Figure 21: Global Digital Health Index

Figure 21: Global Digital Health Index

Malawi has not yet been assessed by GDHI, but an examination of the indicators used to determine and track progress is helpful is understanding Kuunika’s role in facilitating the country’s digital health environment. Of the seven categories listed, Kuunika can be seen to have directly contributed to them all, to some extent. The key contribution comes under ‘Leadership and Governance’, where the establishment of a specific MoH department dedicated to digital health (the DHD) is considered a major achievement. Other contributions towards improving the legislative and policy environment also count. Under ‘Standards and Interoperability’, Kuunika’s design ethos is entirely aligned with GDHI best practice. Areas of weakness across all indicator categories include budgetary commitment, integrated curricula and infrastructure maintenance – these are advanced goals beyond the possibility of Kuunika, but which indicate the direction to move towards.

Whether the COVID-19 pandemic led to a ‘digital surge’ in the health sector, a trace and review of the data and use chain suggests that indeed it did. However, there were specific gaps in access to the tools and technologies, in particular for healthcare workers in health facilities. Limitations of time and resources impacted on depth of training and number of devices available. Connectivity and data-cost issues compounded this, and these issues remain. Other factors affecting sustainability are continued political commitment, coordination of multiple donors involved in e-health and changing individuals’ mindset around unfamiliar change, Nevertheless, Kuunika did contribute towards a significant increase in digitalization in the health sector during 2020. To sustain this, there are several obstacles to overcome. Kuunika has demonstrated the potential to be the convening point for the international community –including new donors – who are willing to support Malawi’s digital plans in the health sector. It is critical to now tread carefully to avoid donor dependency and to ensure that development is government-led. There is need to develop a clear transition plan from Kuunika support to withdrawal. It should include the overall government commitment, including technical and financial aspects. Stakeholders we interviewed did not believe that the Ministry on its own can yet take over and manage these implementations, and strongly encouraged Kuunika Phase 2. This should primarily focus on the areas discussed to prepare and empower the Ministry of Health for takeover and sustainability.