Anticipation and response: pandemic influenza in Malawi, 2009

Sambala, Evanson Z.; Manderson, Lenore

Most respondents conceded that the country had taken reasonable steps to achieve the goals of the plan, but were disappointed in the response actions and identified areas for improvement. One respondent reflected, 'We did something, but of course not very well, because most of the activities we had embarked on were affected by the lack of critical infrastructure' (P8). Another respondent, a lay person who was involved in implementation, argued that preparedness required the use of the available infrastructure, such as existing surveillance systems and laboratories. However, in Malawi, key infrastructure was severely limited, hence the use of diagnostic laboratories in Kenya. Establishing new infrastructure such as laboratories during emergency situations is practically impossible, given that this would take several years. For most respondents, the only way to achieve responses that mirrored preparedness plans was to improve health services generally, but essential services to facilitate rapid diagnostic, care and monitoring of disease spread all needed strengthening. A few respondents identified existing infrastructures, such as the Health Management Information System (HMIS), an information technology system that could have been deployed and adapted to provide timely information on influenza outbreaks. Respondents across the interviews were aware that having a functional information technology system would ensure the easy flow of information about the pandemic outbreaks, specifically to inform public health policy about, for example, whether additional staff were needed. Several suggested linking this with the integrated disease surveillance response (IDSR) system for management of health information, including planning for and management of health services.