Stakeholders perspectives on paper-based and electronic clinical decision support systems in Malawi Africa.

Abstract: The objective of this paper is to explore the perceptions of key stakeholders involved and/or affected by existing paper-based decision support guidelines (known as Community Case Management (CCM)) and a proposed digitised mobile clinical decision support system (CDSS) of CCM in rural settings of Malawi, Africa. Data was collected using field notes and semi-structured interviews with 17 key stakeholders (i.e. clinical, technical, development aid support (NGO), government and community health workers both in Malawi, Europe and USA). Stakeholders provide a rich insight into the variety of both perceived benefits and challenges of the existing guidelines and the proposed electronic CDSS. It was found that all stakeholders believe that the CDSS will improve adherence to guidelines and subsequently result in better care for children. It is further envisioned that the time needed for administration with the current paper-based approach could be reduced using electronic, as opposed to manual, collation and sending of records. This paper acts to underpin the rationale and motivation for the development and rollout of an electronic CDSS to support community health workers in their assessment, classification and treatment of young children in rural settings in Malawi, Africa.