7. Recommendations for Kuunika phase 2

Recommendation 1: engage throughout with Districts - leadership, ownership and governance

Rationale: the ultimate goal of any data system should be to deliver optimal health services that lead to improved patient outcomes. That necessitates proper District buy-in, which was not embedded into Kuunika from the outset.

Recommendation 2: work for greater aid effectiveness - alignment with other partners working on digital health data

Rationale: information from national level respondents is that a 'Sector-wide Approach (SWAp) Revival' Concept Note is in development. There is increasing emphasis on maturing away from a proliferation of pilot projects and toward proven and scaled solutions built on common standards within an architecture.

The consensus appears to be that any such action would seek to re-introduce SWAp principles to alignment, joint planning, working and Monitoring, Evaluation and Learning (MEL), but not (at least initially) any financial disbursements to government entities. Investments and implementation for digital health data require far more harmonization. Application of a number of SWAp principles could potentially link disbursements to District performance, monitored using digital data. This would, however, necessitate genuinely effective support and training to all those engaged with collecting and using data to plan and deliver services.

Kuunika (and the Bill and Melinda Gates Foundation) should continue work with the MoH to support greater alignment and harmonization of all partners' digital health data interventions. If there is a SWAp-light framework developed for digital health data, Kuunika should consider a role as an integral partner, calling upon cumulative project experience, expertise and its position at the center of national developments.

Recommendation 3: continue to support the MoH Digital Health Division

Rationale: the Digital Data Division should continue to receive Kuunika support; it is the site of government technical capacity. In its inception phase Kuunika 2 should plan for greater DDH coordination with and support to District digital health data systems.

Recommendation 4: ensure digital data systems are designed with users in mind and work to maximise all levels having access to participation, training and ongoing support

Rationale: systems should not be designed without properly thinking of who will use them and how, and the capacity development each individual cadre will need. With hindsight, the adoption of HIV as a data use case for Kuunika may have limited scope and flexibility - collection of HIV data was and remains tightly managed at the national level. Districts and Health Facilities did not have oversight of such data, or effective ownership.

Recommendation 5: build in sustainability from the outset

Rationale: while there is increasing resistance to a 'proliferation of pilots' in the digital health data sphere, Kuunika 2 has options to build on the foundations not only of the project, but to engage closely with the Blantyre Prevention Strategy, which is focused on building Districts systems, capacity and ownership. Such relationships, allied to any development of greater partner alignment and harmonization, could enable not only economies of scale but evidence-based prioritization of interventions proven to be effective.

Recommendation 6: have more focus on equity aspects of digital data systems

Rationale: data are never neutral. Just one point is disaggregation of data - their collection, their identification, their analysis and their use. WHO, UN Women, many civil society organizations and

others continue to press for greater equity of data disaggregation, and greater application of such principles in the context of digital data.