As in many developing countries, lack of reliable data and grossly inadequate appreciation and use of available information in planning and management of health services were two main weaknesses of the health information systems in Malawi. Malawi began strengthening its health management information system with an analysis of the strengths and weaknesses of existing information systems, sharing findings with all stakeholders. All were agreed on the need for reformation of various, vertical programme-specific information systems into a comprehensive, integrated, decentralized and action-oriented simple system. As a first step towards conceptualization and design of the system, a minimum set of indicators was identified and a strategy was formulated for establishing a system in the country. The design focused only on the use of information in planning, management and the improvement of quality and coverage of services. All health and support personnel were trained, employing a training of trainers cascade approach. Information management and use was incorporated into the pre-service training curriculum and the job description of all health workers and support personnel. Quarterly feedback, supportive supervision visits and annual reviews were institutionalized. Civil society organizations were involved in monitoring coverage of health services at local levels. A mid-term review of the achievements of the health information system judged it to be one of the best in Africa. For the first time in Malawi, the health sector has information by facility by month. Yet very little improvement has been noted in use of information in rationalizing decisions. The conclusion is that, no matter how good the design of an information system, it will not be effective unless there is internal desire, dedication and commitment of leadership to have an effective and efficient health service management system.

Nearly all facility registers were available and complete. But accuracy varied, with antenatal care and HIV testing and counseling performing the best and family planning and acute respiratory infections data less well. Most facilities visibly displayed routine health data and most hospitals and district health offices had staff trained in health management information systems, but training was lacking at the facility level as were routine data quality checks and regular supervision.

Background Linking facility and household surveys through geographic methods is a popular technique to draw conclusions about the relationship between health services and population health outcomes at local levels. These methods are useful tools for measuring effective coverage and tracking progress towards Universal Health Coverage, but are understudied. This paper compares the appropriateness of several geospatial methods used for linking individuals (within displaced survey cluster locations) to their source of family planning (at undisplaced health facilities) at a national level. Methods In Malawi, geographic methods linked a population health survey, rural clusters from the Woman’s Questionnaire of the 2015 Malawi Demographic and Health Survey (MDHS 2015), to Malawi’s national health facility census to understand the service environment where women receive family planning services. Individuals from MDHS 2015 clusters were linked to health facilities through four geographic methods: (i) closest facility, (ii) buffer (5 km), (iii) administrative boundary, and (iv) a newly described theoretical catchment area method. Results were compared across metrics to assess the number of unlinked clusters (data lost), the number of linkages per cluster (precision of linkage), and the number of women linked to their last source of modern contraceptive (appropriateness of linkage). Results The closest facility and administrative boundary methods linked every cluster to at least one facility, while the 5-km buffer method left 288 clusters (35.3%) unlinked. The theoretical catchment area method linked all but one cluster to at least one facility (99.9% linked). Closest facility, 5-km buffer, administrative boundary, and catchment methods linked clusters to 1.0, 1.4, 21.1, and 3.3 facilities on average, respectively. Overall, the closest facility, 5-km buffer, administrative boundary, and catchment methods appropriately linked 64.8%, 51.9%, 97.5%, and 88.9% of women to their last source of modern contraceptive, respectively. Conclusions Of the methods studied, the theoretical catchment area linking method loses a marginal amount of population data, links clusters to a relatively low number of facilities, and maintains a high level of appropriate linkages. This linking method is demonstrated at scale and can be used to link individuals to qualities of their service environments and better understand the pathways through which interventions impact health.

The thesis was motivated by the underutilisation of GIS in health in developing countries due to lack of long-term maintenance of geodata. Geodata maintenance is recognised as the central component of any operational GIS for continuously meeting new user requirements. However, the explicit description on how to perform geodata maintenance is missing in GIS literature. GIS literature has not exhaustively defined key activities except geodata collection and geographic database update. The understanding is that geodata maintenance aims at meeting new user requirements. Therefore, to define the exhaustive set of activities, key actions for the requirements analysis are to be identified and defined as part of geodata maintenance. In addition, since geodata maintenance is complex and expensive while many organisations have the shortage of local GIS expertise, key decisions are to be made on when and how to collaborate with other organisations to access such expertise at a low cost. At the same time, the user organisation is to provide opportunities for external experts to impart knowledge to local users during collaboration for the continued GIS support. Therefore, this research aimed at proposing a framework for geodata maintenance in health in developing countries and investigating the contribution of collaboration towards geodata maintenance and the building of local expertise. The study was guided by three questions: (1) What are activities of geodata maintenance in health sector in a developing country setting? (2) How can collaboration assist in the maintenance of geodata in health sector? and (3) How can collaboration contribute towards the building of local expertise for geodata maintenance in health sector?The research was qualitative, interpretive case study using the case of Ministry of Health in Malawi. It was conducted from July 2015 to January 2017. Data was collected through the participant observation, semi-structured interviews and artefact examination. The data analysis was done during the individual paper writing and thesis writing in which the following four key steps were appliedimmersion in the data, coding, creating categories and identification of themes.