Annex 2: Topic Guide & Informed Consent Statement for Key Informant Interviews

a. Informed Consent Statement

Thank you very much for agreeing to make time to discuss with me today. My name is Shawo Mwakilama and I am conducting a short study for Mott Macdonald in UK. They have been commissioned by the Bill and Melinda Gates Foundation to independently evaluate the Kuunika programme at the Ministry of Health, which they have funded since 2016.

What will the Kuunika evaluation do?

The Kuunika evaluation will address the following five simple questions: As a result of the Kuunika interventions…  1. Has data quality improved?  2. Has data use increased?  3. Has decision-making improved?  4. Have key HIV service areas improved?  5. What explains the changes (or lack of them)? 

What is Kuunika?

It's a project that aims to key barriers to better use of routine data in the health sector; it has been doing that primarily by improving the interoperability and accessibility of the District Health Information

System (DHIS). Since March 2020, Kuunika has also been assisting the reporting of the national emergency response to the COVID pandemic.

It is this combination of issues, the support of Kuunika to the pandemic reporting and how that may have unexpectedly helped with its original goal of promoting more and better use of health data, that I’d like to discuss today.

Informed Consent Statement

Our discussion today will take a maximum of 1 hour. I have a guide that lists the key questions I should like to ask you; our discussion will be based on the experience and knowledge that you bring. There are no 'right' or wrong' answers; what is relevant is what each of you as an individual, a health professional, has experienced, what your views are, what you might like to see happen. Your responses will all be anonymous; we shall not identify you by name or location [If, in the course of the interview, it seems appropriate to record the session, I will ask your permission and tell you when recording begins]. 

Do you have any questions or comments before we begin?

b. Topic guide

Key Informant Category Question topics

Kuunika project staff/ partner organizations Background

• What are the main objectives of Kuunika program? • What major activities has Kuunika been implementing over the years?

Since the advent of Covid-19 in Malawi in early 2020, do you think the country has experienced a surge in demand for digital data in the health sector, and use of it for decision making? i. General Digital Surge in Malawi

• In your observation, has Malawi experienced any surge in the use of digital technologies since early 2020 when first cases of Covid-19 were report in the country and eventually “lock-down” measures implemented by Government? • What kind of evidence is there to demonstrate this digital surge in Malawi since the advent of Covid-19 in the country? • What are the key features of this digital surge?

ii. Digital Surge in the Health Sector

• Has there been a digital surge in the health sector in the country since the emergence of Covid-19 pandemic? • If so, what evidence is there of a digital surge in the health sector? • To which program(s) and partner(s) can you attribute this digital surge?

o What did they specifically do, which stimulated this digital surge? • What kind of digital data was central to authorities in Government for planning and responding to the pandemic? o What did Kuunika program specifically do on this aspect? Was it successful or not?

To what extent did Kuunika initiate, direct and sustain the digital surge in the country, in general and the health sector, in particular?

• What technological innovations has Kuunika developed and implemented for MoH/ health sector in Malawi which direct relate to Covid-19 pandemic response? o When were these innovations developed and rolled out? o Who were the target groups? o How did they benefit (or not benefit) from the innovation(s)? • Did these innovations initiate and direct the digital surge? o In the country? o In the health sector? • If so, how did this happen? • How did Kuunika program address the usual resistance to change and new technology in the health sector? • What key challenges were faced in the process and how were they addressed?

What aspects of Kuunika project design, activities and implementation supported monitoring and response to Covid-19 pandemic in Malawi?

• Which Kuunika innovations supported Covid-19 pandemic’s planning and response at national, district and health facility levels? • To what extent have these innovations been effective (or ineffective) in enhancing monitoring and response to the pandemic?

• What have been some of the bottlenecks faced in the design and implementation of these innovations? o How were they addressed?

What aspects of Kuunika project are likely to help sustain the current digital surge in the health sector and/ or in the country?

• What aspects will help sustain it in the health sector? • What aspects will help sustain this at national level?

In your assessment, what are some (non-Kuunika) key contextual determinants which are promoting the sustainability of the post-Covid-19 digital data surge in Malawi’s health sector?

• What is the nature of key infrastructure and related elements in the health sector and the country, which underpin the sustainability of this digital surge? • Have the existing political environment and policy framework been in supportive of the digital surge? o If so, to what extent? • What are some of the major social, cultural and economic factors which promote the sustainability of the digital surge in the health sector?

Which key contextual determinants are limiting sustainability of the Covid-19 digital surge in the health sector?

• What political factors would limit, or prevent, the sustainability of the digital surge in the health sector? • Which social, cultural and economic factors could obstruct the sustainability of this digital surge?

Key Lessons and Recommendations

• When you look at the Kuunika program and its contribution to the health sector in Malawi, what key lessons can we draw from it?

• Based on your experience with the Kuunika program, what can you recommend for the prospective design and sequencing of new digital health sector programmes that can sustain and build on the current ‘digital surge’?

• What would you recommend as strategies through which the above could be adopted into the national health systems that have hitherto been resistant?

Background

• What are the main objectives of Kuunika program? • What major activities has Kuunika been implementing over the years for Ministry of Health?

Ministry of Health – HQ officials (DHN, QM, CMED and PHIM) Since the advent of Covid-19 in Malawi in early 2020, do you think the country has experienced a surge in demand for digital data in the health sector, and use of it for decision making?

• What kind of evidence is there for this digital surge in Malawi since the advent of Covid-19 in the country? • How about evidence or features of this digital surge in the health sector? • If yes, to which program(s) and partner(s) can you attribute this digital surge? o What did they specifically do, which stimulated this digital surge? • What kind of digital data has been central to authorities in Government for planning and responding to the pandemic? o What did Kuunika program specifically did on this aspect? Was it successful or not?

To what extent did Kuunika initiate, direct and sustain the digital surge in the country, in general and the health sector, in particular?

• What technological innovations has Kuunika developed and implemented for MoH/ health sector to support to Covid-19 pandemic response? • Did the innovation(s) initiate and direct the digital surge? • If so, how did this happen? • How did Kuunika program address the usual resistance to change and new technology in the health sector?

What aspects of Kuunika project design, activities and implementation supported monitoring and response to Covid-19 pandemic in Malawi?

• To what extent have these innovations been effective (or ineffective) in enhancing monitoring and response to the pandemic? • What have been some of the bottlenecks faced, and how were they addressed?

What aspects of Kuunika project are likely to help sustain the current digital surge in the health sector and/ or in the country?

In your assessment, what are some (non-Kuunika) key contextual determinants which are promoting the sustainability of the post-Covid-19 digital data surge in Malawi’s health sector?

• Nature of infrastructure and related elements in the health sector and the country? • Political factors/ policies? • Social and cultural factors? • Economic factors?

Which key contextual determinants are limiting sustainability of the Covid-19 digital surge in the health sector?

Districts (DHOs, Councils and Health Facilities)

• What political factors would limit, or prevent, the sustainability of the digital surge in the health sector? • Which social, cultural and economic factors could obstruct the sustainability of this digital surge?

Key Lessons and Recommendations

• When you look at the Kuunika program and its contribution to the health sector in Malawi, what key lessons can we draw from it? • Based on your experience with the Kuunika program, what can you recommend for the prospective design and sequencing of new digital health sector programmes that can sustain and build on the current ‘digital surge’? • What would you recommend as strategies through which the above could be adopted into the national health systems that have hitherto been resistant?

Background

• Are you familiar with Kuunika program and its activities? o If yes, what do you know about Kuunika? • What major activities has Kuunika been implementing in your district/ health facilities?

Since the advent of Covid-19 in Malawi in early 2020, do you think the country has experienced a surge in demand for digital data in the health sector, and use of it for decision making?

• In your observation, has Malawi experienced any surge in the use of digital technologies since early 2020 when first cases of Covid-19 were report in the country and eventually “lock-down” measures implemented by Government? o What kind of evidence is there to demonstrate this digital surge? • Has there been a digital surge in the health sector in the country since the emergence of Covid-19 pandemic? o If so, what evidence is there for this digital surge? • To which program(s) and/ or partner(s) can you attribute this digital surge? o What did they specifically do, which stimulated this digital surge?

To what extent did Kuunika did Kuunika initiate, direct and sustain the digital surge in the country, in general and the health sector, in particular?

• How do you routinely monitor and report about Covid-19 cases and response plan? o Which reporting forms do you use (manual or electronic)? o What medium do you use for reporting and how often? o Why do you use this platform?

• What technological innovations has Kuunika developed and implemented in your district and/ or health facilities? o When were these innovations developed and rolled out? o What purpose(s) do they serve? o Did these innovations initiate and direct the digital surge in your district and/ or health facility? o If so, how did this happen?

What aspects of Kuunika project design, activities and implementation supported monitoring and response to Covid-19 pandemic in Malawi?

• Which Kuunika innovations supported Covid-19 pandemic’s planning and response at district and health facility levels? • To what extent have these innovations been effective (or ineffective) in enhancing monitoring and response to the pandemic? o What have been some of the bottlenecks faced, and how were they addressed?

What aspects of Kuunika project are likely to help sustain the current digital surge in the health sector and/ or in the country?

In your assessment, what are some (non-Kuunika) key contextual determinants which are promoting the sustainability of the post-Covid-19 digital data surge in Malawi’s health sector?

• Nature of infrastructure and related elements in the health sector and the country? • Political factors/ policies? • Social and cultural factors? • Economic factors?

Which key contextual determinants are limiting sustainability of the Covid-19 digital surge in the health sector?

• What political factors would limit, or prevent, the sustainability of the digital surge in the health sector? • Which social, cultural and economic factors could obstruct the sustainability of this digital surge?

Key Lessons and Recommendations

• When you look at the Kuunika program and its contribution to the health sector in Malawi, what key lessons can we draw from it? • Based on your experience with the Kuunika program, what can you recommend for the prospective design and sequencing of new digital health sector programmes that can sustain and build on the current ‘digital surge’? • What would you recommend as strategies through which the above could be adopted into the national health systems that have hitherto been resistant?

Digital Surge in Malawi

• In your observation, has Malawi experienced any surge in the use of digital technologies since early 2020 when first cases of Covid-19 were report and eventually “lock-down” measures implemented by Government? • What kind of evidence is there to demonstrate this digital surge in Malawi since the advent of Covid-19 in the country? o What are the key features of the digital surge?

Telecoms/ Information Technology Sector Extent of Data/ Internet Use

• Which sectors have been demanding, purchasing and consuming more data/ internet services for connectivity during the pandemic? • Do you have metrics to share comparing internet uses prior to Covid-19 and during the pandemic? • What kind of information do you think people have been accessing or want to access?

Digitalization in Health

• Crossing over to health, have you been providing any specific support to this sector during the pandemic? If yes, what kind of support and under what framework or agreement? • Are you aware of Ministry of Health’s Kuunika Data for Action program? • If yes, what do you know about Kuunika? • Do you have any formal agreement or partnership with Kuunika program? If yes, what is the agreement about? • In your view, has Kuunika helped in any way in the digital surge in the health sector?

Obstacles to Digitalization

• What are the major impediments to digitalization in Malawi, and in the health sector in particular? • What solutions would you propose to overcome these impediments?

Sustaining the Digital Surge

• What needs to be done to sustain the digital surge in the country? (policy, technology, socio-economic aspects?) • What specific components are required for this sustenance of the digital surge (infrastructure? data cost? etc)?

a. Internet Service Providers (Airtel, TNM, MTL and Globe Internet) b. IT experts

Other GoM Agencies –officials (Ministry of Information, Digital Surge in Malawi

• In your observation, has Malawi experienced any surge in the use of digital technologies since early 2020 when first cases of Covid-19 were report in the country? • What kind of evidence is there to demonstrate this digital surge in Malawi?

Information Demand

• What kind of information has the public been demanding and accessing since the onset of Covid-19 pandemic?

Department of Disaster, etc)

• What platforms do the majority of members of the public use to access such information? o How effective have these platforms been?

Digital Divide

• To what extent do we have digital divide in Malawi? • In general, which groups or categories of people lack access to: o Digital technology? o Digital information? o Internet? • What can be done to bridge this gap?

Digitalization in Health

• What is your observation on digitalization in the health sector during the Covid-19 pandemic? • What aspects in health sector did you see went digital during the Covid19 pandemic? • What digital/ IT related innovations during the pandemic helped Government (MoH, Dept. of Disaster and other key stakeholders) plan and respond effectively to the Covid-19 pandemic? o Who provided support on such innovations? • Did the innovation(s) make any difference in the fight against Covid-19? • Was Government going to manage the situation without such innovation(s)?

Kuunika Activities

• Are you aware of Ministry of Health’s Kuunika Data for Action program? • If yes, what do you know about Kuunika? • Has your Ministry/ Department be involved in any Kuunika activities? If so, which ones? • What was the extent of your involvement in the above activities? • Which of these activities directly relate to Covid-19? • In your view, has Kuunika helped in any way in the digital surge in the health sector? If so, how?

Sustaining the Digital Surge

• What needs to be done to sustain the digital surge: o In the health sector? o In the country? • What specific components are required for this sustenance of the digital surge (infrastructure? data cost? etc)?