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By the time Malawi registered the first three COVID-19 cases in April this year, a functioning digital system was in place for surveillance, contact tracing and clinical case management for the disease. The Malawi Government had reacted quickly when it became aware of growing concerns for the novel disease, and its Ministry of Health convened all partners involved to a meeting in March, after which a technical implementation plan was rapidly developed. The plan laid the foundation for coordinating all digital platforms that generated data for the response.
Luke International is one of the main partners in building digital tools for disease surveillance in Malawi. In 2014, when Ebola struck West Africa in one of its worst outbreaks, LIN started to work with the Ministry of Health to strengthen the country’s surveillance system. An electronic medical records systemi was already installed in more than 80 health facilities (now in 200 health facilities) throughout the country with funding from the US Centers for Disease Control as part of ongoing efforts to strengthen data systems and health data management. Building on this, a surveillance and response project was implemented in partnership with the local Baobab Health Trust, with all data transmitted to a national repository. The project also introduced fever screening at the two international airports in Lilongwe and Blantyre.
LIN had also received support from UNICEF to pilot a mobile-based application, developed by WHO, for strengthening weekly reporting of data in fourteen targeted districts. In 2019, when the Cyclone Idai hit Malawi and caused flooding in 15 districts and affected more than 900,000 people, the urgent need to strengthen
epidemiological surveillance and emergency preparedness was evident. It led to a follow-up project for post-disaster disease surveillance and response. The result was the One Health Surveillance Platform, which aimed to be a robust, coordinated and effective system that can collect, analyze and provide feedback in real time for potential disease outbreaks.
The surveillance platform is built on a district health information system that was originally developed by the University of Oslo, and which now has a global reach. With the COVID-19 pandemic escalating, the Ministry of Health saw an opportunity to leverage the platform to aid the response. The project quickly shifted gears and built in functions that supported the needs to manage the growing number of cases. Eventually, the One Health Surveillance Platform became the main platform for all COVID-19 data.ii More than 550 users were trained in the system in 16 districts across the country.
Photo 1. DHIS2/OHSP Application Training at Thyolo District Health Office in Malawi
In order to harmonize all digital support for fighting COVID-19 in the country, an appliance funded by the Bill and Melinda Gates Foundationiii, was used. The Kuunika project, which it was called, was designed as a HIV-related health data project. The intention had also been, however, to build the necessary infrastructure for different digital systems to exchange and make use of information (interoperability) that would have a wider impact beyond the HIV program. Adopting a health system rather than a single disease approach has allowed the project to swiftly provide solutions that were direly needed during the COVID-19 pandemic, i. a. to set up an internal dashboard for government decision and policy making.
LIN’s technical advisor, Joseph Wu, was requested to assist with the running of the emergency operation center for COVID-19. When asked what key lessons we can learn from Malawi’s response, his answer was clear: Coordination. From very early on, the Ministry of Health mapped out all the partners and digital products available. Where gaps were identified, the work was divided and assigned in a coordinated matter. The coordination did not only apply to administration, but also included the technical level. The developers that were in charge of different national systems sat together and discussed – and the end product is that the systems can be easily integrated, he said.
Rumors can spread faster than the virus itself. Therefore, it was pertinent to provide reliable information. For that purpose, community approaches were applied.iv One of the solutions offered is a WhatsApp chatbot where people may find information on COVID-19 and the latest statistics. It allows communities to self-register potential suspects, self-report on signs and symptoms and receive daily reminders and updates. The team also worked with various organizations to integrate different community engagement applications, including a rumor log program.
For the public, the team built the COVID-19 National Information Dashboardv, allowing anyone with internet access to check out the latest statistics in Malawi.
Photo 2. Screenshot of the Malawi COVID-19 National Information Dashboard
Misinformation and lack of information is especially problematic in rural areas. Through funding from the Bjorgaas Social Welfare Foundation, LIN held various outreach campaigns, engaging with community members to provide information on what COVID-19 is and measures that can be taken to protect oneself (hand-washing, social distancing etc). Soap and water buckets to encourage hand-washing was distributed. During the sessions, it was observed that many people still believe that Malawi is not affected by the pandemic and that it is just part of a political agenda. There were misconceptions that drinking spirits or lemon and hot water can cure the disease. Concerns were also expressed on how social distancing can be done in a household and in public transportation. The response from communities the Mzimba and Nhkatabay districts, where the outreach was done, has been positive. It was noted that LIN was the first organization to invite community members to ask questions and hold discussions on COVID-19.
Photo 3 (Left). Handwashing demonstration by a community member from the Kawanga area in Nhkatabay District. Photo 4 (Right). One of the community member at Sanje asks questions concerning COVID 19.
i Electronic Medical Records Systems (EMRS)
ii The platform is complete with modules such as point of entry health declaration, case-based surveillance, contact registration and tracing, lab test ordering and results viewing, and interoperability to other systems.
iii Called Kuunika –Data for Action project
iv The mQuarantine combo COVID-19 community solutions
v Malawi COVID-19 Information Website: covid19.health.gov.mw