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. Malawi started the electronic integrated disease surveillance and response (eIDSR) system enhancement in 2015, progressing with the aim of a One Health Surveillance Platform (OHSP) using District Health Information Software 2 (DHIS2) as its technical backbone, resulting in supporting the COVID-19 pandemic response resiliently and impacting the IDSR performance. Digital solutions are critical components of One Health surveillance; however, evidence of successful establishment and implementation of digital One Health surveillance systems with adaptability is scarce.

Objective:

This study aims to report on the establishment of OHSP in Malawi and how an adaptive digital health solution contributed to strengthening and impacting the country's electronic integrated disease surveillance and response during the COVID-19 pandemic and beyond the pandemic.

Methods:

The establishment of Malawi's OHSP was based on the action design research (ADR) methodology with a transdisciplinary approach. The core team reflected the multiple iterative processes of building the OHSP and formalised its impact on IDSR reporting quality.

Results:

The OHSP core team conducted multiple iterative cycles in building the platform, leveraging lessons from previous eIDSR pilots, reused digital health infrastructure and developed the DHIS2 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. The pandemic shock resulted in the OHSP national scale-up and impacted the national weekly IDSR reporting quality from non-existence in 2015 to 97.8% and 74.5% for completeness and timeliness, respectively, in 2024. Strong government leadership and coordinated implementation ensured financial and organisational sustainability, enabling rapid nationwide scale-up. The DHIS2 proved highly adaptable and robust for emergency response. The established One Health stakeholder ecosystem, awareness mechanisms, and adaptive resilience of the OHSP digital solutions were critical success factors in attaining the One Health surveillance goal. OHSP was proven to be resilient in responding pandemic, but gaps remain in community-level surveillance and inadequate infrastructure to fully support the OHSP functionality in the country.

Conclusions:

The establishment of OHSP significantly bolstered the surveillance function for weekly IDSR reporting. Government leadership and good coordination were keys to success. Continuous capacity building, enhancing community-level surveillance with digital innovations, adaptable technical infrastructure and reuse strategy can provide long-term sustainability for One Health surveillance. 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.