Innovation – C4D Network

As mobile technology has become ubiquitous, Malawi has seen several robust service delivery mobile applications for healthcare deployed with different levels of success. SMS and phone hotline projects have reached national scale and have been widely regarded as having both high impact and ease of use. Unfortunately, to date, no smartphone applications have been able to scale to a national audience and systems remain in silos both geographically, topically, and technically. With limited resources, how do we determine which solutions should expand, where pilots can provide
new insights into existing gaps, and how to create a national policy that allows for both innovation and scale?

To aid the Kuunika: Data for Action project in developing and implementing mobile technology in Malawi, and to a larger extent, to aid the Ministry of Health and Population in the governance of mobile technology, Cooper Smith conducted an independent evaluation of mobile health technology systems currently being implemented in Malawi. This assessment provides a concrete way that Malawi can adapt high-level frameworks and tools into assessments that provide evidence for policies, standards, and strategies in mobile health.

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Background: Poor governance impedes the provision of equitable and cost–effective health care in many low– and middle–income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, “good governance” interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care.

Multi–stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized.

Results

The authors identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified little formal evaluative research.

Conclusion

Innovative digital approaches are increasingly being used to facilitate good governance in the health sectors of LMICs but evidence of their effectiveness is still limited. More empirical studies are needed to measure concrete impacts, document mechanisms of action, and elucidate the political and sociotechnical dynamics that make designing and implementing ICTs for good governance so complex. Many digital good governance interventions are driven by an assumption that transparency alone will effect change; however responsive feedback mechanisms are also likely to be necessary.

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mHealth in Malawi – Landscape Analysis (Ministry of Health and Population, Malawi, 2018)

Digital technology for health sector governance in low and middle income countries: a scoping review (Journal of Global Health Research Article, 2016)