Embarking on the Journey to Self-Reliance in Malawi
What is the Journey to Self-Reliance?
The journey to self-reliance (J2SR) is an emerging commitment among development partners, funders, and developing country host governments to jointly pursue locally-sustainable solutions to the long-running development challenges that governments in developing economies have been facing.
The J2SR is a realization that, while valuable, international aid is not sustainable, and a marked shift in the objective of international aid is required. Today, organizations around the world are focusing on empowering governments in developing economies to design and support solutions that can be locally sustained into the long term.
In a recent MEASURE Evaluation report, USAID clearly outlines the US Government goal of purposefully deploying its aid to help developing countries attain self-reliance through the development of resilient health systems as a necessary precondition. As such, USAID has supported evidence gathering efforts through partners such as FHI360 and JHPIEGO to research practical strategies for supporting countries in their journey to self-reliance at scale.
We’ve found that this approach resonates with many host governments who understand that sustaining health systems with international aid is not possible and therefore desire to take ownership and sustain systems locally. In pursuing the J2SR, countries and development partners have to assure sufficient commitment (e.g. legal framework, policies & strategies, governance mechanism, etc.), capacity, and the relevant change management implications in ethics, norms, and cultural values that are needed to support and attain the J2SR aspiration.
This calls for multisectoral collaboration and partnerships across public and private organizations.
We started on this journey a long time ago
Globally, Dimagi has pioneered the development and deployment of innovative technology products to support national health systems since 2002.
From the beginning, we’ve worked hard to include the people on the ground in the design of our solutions, often calling to “design under the mango tree.” We understand that if any of this is going to work, it’s going to need to be embraced by the people who will actually use it every day.
Driven forward by the goal of sustainable impact, Dimagi now supports national governments and partners to enhance the efficiency and effectiveness of frontline healthcare workers through design and deployment of locally-responsive digital health tools. Together, we build technical capacity within local teams in order to ensure the sustainability of the tools at the local level.
Our flagship solution, CommCare, is an open-source, user-friendly, and easily adaptable digital platform that local teams can easily manage without any coding experience. We also host the Dimagi Academy—a suite of training materials and digital library that users can access and regularly update themselves on how to build applications on CommCare, where to find help from a global practice of users, and how to fix challenges with applications.
How to align both your products and services with the J2SR
Beyond our software solution, Dimagi has the most experienced team in the world when it comes to ICT4D programs.
Our “designing under the mango tree” approach to application development involves designing the applications with the lowest level of users under their local conditions to ensure the tools respond to local needs and realities for ease of use, often resulting in quick buy-in and faster adoption.
In addition, Dimagi supports capacity building of local trainer teams, so they can ably support successful deployment and naturally evolve into local champions, driving adoption and institutionalization of the digital tools into the MoH structures. Dimagi works closely with ministries of health and builds capacity for the local teams they identify.
For long-term sustainability, we also support local capacity building in more technical areas, such as developing new application tools on CommCare, revising or adapting existing ones, and managing CommCare servers hosted locally. The goal is to prepare the local teams to be able to maintain the application in future to reflect changes in programmatic protocols or guidelines and align them with new research evidence and best practices.
We find value in supporting the transition to host governments with the placement of local technical advisors who better understand the local context and are hired in a collaborative way with host governments to work with the MoH from within, supporting their local digital health strategy implementation.
Supporting the ONSE Project in Malawi: A True Journey to Self-Reliance
Through the USAID-funded ONSE Project, Dimagi is helping Malawi’s Ministry of Health (MoH) realize their vision of a locally-owned, locally-managed, and locally-sustainable digital integrated supportive supervision (ISS) tool.
Based on approved MoH supervision checklists and protocols, we fully digitized and supported the deployment of the ISS tool. The digital ISS (complemented with an online superset dashboard) is now a national supervision tool used by all 28 districts in Malawi under MoH leadership. In line with the MoH’s vision for full local ownership, Dimagi has supported ONSE’s effort to recruit and place a technical support engineer in the MoH and provided them with the technical capacity they need for longer-term capacity building.
In anticipation of transitioning the digital ISS tool to the MoH within the next 12 months, Dimagi has completed the first phase of technical capacity building of MoH team members in application building and management in CommCare.
Moving forward, we will continue to work with the MoH technical team to support ongoing capacity building remotely, while assigning some of the ongoing ISS checklist revisions to the team to see how they are picking up on the technical areas.
We also plan to support ONSE and the MoH with local server installation, ISS data migration from cloud servers to local servers, server deployment, and technical capacity building with MoH core IT team to manage ISS servers locally.
As a strong subscriber to local sustainability and the J2SR goal for digital health systems, we remain committed to supporting ONSE and the MoH on this path to truly attain MoH self-reliance vision with respect to sustained long term management of the digital ISS investments in Malawi.
Continuing on this journey
National governments want to own and manage their own digital health systems.
Funders and private organizations (including technology companies like Dimagi) want to ensure these health systems are able to employ proven, high-impact solutions.
In Malawi, the convergence of a committed MoH and a tech-experienced partner in Dimagi have presented a great opportunity to demonstrate that the J2SR’s goal of locally-sustaining digital health investments is still feasible.
With this shared commitment, we can overcome any restraints—because we have to.
As we continue to explore how best to manage the journey to self-reliance in countries around the world, we would like to invite your comments and suggestions on how else digital health technology partners such as Dimagi might better support national governments to achieve this ambitious, yet much-needed goal.
Please share your feedback and ideas to help refine our approach to better support the J2SR going forward here.
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