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Jonathan Jackson: Welcome to High Impact Growth. I’m here with Simeon from the Ministry of Health in Malawi at the Global Digital Health Forum. Very excited to speak. Simeon, can you start just by sharing your background and your role within the Ministry of Health?

Simeon Yosefe: Yeah. I’m Simeon um, currently I’m actually head of Digital Health in Mara. My background is not really from the IT field. I’m a statistician by profession, so I have spent all my years as a statistician and I started now focusing on the technology. I think starting from 2014 when I joined Minister of Health, because I actually intended to change the way things are done within the ministry, especially in terms of data management.

And when that happened, the issues of. Uh, probably digital. Digitizing the services came in and then, yeah, we, we actually took it from there. And up, up to now, the minister appointed me to, to head, digital health,

Jonathan Jackson: Wonderful. That’s a, that’s a big role. Malawi’s been at the forefront of some amazing digital work over the years and has a, an aggressive and, and bold strategy going forward. Can you share a bit about the projects that you’ve overseen so far and what you have in your roadmap coming out?

Simeon Yosefe: Uh, in terms of the projects, um, yeah, we have quite a number of them. I think serious changes have actually started to, to take shape in 2021, after Covid, but also, uh, when the, uh, management of the, department Okay. Changed, uh, hands from, the initial department where digital health was rocket.

Uh, directed a lot of quality to planning, where now I was actually made to actually head the, the digital health division. Uh, we actually looked at the, the way things were done and then that most of the investments in digital health were actually siloed, were project based.

And because they were project based, most of the issues would actually, uh, probably lack, sustain. , uh, we have so many systems that were actually probably deployed by various partners who actually wanted to invest in digital health, and these systems have not really made it, um, so long after the, the expire of the, the, probably the client that actually initiated the, the pay system.

And when we looked at the moment I just came in, I looked at the issue of trying to understand what the landscape is. So we did an assessment and then we actually discovered that we had more than 40 different systems running in the sphere. And that was not sustainable. And some of these systems probably they had actually died long time ago, but they were still being reported that we have these kind of systems in the, uh, in the facilities.

And the other issue was like these systems were mostly named after who actually initiated, or who actually implemented that. there was that, not that kind of ownership from the, the facilities where the systems were running because it was actually named after the, the partner who supported. So if the support goes, even the lo uh, healthcare workers who are using the system also stop using the system because it, it doesn’t actually have any support any longer.

And that has really affected the, the way, uh, systems are and even the gadgets. They could not be maintained. The ones who are supposed to come to maintain the, the, the gadgets are not there. So it has actually, put us in a very awkward situation. And in some instances you could actually probably have a situation where a patent has come say, okay, our grant is coming to an end.

We want you to adopt this system. And what I have always actually said , to people is that, uh, or to the partners, is that for government to actually adopt a system, it’s not an. and is a thing because if they were not actually engaged from the word go, then it means they were not actually planning for it.

And for you to say, okay, we want you to take this while they were not actually prepared, then that means that system is not going to have the support that is required. Uh, in the end it’s going to die. Uh, so a after that I said, no, let, let’s do the assessment of all these different systems that we.

we did the assessment. Uh, we, we actually realized that these systems were just duplicating each other. And, uh, what was really sad at that time, it was like much of the work or much of the resources that were spent would have actually been put to a better use if we are more coordinated. And then I said, okay, in that case, let’s try to establish these systems and.

which ones are actually just duplicating the other and see if we could probably, if those that are duplicating each other, if they would just be made to run on the same platform and then have those people who are supporting those kind of system come together and support that. And the other thing that I also discovered in working in that, that is that I think patterns, they have a, a very good motive of actually coming in to work, but.

The issue that really takes the center stage is the issue of visibility. They want to be seen that, they’re the ones who, uh, have actually probably implemented A, B, C, D in the end. Uh, it it, it actually makes them to start working in a more of competitive way instead of being complement to each other.

So we are also trying to regulate those kind of things and then, . The other area that we, we, we felt really needed attention is the area of infrastructure. Uh, much of the projects that I have mentioned, whether you are talking of the EMRs as that have been deployed in the facilities whatsoever, you talk of probably community based whatsoever.

We have lack infrastructure that could sustain these different systems. And because of that we, we started now seeing what, what is it that we can do best and then we. Probably emphasizing this to all the partners that no, if you really want to work with us in digital health, you also need to focus your attention on the infrastructure because we can’t keep on, uh, let’s say for example, someone comes with a dongo or comes with a MiFi, a MiFi, or a dongo.

If it has actually probably, uh, a steady, stronger, it’ll not actually exceed, exceed. It’s, it’s, it’s going to be gone. And that was the situation where now a lot of partners will actually say, okay, we are implementing this. We are actually giving you this dongo. We will be giving you a data bundle so that you can actually do this.

We are trying to get rid of that so that we, we now focus on, uh, long-term investments and, and yeah, it’s, it’s good that now it’s, it’s opening up. We, we, uh, partners have actually opened up. They’re actually willing to probably, , uh, long term infrastructure and I’m sure we are going to, to actually get better.

I think by the end of 2023 we should have something bigger than within the country.

Jonathan Jackson: That’s great to hear. Uh, Simon, we, uh, we’ve been working in, in Malawi for over a decade and have seen this huge shift, as you said. You know, it used to be very, partner led doing a lot of vertical programs that were all going away at the end of the funding cycle, uh, to this much more strategic position.

That obviously sounds like the right way to do it, but is difficult to get there. So as, as you’ve gone through this process and the government’s gone through this process, what successes and, you know, recommendations have you had in how you were able to transform this mindset and what challenge? Did you bump into, you mentioned visibility and, and partner motivations.

And this is a huge problem, you know, as a tech partner, we want to, , serve the government and, and the strategy you have, but obviously we’re also chasing funding. You know, it’s so exactly as you said, we have that conflict where on the one hand, yes, of course we wanna line to the national digital strategy, but on the other we, we want to get, you know, funded for our work.

And so Absolutely. Right. , but yeah, we’d love to hear successes and c.

Simeon Yosefe: The first thing that I actually, um, undertook even before doing the, the assessment of the different systems that, that are being implemented by different partners. What I did first was to actually harmonize the work plans for all. The players in, digital health because why I actually, decided pushed for that is to understand what is it that the patenters are focusing on, because I know that they are, they are, uh, partners when they, they, they come.

They have specific areas of interest. What is it that they want to put their resources on so that they could actually get what is it that they’re interested in? Much as they actually are supporting us, they also have the interest that they would actually want to get from this investment.

So what I did was to make sure that the work plans are actually harmonized. We, we pull these, We see where are much resources going and which areas are actually neglected. It’s when we actually identified that infrastructure was one of the neglected components because a lot of partners we are running away from that they were just focusing on somewhere where they would probably get the, the, the results immediately.

Probably within months they get whatever they want and then off they go. So we actually thought of, okay, let’s try to harmonize our, we. And we see where we have duplications and how much resources can we free for where there are duplications so that we can now shift these resources to the areas which are integrated.

It’s when now we started talking of what kind of infrastructure, okay, we need to come up with the blueprints for the infrastructure. When we are actually talking of putting up infrastructure in the facilities. What should be the standard? That blueprint was actually prepared. And then in terms of, okay, when we want actually to talk of like the connectivity, what are we talking about?

What is it that it needs to in include? We actually had all those and then we had the launch of the digital health strategy, which is now a blueprint for us to actually see where we are going to go and then I still realized that we were liking the, the word enforcement mechanism because whatever we were doing, we did not have alleg greater document, which would really like enforce that, okay, if someone breaches this, what would be like the outcome?

So we, we realized that we didn’t really have that guiding document, which was a policy. At the moment, we, are like in the final stages of drafting the policy. What is remaining now is to actually probably, uh, come up with a, uh, cabinet paper, which is actually going to present this policy to cabinet for, for deliberations and possible, uh, deliberations, empowerment for it to actually be passed.

Why we have actually done that. It’s like we, we don’t want, like, partners to have like a leeway or in other ways to find a loophole that, okay, we could actually, we can do this. Um, we will say, no, we, we didn’t have any likeor. What is it that we have actually contravened? Or what, what framework have we actually breached?

We would not actually have anything. So what we want is, okay, this is what we, we are looking. , we have actually indicated the issues of how to can new systems be brought into the, the space sphere, because that’s very critical and someone cannot just decide today that, okay, um, I have this system, I have developed this system.

I want this to be implemented. It’ll actually have to go through a liros process for it to be approved so that it’s actually, uh, deployed within the, the. , we are doing all those to, to bring sanity, but at the same time, to, to make sure that whatever investments we are making in that, that area, they’re actually sustainable.

So yeah, those, those, those are the kind of situations I think in, in terms of the challenges, I think, yeah. Initially the implementers and patterns altogether, they did not really understand what was the concept that we were trying to put forth. They thought that we just want probably to. Tell people to stop in using their systems whatsoever.

They didn’t understand that what we are trying to look what is the issue of such an ability. So af after we had actually taken the process, engaging them whatsoever, now everybody can understood that, that that was the best direction for us to take. Uh, much as it would mean that some of the systems that probably partners have actually, uh, cherished most will actually have to be discontinued.

We, we have to do that for the sake of the country, and we want to make sure that whenever we are coming in with resources, with support, it should really be going to where it’s going to make the difference so that the common people of MAI actually benefit from these investments.

Jonathan Jackson: That’s great. And the need to have a clarifying policy, I think is a huge thing to stress because it’s one thing for all the partners to agree to have a technical working group and align behind a vision until it conflicts with their grant deliverable or until it is financially not in their interest.

Then all of a sudden they work around. Yeah, the. . Yeah. And so I think going into that policy framework, giving it real clarity and teeth, you know, to say, look partners, if you want to be here to support the Malawi people, you’re gonna get behind this policy document. That sounds like excellent advice. Um, one of the things I’ve been talking with other, uh, partners about, and I mentioned this on my panel within, uh, the Ethiopian context, is defining shared value.

You know, defining, we’re gonna pay million dollars for this system over five years. What’s the health. We’re gonna get as a result. How do you think about that and how have you reached that level of discussion within the policy or the strategy that you’re having in terms of not just what do we think is gonna happen, but how do we reevaluate whether this is having the value we expected it to have and either continue or discontinue?

Because these digital health investments, they’re not one time. Yeah, right. You have to continue to operate ’em with scarce resources and, and so how do you think about that challenge?

Simeon Yosefe: Yeah. We really have challenges because, when partners are actually investing. They have specific deliverables that they would want to see. They have specific issues that they would want to achieve within a certain period. Now, having that in mind, what I have always probably discussed with, with the team or the partners as they come is that as government, we have a broader vision of where we want to go.

Now as we have a broader vision, Whatever partners really want is a subset of what government wants. So as they are trying to support that subset that they’re interested in, they should not only focus on that subset, but they should focus the whole vision that government has because it’s, by doing that, they will not only support what they’re interested in, but they also drive the agenda of the government.

Why that is very critical. As government, we have a wide range of areas where we really, we really see that here. There is a need that we really need to address why, for an implementing partner or the donor, they would just be interested. I, I can give an example of, probably Pep. Pep would be interested in issues only to do with.

But for us, what we are actually saying now is, okay, we can actually talk of HIV V. Yes, but what about the person who is both HIV, has tb, is actually pregnant or has some kind of like some kind of non-communicable diseases. What is going to happen with this person? Will you only take care of the HIV component

and then we, we, we had discussions at that point. They said, okay, no, I think in, in that case, we, we should actually start like flexing our procedures and rules that really govern our support whatsoever because what, what I have always said is if you go in countries, and this is happening to most c.

You actually hear that? No. For us, we had like HIV system is doing very well because it’s supported by C D C O. It’s supported by a pep. It’s supported by this one. They have moved in that. But then what about the other components that they’re living out, which are actually found within the same patient who is HIV positive?

They haven’t taken care of. and we, we had really, uh, like discussions on this and we, we finally agreed that, okay, now it has today to be opened up. So that’s where now what we said is, okay, for us as a country, we want to implement, deploy comprehensive systems. A system that actually encompasses everything.

Not only focusing on one company. HIV may be a, a starting point, but we want these resources not only to be limited to hiv, but they should cover everything. . And by doing that, we ensure that we are taking care of everything. If a mother is pre pregnant, is HIV positive, or is also tib all these will actually be taken care of because we have brought all this work together and those who are providing the care will actually provide this care within the same framework and the same environment, that will definitely improve the situation.

So we had those kind of discussions and it, it was not easy to actually drive home the. , but we actually made it.

Jonathan Jackson: That’s such an amazing example and I think is reflected in a lot of PEPFAR’s global thinking Now. In their latest release of their five year strategy. It, it is exactly resonant with what you just said. And not only that, but it’s often cheaper to do it the right way. Siloing off these digital systems for these vertical use cases can often be harder than making it comprehensive for all of these different functions at the clinic, at the community level.

Um, so just an an excellent point, Simon. Thank you so much for coming by. We really appreciated the time.

Thank you so much to Mr. Simion USFA there was a lot of rich guidance, both for people within ministries of health and digital health partners working on technology solutions. I wanted to share a couple of my quick takeaways. First digital health providers need to align closely to the vision and digital health strategy of the government of the country that they’re working in.

Second Malawi’s working on policy guidance. That will ensure that digital health systems work for Malawi. This seems like a really strong move to ensure that partners are aligned to the government. And its goals. And the donor or partner priorities. Don’t conflict.

Lastly, I heard so clearly the need for digital systems to take a comprehensive and human centered approach. I love Mr. Yosefe’s example of a woman with HIV who may also be pregnant. And a program and digital tool that only supports HIV. Justin doesn’t work. We are whole complex people with intersecting needs.

And digital technology needs to support all aspects of wellbeing.

Thank you so much. Please like rate, review, subscribe, and share this episode. If you found it useful, it really helps us grow our impact and write to us@podcastatdimagi.com. With any ideas, comments, or feedback.