Background:
The Malawi Ministry of Health launched its Digital Health strategy 2020-2025 in November 2021. The digital health strategy is aligned to the Health Sector Strategic Plan II 2017-2022 with seven (7) priority areas supported by MoH and partners. The strategy has a vision for a sustainable and harmonized country led digital health system that covers all areas of service provision and enables efficient delivery of health services to beneficiaries at all levels of the health system. Malawi is currently developing its digital health policy, as an overarching policy on digital interventions in Malawi, a government Policy that will guide the digital health strategy implementation by all stakeholders in Malawi.
The aspirations and priorities outlined in the digital health strategy guided the development of the digital health policy with reference to WHO global and regional guidance among other key national documents. The six strategic areas;
- Leadership and governance
- Computing infrastructure
- Connectivity
- Hospital information system
- Strengthen human resources for digital health
- Interoperable heath information exchange framework
- WHO global and regional guidance on digital health
In 2005 the World Health Assembly through its resolution WHA58.28 on eHealth urged Member States;
- Draw up a long-term strategic plan for developing and implementing eHealth services;
- To develop the infrastructure for information and communication technologies for health
- To promote equitable, affordable and universal access to their benefits.” Countries
- Stakeholders urged to direct their efforts towards creating a consistent eHealth vision in line with a country’s health priorities and resources
- Develop an action plan to deliver the proposed vision
- Framework for M&E of eHealth implementation and progress
In the unanimous WHA resolution 71.7 on digital health passed in 2018, member states emphasized the need for “digital health solutions to complement and enhance existing health service delivery models, strengthen integrated, people-centered health services.” As a result, the Country asked for support from WHO to develop a roadmap/strategy towards compliance with the resolution. As a result, a scoping review mission was carried out in 2019 led by WHO AFRO and HQ together with partners. As a result, this culminated in the development of Malawi Digital Health strategy and at present different partners are supporting different components of the strategy with WHO supporting the above noted components. In supporting the Country all the levels of the organization have been involved.
More than 120 Member States – including low- and middle-income countries – have developed such strategies and policies. The digital health policy and strategy for Malawi draw aspirations from the vision of the WHO global strategy on digital health
The vision of the global strategy is to improve health for everyone, everywhere by accelerating the development and adoption of appropriate, accessible, affordable, scalable and sustainable person centric digital health solutions to prevent, detect and respond to epidemics and pandemics, developing infrastructure and applications that enable countries to use health data to promote health and well-being, and to achieve the health-related Sustainable Development Goals and the triple billion targets of WHO’s Thirteenth General Programme of Work, 2019–2023. The purpose of this global digital health strategy is to strengthen health systems through the application of digital health technologies for consumers, health professionals, health care providers and industry towards empowering patients and achieving the vision of health for all.
Background to the assignment
Since April 2021, WHO has supported various digital health solutions in Malawi. To benefit from the invested resources with results documented from digital health tools roll out by WHO will require implementation of support plans for each of the digital health initiative in line with the national Digital Heath Policy and Strategy. End use satisfaction for each of the digital health tool at primary health care levels towards UHC will require reliable support from the experienced international Consultant working closely with the WHO country office, MoH Quality Management Directorate, MoH Digital Health division, Directorate of Policy and Planning and Public Health Institute of Malawi.
1. Functionality of the Online CPD platform on quality of health care designed in Moodle e learning platform for front line health workers.
The e-learning platform with enhanced end user design features was pretested and rolled out in health facilities for front line health workers coupled with capacity building of MoH Quality Management Directorate and digital health team on Moodle eLearning platform design and loading the learning content. The online MNCH quality of health care CPD platform aims to bridge the knowledge and skills gaps in quality of health care and to reach health workers with primary and refresher knowledge on self-assigned modules. Since roll out in April 2022, over 500 health workers have accessed the online CPD platform, however effective use of the platform for learning and improving patient care has not been registered. Hands on support is still needed to update and finalize the online CPD content with MoH team of content developers and the digital health team, further quality assure, upload more content and address inputs from the pretest exercise from content developers and health workers as end users.
2. Registered all key Malawi Digital Health tools in the Digital Health Atlas (DHA), uploaded on a WHO web portal and ensure validated use at primary health care levels.
WHO has developed a global repository to register digital health products, including those related to COVID19 vaccination management, called the Global Digital health Atlas (DHA).
Malawi is among the counties identified by WHO to implement the Digital Health Atlas to
strengthen governance of Digital Health tools at Country level. Over 60 digital health tools have been registered nationally in Malawi spread across primary, secondary and tertiary levels of health care. However, functionality at primary health care levels and scale has not been systematically assessed and contribution to patient client flow systems and outcomes at primary levels of health care. Registration of the various tools on the WHO web portal needs to be finalised and made accessible to Malawi Ministry of Health on updates, registration and deregistration and towards making the web portal a public good. This includes registration of the online CPD platform, Covid-19 vaccination digital tools and One Health Surveillance Platform interoperable in DHIS-2.
3. Functional OHSP/DHIS2- IDSR reporting system to improve the IDSR timeliness on weekly reporting
Ministry of Health rolled out the third edition guidelines on Integrated Disease Surveillance and Response in all the districts using the One Health disease surveillance approach. The goal of One Health disease surveillance approach is to achieve optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. The One Health Surveillance Platform (OHSP), a digital health platform has been adopted to improve IDSR weekly and monthly IDSR reporting target of 80% on timeliness of weekly reporting. The OHSP is interoperable with DHIS-2 HMIS system, will need further support for functionality at primary health levels, addressing trouble shooting challenges and to ensure consistence in IDSR reporting by addressing operational challenges working with MoH digital health vision and the Public Health Management Institute (PHIM).
4. Functionalized Digital Adaption Kits (DAK) integrated in routine health services in two piloted health facilities as part of strengthening the health care delivery and health information system.
Use of the Digital Application Kit (DAK) to improve efficiency of health delivery systems and processes and interoperability with the existing electronic medical systems (EMR) is a new concept and will require orientation of the national Task Force as oversight and the roadmap development will be critical inclusive of customizing to the country digital health strategy and guidelines and protocols on integrated service delivery and towards universal health coverage and SDG3 targets. The DAK are software-neutral, operational, and structured documentation based on WHO clinical, health system and data use recommendations to inform the design of digital systems more systematically and transparently. As a follow up to WHO support to strengthening health information systems in the Country, the Country has planned for the introduction of DAK in Malawi and this has been articulated in the concept note, DAK Adaptation, Software Integration and implementation in one pilot district and to facilitate scale in within one year of implementation. The tool, referred to as the digital adaptation kit (DAK), has in-built prompts that provide a step-by-step guide to health workers to arrive at the most plausible diagnosis, suggest investigations that should be carried out and treatments that should be started. For demonstration purposes, the electronic system which has incorporated digital adaptation kits can be deployed at select model facilities to act as a demonstration site. This tool already incorporates the ANC and family planning DAKs including other SMART guidelines like the ICD11. The experience will guide development of steps taken to adopt and automate PHC facility processes and generate scale support from government and implementing partners.
5. Reviewed HMIS/DHIS2 to align with HSSPIII health data and information needs with incorporation of national and district inputs on revisions
Ministry of Health is in the final stages of HSSPIII development that will align with the Health Information System strategy and guidelines. revision of the health information systems to align with the current data needs for HSSPIII and integration of data disaggregation inclusive of gender and disability status for all department inclusive of reproductive health, clinical services, community health, programmes under communicable and non-communicable diseases. Revisions of the DHIS-2 its customization to the current data needs will be key. All processes led by MoH Central Monitoring Evaluation Department (CMED). The District Health Information Systems (DHIS) is an open source, web-based platform most commonly used as a health management information system (HMIS). The purpose of the DHIS is to document data that are routinely collected in all public health facilities in a country using the system.
6. Gap analysis and develop an implementation plan to link Malawi Heath Facility Data Base to the WHO Global Health Facility Database
The World Health Organization in partnership with the University of Columbia are rolling out the Global Health Facility Database Project (GHFD) in its member countries. In September 2021, the WHO GIS Centre Health (“GIS Centre”) created an initiative – the GHFD project to improve the capacity of Ministries of Health (MOH) of the WHO Member States to maintain, regularly update and use the master list of health facilities for their respective country and, at the same time, contribute such data to a Global Health Facilities Database (GHFD) where the data can be accessed as a public good.
The GHFD is a standardized and open database that serves as a global central repository for a given set of health facility information to help the countries and international community better prepare for health emergencies, increase capacity to leverage data, create more efficient, effective, and targeted programs, and transform data availability from a global gap into a global public good. Since Malawi has an existing heath facility master list/database, a gap analysis will be developed to inform the the implementation plan to link Malawi Heath Facility Data Base to the WHO Global Health Facility Database.
Various support plans have been developed in consultation with MoH relevant directorates for each of the digital health support area that will guide work of the consultant.
Deliverables
Expected outputs/deliverables
Key outputs
- All online CPD modules reviewed, customized with user friendly features, appraised, and uploaded on the Moodle e learning platform
- Addressed end user inputs to continuous improvement of the online CPD platform. This includes customized online quality of health care content into Moodle e-learning platform easy to read and navigate with features that enable learning.
- Capacity build for MoH staff in using the Moodle eLearning platform to design other remaining modules and courses.
- Complete registered digital health tools in the web based digital health atlas accessible to MoH to register and deregister and use by stakeholders. This includes the online CPD platform Covid-19 vaccination One Health Surveillance Platform, other updated covid-19 specific tools registered on the WHO website.
- Functioning One Health Surveillance Platform with updated forms (same and interoperable in DHIS-2) to support OHSP/IDSR weekly and monthly reporting
- Functional Digital Application Kit for selected modules in the piloted health facility with documented health workers inputs to improve the DAKs.
- Functional Model Health facilities implementing Digital adaptation Kits (DAKs)
- Documented HMIS and DHIS-2 revisions with the various directorates
- Validated and verified list digital tools coverage at primary health care level
Expected Outcomes
- End user satisfaction of the online CPD content, its lay out and user friendliness
- All digital health tools are registered on the Malawi digital tools portal and WHO AFRO website and validate for availability and coverage
- OHSP Covid-19 and IDSR reporting are integral and supported as one system of reporting at health facility, district, and national level
- End use satisfaction for each of the digital health tool at primary health care levels towards Universal Health Coverage
Qualifications, experience, skills and languages
1. Education
Essential: A Bachelor of Science degree in Computer Science, Computer Engineering, Information Technology, Health Informatics, Medical Informatics, Digital Health, public health or a related field.
Desirable: some prior educational background in health-related fields; additional certification in one or more digital health products.
Experience
Essential: A minimum of 3 years’ experience in the development and implementation of digital health systems and strategies, including knowledge transfer and/or production, dissemination of tools, and business analysis.
Desirable: Experience in training/orientation, planning and delivery of technical assistance is also required.
Skills/Knowledge
- Ability to use Microsoft products: MS Word, PowerPoint and Excel
- Ability to write reports and analyse data
Languages
- Expert knowledge (written and spoken fluency) of English.