilities/ Locations with Faulty Devices Health Facilities with Network Challenges Health Facilities/ Staff who Lost Devices

Not Trained & No Data Bundle

Health Facilities with Inappropriate Devices

Blantyre

Zomba

Maching a

Balaka DHO -

- Health Facilities 5 - 5 25 DHO - - - Health Facilities - - - DHO - Health Facilities - - 22

DHO - - - - Health Facilities 2 2 - - -

Both Zomba and Balaka appear to be stable and with very small issues. The latter reported only two cases of faulty mobile devices and two cases of network challenges. However, there are serious problems in Blantyre and Machinga districts. In Machinga, all 22 health facilities do not use OHSP for reporting. Instead these are done at DHO’s office by designated staff – DEHO or IDSR focal - because the facilities received small phones which do not work with the OHSP. There are some keys and features which cannot be operated using such small phones as opposed to when the system is used on a tablet, computer or large smart phone. Lastly, Blantyre reported the majority of issues ranging from faulty devices through lost devices to not receiving training and data bundles to use for OHSP work. A final issue relates to clarity over the ownership of the mobile devices. Users are not sure what to do in cases of lost of malfunctioning devices. In addition, since the mobile devices were handed over to individuals who attended OHSP training at the District Health Office, the recipients ended up personalizing them. This restricts usage by other healthcare workers in the health facilities and ports of entry. Again, this is one of the explanations of continued use of paper based system on COVID-19 reporting.