7 Conclusion and recommendations

This final section of the report presents the investigators’ concluding observations and recommendations from Special Study 2.

7.1.1 Conclusion

This special study has focused on the digital health governance experience of the Kuunika Project over the period 2016-2021. The study has focused on four questions relating to roll-out of the DDE, implementation process and aid effectiveness themes, the policy and regulatory environment and lessons learnt. The authors have addressed these questions by triangulating evidence from an extensive desk review, key informant interviews and group discussions with the Kuunika team.

While the findings presented in this report may not be definitive, they do reflect a range of stakeholder perspectives on a complex initiative that was implemented in a highly dynamic context. From review of findings across the four study questions it is notable that, while progress in the early years of the project was slow, it did provide the Kuunika team with a firm foundation of operational experience and lessons. These, in turn, have enabled significant contributions to digital health systems strengthening and governance in the final sustainability phase of the project.

7.1.2 Recommendations

Recommendations from this study include specific recommendations and general recommendations for BMGF and the Government of Malawi. The general recommendations are also relevant to other development partners.

Specific recommendations:

● Support the Digital Health Division. Recognise the strategic benefits of a knowledgeable and trusted team embedded in the Digital Health Division that can respond to digital health opportunities and priorities. Seconded TA needs to be high-calibre with distinct skill sets.

Ensure there are clear guidelines on preventing conflict of interest. ● Prioritise governance capacity. Support efforts to ensure the Digital Health Division has appropriate capacity on digital health governance, standards and compliance – governance officers should work closely with the ICT Ministry and prioritise finalisation of the digital health SOPs. ● Support Kuunika to develop a capacity development plan that includes skills transfer approach and an exit strategy.

General recommendations:

● Promote the principles of responsible ‘global digital health citizenship’ and partnership among all key role-players. This means convening around a single shared digital health vision, strategy and roadmap. These should be based on a modular digital architecture and be consistent with open source and open standards principles. ● Invest for scale and sustainability from the outset. This means thinking beyond the programme ‘use case’ to consider each solution’s horizontal and vertical linkages within a wider systems architecture. Consider complementary investments in digital health governance capacity at all system levels, including longer-term investments / collaborations to protect data privacy and security.