6.1 Lessons and Recommendations

6.1 Lessons and Recommendations:

• Kuunika and the DHD have the potential to be the convening point for the international community– including new donors - who may now be more willing to support Malawi’s digital plans.

It is felt that without Kuunika’s ongoing support the DHD will not yet be able to fulfil this potential alone, warranting a further phase of Kuunika. • We understand that Kuunika is developing a strategy to systematically address the challenges faced in operating and managing the OHSP at local and national levels, as well as to build capacity at all levels for sustainability. It should contain a clear path of transition and timeframe and the overall government’s commitments, including technical and financial aspects.

• Multiple donor-led health programmes and data collection processes at district level are starting to overwhelm health workers and affecting the quality of DHIS2. Better co-ordination and standardisation will improve this. • Infrastructure, finance and logistics limitations are still very apparent. These failures are contributing to continued preference for paper systems and need to be addressed urgently. In order to achieve affordability of IT services, Government should put in place incentives to boost competition in the IT/ telecommunications sector. • Data gaps that appear in the OHSP server at PHIM should be addressed at source • System technical support is limiting usage. E-Govt officers at district level could assist in providing first level support and systems troubleshooting by being more immediately if integrated into the Kuunika programme. • To avoid OHSP users at local level purchasing data bundles using their personal resources,

Kuunika/MoH should negotiate with Airtel for provision of free data bundles or to provide a certain amount of data as a start-up contribution to all Airtel network users. • The OHSP/DHIS2 webpage has problems which should be corrected

In summary, key lessons by question area are:

Covid-19 Immediate Response

• Reputational boost for Kuunika and DHD in effective rapid response to pandemic, evidenced by direct requests from President for more digital tools • Demonstration effect to MoH of the potential power of digital continues to foster leadership in

DHD • Kuunika has the potential to be the convening point for international community–including new donors - who

Sustainabilty

• Locating OHSP on DHIS2 continues core Kuunika aim of an interoperable central platform. • Act Fast, Fail Fast, Learn Fast: Kuunika must ensure it does the latter to build on lessons learnt during Covid19 • Infrastructure, finance and logistics limitations still very apparent. These failures may be contributing to continued preference for paper systems.

Aid Effectiveness

• Increasing donor interest in

DHD important to harness but be careful it doesn’t end up in even greater donor dependency. • Have a clear capacity building and exit plan from the start. • Multiple donor-led health programmes and data collection processes at district level are overwhelming health workers and affecting the quality of

DHIS2. Need more co-

In summary, key lessons by question area are: may now be more willing to support Malawi’s digital plans. • Urgency of covid response drove agreement of a clear business plan and data architecture that built on the existing application architecture prior to development. • But some corners cut in usercentred design principles and training for OHSP due to urgency. Don’t repeat. • Covid-19 monitoring is yet another silo-ed programme multiplying reporting procedures and forms at facility level • OHSP/DHIS2 webpage has problems which should be corrected • System technical support from the centre needs to be improved. Build out from eGovt technicians at district level. • Too soon to hand over to DHD: Kuunika 2 warranted. ordination and standardisation.