Evaluation of the development, implementation, maintenance and impact of three digital surveillance tools deployed in Malawi during COVID-19: Protocol for a Modified Delphi Expert Consensus study (Preprint)

BACKGROUND The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems in order to safeguard a globally connected society, especially those in low-to-middle income countries. Africa’s rapid adoption of digital technological interventions created a new frontier of digital advancement during crises or epidemics. The use of digital tools for disease surveillance can assist with rapid outbreak identification and response, handling duties such as diagnosis, testing, contact tracing, and risk communication. Malawi was one of the first countries in the region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. OBJECTIVE The aim of this study is to seek expert consensus using the Delphi methodology to examine Malawi's COVID-19 digital surveillance response strategy and to assess the digital tools using the World Health Organization mHealth Assessment and Planning for Scale Toolkit. METHODS This protocol follows the Guidance on Conducting and REporting DElphi Studies. Participants must meet the following requirements: must have first-hand experience on the design, implementation and maintenance with COVID-19 digital surveillance systems. There will be no restrictions on the level of expertise or years of experience. The panel will consist of approximately 40 participants. We will use a modified Delphi process whereby rounds one and two will be hosted online via Qualtrics and round three will encompass a face-to-face workshop held in Malawi. Consensus will be defined as ≥70% of participants strongly disagree, disagree, somewhat disagree or strongly agree, agree, somewhat agree. During round three, the face-to-face workshop, participants will be asked to complete, the mHealth Assessment and Planning for Scale Toolkit assessment on the digital tool on which they are experts. The MAPS toolkit, will enable the panel members to assess the digital tools from a sustainable perspective from six distinct, yet complementary axes i.e. 1) Groundwork, 2) Partnerships, 3) Financial Health, 4) Technology & Architecture, 5) Operations and 6) Monitoring and Evaluation. RESULTS The ability of a country to collate, diagnose, monitor, and analyze data forms the cornerstone of an efficient surveillance system, allowing countries to plan and implement appropriate control actions. Malawi was one of the first countries in the African region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. CONCLUSIONS We anticipate findings from this Delphi study will provide insights into how and why Malawi was successful in deploying digital surveillance systems. In addition, findings should produce recommendations and guidance for the rapid development, implementation, maintenance and impact of digital surveillance tools during a health crisis.