5.3.3. Discussion on Kuunika’s role

The majority of OHSP users (70.6%) use personal money to purchase data bundles for the OHSP system, and obviously this is Airtel network. Only 23.5% of them use free TNM data. This is mainly due to unavailability of TNM coverage of most of the localities in question. This 70.6% is also a clear demonstration of the seriousness and commitment of system users to ensure they get their work done as expected. This is a very critical piece with regard to sustainability of the OHSP system. Some users still feel they need to be receiving a certain amount from Kuunika or the District Health Office., whether as a start-up for the month or for the entire period. If it is a start-up, then they would be able to supplement data for the rest of the month. This is so because mobile devices were given to individuals and they take care of them as their own asset.

5.3.2.5 Post Deployment Support

Kuunika embedded systems support in its plan for the OHSP system. This support, however, is primarily done remotely. Kuunika does not appear to have any technicians operating at local level to provide first level support on site or from the district level. There is also no evidence of Kuunika selecting and empowering OHSP champions who could be providing basic troubleshooting before issues are escalated to the district or national level. The Kuunika team is small and operating from the national level, meaning that there are always outstanding issues in the districts. These are more apparent in Machinga among all the four sampled districts. Besides system champions, it is also clear that Kuunika is missing an opportunity of utilizing government personnel who could perhaps provide support in the districts. Government through the Department of e-Government has technicians in district councils providing IT support to government institutions, including District Health Offices. These could be utilized by the project to provide timely systems support in the districts if there could be involvement of e-Government Department in the work of Kuunika. The e-Government Department is in-charge of the Government Wide Area Network (GWAN) and other related infrastructure, which could also benefit the Kuunika programme if there is collaboration.

5.3.3. Discussion on Kuunika’s role

The details above illustrate that Kuunika was swift and thorough in meeting the digital demands of the Ministry of Health after the recognition that digital data and science would be central to guiding government in its response to the pandemic. The approach taken was to ensure timely capturing and quick submission of data from the source (i.e. community, health facilities and ports of entry). At this level, the OHSP system, as well as standardized COVID-19 paper forms (transmitted mainly via WhatsApp), assisted and continue to assist healthcare workers as they undertake case detection, contacts tracing, follow ups and required reporting across the country. This reporting is done on a daily basis to enable the Ministry’s management and PTF to make informed decisions in a timely manner, but also to keep the general public and other stakeholders informed about the situation of the pandemic on the ground. Alongside this, the same OHSP and standardized paper tools assist the health workers in reporting for IDSR on a weekly and monthly basis. However, when one critically looks at this data supply chain, it becomes clear that the level of digitalization is quite limited to the OHSP users (at community, health facility and port of entry) who received the mobile device or had the application installed on their personal device for reporting with one person at district level (i.e. either DEHO or IDSR Focal Person) designated to oversee and manage district reporting, and the staff at PHIM receiving, consolidating and analyzing these data. Another key group included in this digitalization is that of senior officials in the Ministry of Health and members of the Presidential Task Force on COVID19 as they have access to internal dashboards and reports. There is no direct involvement or capability of other healthcare workers including health facility in-charges, Directors of Health and Social Services (DHSS), District Health Management Teams (DHMT), Hospital Directors, and other key health personnel to see data being collected within their level and access it for review before it is transmitted to the central level. Even when it is submitted to central level, they cannot access the data for their own district until it is