JMIR Publications

ABSTRACT

Background:

Facing the threats of emerging and re-emerging health issues requires the One Health surveillance systems to provide information for integral responses. The One Health approach emphasises inter-sectoral and multidisciplinary collaboration across human, animal, and environmental health and offers promising avenues for strengthening public health management and emergency preparedness. Digital solutions are critical components of One Health surveillance. However, evidence of successful implementation and experience in establishing a resilient digital One Health surveillance system are scarce.

Objective:

This study aims to describe the establishment of the One Health Surveillance Platform (OHSP) in Malawi and assess its contribution to strengthening the resilience of the country's digital health surveillance system before and during the COVID-19 pandemic.

Methods:

The establishment of Malawi's OHSP was based on the action design research (ADR) methodology. The core team synthesised an analytic tool to assess OHSP's establishment and resilience amidst the COVID-19 pandemic.

Results:

The OHSP core team applied ADR methodology, leveraging lessons from previous electronic integrated diseases surveillance and response (eIDSR) pilots, and developed digital solutions in 2019, right before the COVID-19 pandemic. The initial establishment was to cover 48.3% of the country's health districts. Pivoting from the initial plan as the COVID-19 pandemic emerged, the core team swiftly adapted for OHSP to scale up nationwide and assisted the health system in resiliently responding to the pandemic. Strong government leadership and coordinated implementation ensured financial and organisational sustainability, enabling rapid nationwide scale-up. The OHSP/DHIS2 products proved highly adaptable and robust for emergency response. The resilience analysis indicated that OHSP enhanced Malawi's surveillance capabilities in the anticipation and preparation phases during the COVID-19 pandemic. The established One Health stakeholder ecosystem, awareness mechanisms, and adaptive resilience of the OHSP were critical success factors in attaining eIDSR goals. OHSP was proven to be resilient in responding pandemic, but gaps remain in community-level surveillance and inadequate infrastructure to fully support the eIDSR functionality in the country.

Conclusions:

The establishment of OHSP significantly bolstered the resilience of Malawi's health system and partially supported the eIDSR function. Government leadership and good coordination were keys to success. Continuous capacity building, adaptable technical infrastructure, and enhanced community-level surveillance are essential for long-term sustainability. Malawi's experience may apply to other countries with demonstrated value of resilient, government-led digital health interventions. Future efforts should focus on improving interoperability with other One Health domains and investing in infrastructure upgrades to prepare for future emergencies. Clinical Trial: Not applicable.