Lessons from Malawi's collaborative approach to digital health

The government of Malawi, through the Ministry of Health (MOH), is at the forefront of digital health transformation. In 2019, the MOH created the country’s first Digital Health Strategy 2020–2025, which outlines its mission, vision, and objectives for expanding its digital health impact. As stated in the strategy, Malawi’s key digital health objective is “to develop a sustainable and harmonized country-led digital health system that covers all areas of service provision and enables efficient delivery of health services at all levels of the health system.”

To support this objective, in 2020, the MOH formed the Digital Health Division (DHD) to coordinate and manage the development and implementation of sustainable, secure, and interoperable digital health solutions under the Quality Management Directorate (QMD). Since then, Malawi has made impressive progress in implementing digital health interventions and upgrades through collaborative approaches.

PATH began partnering with the MOH to advance health priorities in 2015, and with the Digital Health Division (DHD) beginning in 2023. PATH’s digital health work in Malawi has focused on three projects:

1. Developing an electronic immunization registry (EIR): PATH’s Digital Square initiative has been working to develop an EIR within the Malawi healthcare Information System as part of the GIZ-funded Digital Innovation in Pandemic Control Project (DIPC).
2. Strengthening the sharing and accessibility of data across systems: Improving interoperability enables data use for continuity of care. PATH has provided technical assistance to the DHD since 2023, serving as a secretariat to support DHD technical working groups, coordinating stakeholders for the terminology registry and other interoperability components, and strengthening capacity related to digital standards.
3. Developing a Medical Devices Management System: Improving planning, budgeting, and maintenance for medical devices requires real–time and accurate data. PATH supports the development of a Physical Assets Management System that focuses on medical devices. This involves mapping the software landscape for similar systems, developing and validating system requirements and user requirements, and hiring a software developer. This system will be a key mechanism for tracking physical assets and informing device procurement and maintenance needs in health facilities.

On May 8, 2024, the Malawi Ministry of Health’s Digital Health Division, PATH, and its flagship digital health initiative, Digital Square, hosted a half–day roundtable in Lilongwe to celebrate the work conducted to strengthen Malawi’s health care system through digitalization. The meeting attracted 40 people, including senior officials from the MOH, technical advisors, donors, and other digital health stakeholders.

During the meeting, PATH Malawi Country Representative Raphael Kayambankadzanja spoke about PATH’s mission to advance health through innovation and respectful partnerships, and its approach to digital and data solutions. “The number of partners we have today demonstrates how important respectful partnerships are to us. Digital health is one of the innovations we need to improve so people can thrive and enjoy quality health. We have a lot of expertise from different backgrounds working across connected areas,” said Kayambankadzanja.

Speaking on behalf of the Secretary for Health, Dr. Martias Joshua, the Chief of Health Services responsible for reforms, emphasized the need for coordination to avoid duplication and ensure efforts by development partners are aligned with the country’s strategic plans. He commended PATH for aligning its program to the Ministry’s agenda.

“PATH has made efforts to align its digitalization programs with the Ministry's strategies and approach for harmonization. This is a direct complement for the government to achieve its plans through the HSSP III (Health Sector Strategic Plan). All partners are therefore requested to follow this approach in implementing any program,” said Dr. Joshua, adding that the government would like to focus on developing the Malawi Healthcare Information System (MaHIS).

Participants engaged in discussions emphasizing several key points, including the necessity of developing sustainable digital health projects in Malawi, addressing connectivity challenges faced by facilities in remote regions, and strategizing ways to attract and retain skilled professionals to propel the Ministry's digitalization efforts forward. Additionally, the conversation delved into the importance of implementing tracking mechanisms to assess the effectiveness of investments, identify impactful initiatives, and determine priority areas for future focus.

In her remarks, Dr. Alinafe Mbewe, the Deputy Director for DHD, reaffirmed the Ministry’s commitment to digitalization and asked for continued support from partners and donors. “The Ministry takes digitalization very seriously. All of us realize that digital health is the way to go. It improves the quality of care for patients. As a government, we want to coordinate, ensure we align with our strategy and priorities, and avoid duplication. Digital health is very expensive to run, and we cannot do it alone,” said Dr. Mbewe, thanking partners like PATH who are already working with the Ministry.

With a focus on strategic partnerships, sustainable projects, and coordinated efforts, Malawi is poised to harness the transformative power of digital health, ensuring improved quality of care and enhanced health care delivery for its citizens. To sustain their vision for building robust digital systems, PATH—and other partners and donors working within the country—can support Malawi in several ways.

First, MOH leaders expressed a need to strengthen the capacity of workers within the DHD by providing training on the relevant systems (e.g., MaHIS, iCHIS, OHSP) and processes (e.g., medical device management and supply chain) necessary for digital health transformation, as well as the OpenHIE building blocks being implemented (e.g., terminology services, FHIR®).

Second, transformative, coordinated investments into the scaling of systems would allow the MOH to maintain the institutional governance of those systems and reduce silos.

PATH celebrates Malawi’s achievements and recognizes the dedication of the government, MOH, and DHD to continually prioritize digital health as a means of strengthening its health system. Through the Digital Square initiative, PATH will continue to support the country’s leaders in their journey to digital health transformation, and invites our partners to join us.

To learn more about PATH’s digital health work, visit www.digitalsquare.org and www.path.org/who-we-are/programs/digital-health.