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Table 1: Category of key informant
5. Digital health - again both Malawi and more widely
6. Decentralization and gender
7. Documents from other projects
8. Kuunika, decentralization and the Malawian health system (Kuunika project documents)
9. Kuunika, decentralization and the Malawian health system (Kuunika evaluation reports)
10. The Covid-19 pandemic and its impacts on Kuunika.
Qualitative data collection was conducted between early September and mid-November 2021. Remote KII were conducted with individuals based in Balaka, Blantyre, Machinga and Zomba Districts. Blantyre and Zomba are Districts that have received support from Kuunika (in November 2018 Zomba received an accelerated core package of project support, specifically on the Demographic Data Exchange and the EMR portal), while Balaka has served throughout the evaluation as a comparator District; Machinga was part of the baseline.
The total sample for Special Study 3 was 54, disaggregated into categories of key informant as set out below. More precise details are not provided, because the Proposal submitted to the National Committee for Science and Technology for ethical approval stated that all participation would be anonymous and confidential, in line with approved evaluation principles. All key informants were given informed consent statements and information about the evaluation in advance of discussion.
All key informants were also asked questions about the project and, therefore, contributed to the endline study.
Table 1: Category of key informant
Category of key informant
National stakeholders: MoH, representatives of partners, Kuunika staff 13
District stakeholders: District Health Office (DHO) and Council 8 Health Facility stakeholders: In Charges, nurses, Data Clerks 31 International decentralization specialists 3 TOTAL 54
Limitations include restrictions on travel due to the pandemic and the resultant challenges of conducting remote interviews through Microsoft Teams and Zoom. Connectively problems led to a number of missed key informant interviews (KII). The six Health Facility focus group discussions could only be conducted because Professor Maureen Chirwa travelled to each location and convened the FGDs, which were moderated remotely by Dr Janet Gruber.
In addition, there was a distinct lack of enthusiasm at District level to give time for KII. This was the most challenging cadre to engage with; upwards of 10 additional scheduled KII did not take place, despite repeated attempts by Mott MacDonald and CDM. This was the case in both Kuunika and non-Kuunika Districts.
Another limitation is that due to pandemic restrictions it was not possible to undertake dedicated KII or FGD with Health Surveillance Assistants (HSA)/Disease Control Surveillance Assistants (DCSA) or with any representatives of Health Facility, Village or other category of health committee. This had been possible during the baseline and midline evaluations.
