of
the Malawi Community Health Information System
The Story
In 2019, Malawi’s Ministry of Health and Population (MoHP) set out on an ambitious journey to create a national digital Community Health Information System (CHIS) that would unify fragmented data and strengthen the work of frontline health workers. This phase of the Integrated CHIS (iCHIS) project began with a nationwide assessment to understand what was truly happening on the ground: the gaps, the needs, and the opportunities to build a smarter, more connected digital health ecosystem.
The Challenge
The findings painted a stark picture. Health Surveillance Assistants (HSAs) were overwhelmed by more than twenty-one different paper-based reporting tools, creating duplication and poor data quality. Weak connectivity and frequent power outages further delayed reporting and feedback loops. Meanwhile, various NGO and donor programs operated their own data systems, making it nearly impossible to aggregate information nationally or make timely, evidence-based decisions. At the district level, reports often sat unused, rarely informing planning or resource allocation.
The Turning Point
Recognizing this fragmentation, the Ministry realized the solution had to be both integrated and locally owned – a system designed to thrive in low-resource environments and embraced by all. To make that possible, MoHP convened a National CHIS Task Force that adopted a Human-Centered Design (HCD) approach, ensuring the new system would be co-created with communities, not merely built for them.
The Execution
Over six months, the team embarked on a Human-Centered Design (HCD) journey to reimagine Malawi’s community health information system. The process began with discovery and definition starting with a desk review of over fifty documents on community health and digital systems. National and regional consultations with 213 participants revealed priorities, mapped existing workflows, and highlighted gaps in data use and supervision. Field visits to six districts brought the realities of rural health delivery to life through ethnographic observation, interviews, and workflow mapping, including a powerful focus group discussion with Health Surveillance Assistants (HSAs) who shared their daily struggles and aspirations.
Building on these insights, co-creation workshops generated digital workflow concepts and service blueprints. Personas and journey maps representing HSAs, district data officers, and national planners helped visualize real needs, leading to draft functional requirements such as offline access, solar charging, and DHIS2 integration.
Through continuous testing and iteration, stakeholder validation meetings refined requirements and surfaced critical enablers like government-led change management and phased rollout. Throughout the process, participatory diagramming, rapid prototyping, and iterative feedback ensured that the final design was not imposed from above but shaped by those closest to the work – the people who power Malawi’s community health system.
The Evidence
The assessment painted a vivid picture of Malawi’s community health reality. Health Surveillance Assistants (HSAs) were drowning in paperwork, leaving little time for patient care. Valuable community health data rarely informed district-level decisions, while unreliable power and weak connectivity in rural areas called for mobile, offline-first solutions. Yet amid the challenges, strong community networks and dedicated HSAs offered hope; a solid foundation for digital transformation.
The Result
From these insights emerged a comprehensive roadmap and system design blueprint for a government-owned digital CHIS. The recommendations emphasized integrated reporting, real-time dashboards, and decision-support tools, anchored by a sustainability plan within the Ministry’s structures. By centering users and refining concepts, the project positioned Malawi to launch a scalable, interoperable iCHIS – reducing burdens and powering data-driven health decisions.