During the COVID-19 pandemic in Malawi, demand for healthcare quickly outgrew available resources, straining already overstretched health systems and risking the reversal of past successes. To minimise these public health consequences, the District Health Office in Blantyre, the highest burden district in Malawi, partnered with academics and established the Strengthening District COVID-19 Response (SCORE) Project. The SCORE project aimed to expand the reach of the district health system to individuals and communities through remote triage platform (‘phone clinic’), and a community engagement intervention.
The aim of the ‘phone clinic’ was to use evidence-based triage/management systems to provide rapid identification and care linkage for individuals with severe symptoms, whilst allowing remote management of individuals with mild to moderate symptoms, thus reducing pressure on health facilities. The platform supported follow-up of stable COVID-19 patients not currently requiring hospital care and recovering patients post-discharge. The community engagement component involved empowering local leaders to develop their own evidence-led COVID-19 containment packages, with reinforcement plans led by youth volunteers drawn from within local communities. Credible and up to date information was provided to community leaders and volunteers throughout, and community feedback mechanisms were also incorporated. Community teams linked with the phone clinic and regular monitoring visits by SCORE project team members lent additional support. Information from both the phone clinic and community volunteers fed into surveillance systems, collating intelligence around evolving COVID-19 related concerns from members of the public.
We will describe the programme implementation and present results of our evaluation, with thoughts from health staff and community figures on programme strengths, areas for improvement, and what they see as the future role for these interventions.