Effective health care requires timely access to medical facilities; this significantly reduces mortality rates. Yet, half of the Malawian population lives more than 5 km from a health facility, severely hindering access to essential health care services. Unless addressed, this problem is expected to worsen as the population grows; already in 2023 an estimated 9.7 million people lack access to health care. Accordingly, setting up new health posts and reducing distances individuals must travel to access services is crucial to reducing the disease burden in the country and improving the population’s well-being.

The Approach

The Malawian Ministry of Health (MoH), the Digital Impact Alliance (DIAL), Cooper/Smith and Infosys partnered to address this challenge by using Mobile Network Operator (MNO) data analytics alongside other datasets such as census data and satellite imagery. When combined, these sources can account for population density, migration trends and urbanisation rates. Based on this data, the team developed an accurate and dynamic model for health facility placement. The results are summarised and visualised in an interactive dashboard for policymakers.

The Benefits

For the Malawian Ministry of Health, the combination of data helped determine the optimal placement of the 900 new health posts that would be needed to enable 95% of Malawians to live within walking distance of a health facility. The use of new data sources offers several benefits. It allows for resources to be used efficiently, it improves information accuracy, and it facilitates more timely decision-making. Moreover, this use case shows how public-private partnerships can operationalise the potential of emerging data sources and analytics in supporting government development efforts. The use case significantly contributes to SDG 3 Good health and well-being by addressing the limited access to health care in Malawi and so reducing the country’s disease burden. Optimising the locations for new health posts significantly reduces mortality rates, promotes preventive care and enhances the overall well-being of the population. The project further contributes to SDG 10 Reduced inequality by promoting the adoption of data-driven policies to ensure equal access to medical services particularly in rural and remote areas.

9.7

million

people in Malawi lack access to health care in 2023.

Malawi

The context

The challenges of access to health care in Malawi are multifaceted and can be attributed to several factors, including a lack of infrastructure, poor road networks and a shortage of trained health workers. Rural and remote areas are particularly affected by these issues: many communities are forced to travel long distances to access basic medical services. This may lead to irregular or unattended health check-ups, resulting in delayed diagnoses, increased morbidity and high mortality rates.

Addressing these concerns, the Malawian Ministry of Health announced in 2019 their intention to build 900 new health clinics across the country so that 95% of the population will live within 5 to 6 km of a health facility. To realise this goal, the MoH, in partnership with private companies, used mobile phone data to determine the optimal locations for new health posts.

How it was implemented

In order to prepare a recommendation for the locations of these new health clinics, the project team used a three-step approach.

Step 1: Data Collection

For this analysis, the project team integrated three data sources:

Anonymised mobile phone data (MNO), which included Call Data Records (CDR) and geo-tagged locations of each cell phone tower. To use the private MNO data, Ministry of Health staff needed to ensure the MNO technical staff were trained to ensure the data was properly anonymised. This data then had to be cleaned: inaccurate records were deleted and as this work was done the project team identified quality issues and missing data, which led to recurring work with MNO staff to properly format the exhaustive datasets. Previous research has demonstrated a strong correlation between the density of unique users within a cell tower's catchment area and the corresponding population density, and as a consequence this data provided valuable insights.‍
Population density data from WorldPop. Researchers have developed cutting-edge algorithms that are trained on historical census data to project annual population density at a 100-meter resolution. This information was leveraged by the project team to gain insights into the trends and patterns of population density across Malawi.‍
Location of existing health facilities, which was provided by the Ministry of Health and UNICEF.

Step 2: Gap Analysis

Using data from WorldPop and the location of existing health facilities and their service areas, the project team was able to create maps which enabled the calculation of the population in each district that did not live within 5 km of a health facility.

Figure 1: Map of estimated gaps in coverage related to health services.
Source: Using Mobile Phone Data to Make Policy Decisions

Step 3: Population Movements

After identifying where the gaps in health care service were, the team integrated MNO data to consider population growth and migration patterns. More specifically, the anonymised MNO data was mapped to administrative units to calculate the density of individual callers and then match it to population density using WorldPop data. Fluctuations in caller density could be extrapolated to infer population migration tendencies.

The MNO data showed that the population shifts during work times during the week, shifts to the coast and to markets on the weekends, and that migration takes place during the rainy season. Understanding this pattern of short-term population shifts helped the project team predict population densities over time.

Figure 2: Pattern of short-term population shifts to predict population densities over time.
Source: Using Mobile Phone Data to Make Policy Decisions

How can better data contribute to better policy?

Using this data the analysts developed a model that would optimise the allocation of care facilities and clinics. With the added value of the MNO data, the model endeavoured to maximise coverage of currently unserved populations, taking into account population growth and migration patterns.

With this model, the team was able calculate how many people each new health post would serve. Moreover, this model considered the impact of flooding during the rainy season, determining that some of the health posts would be over-burdened as a result, and adjusted the proposed locations based on this analysis. An added benefit is that periodic or close to real-time MNO data could be used in the future to update the model as health posts are constructed.

The data-driven model proposed optimal locations for the 900 new health posts that would enable 95% of Malawians to live within walking distance of a health facility. These findings were compared with Malawi’s Capital Investment Plan, which included a plan for the locations of the health posts and were found to offer greater coverage while reducing the likelihood of individual health posts becoming overburdened.

Figure 3: Proposed allocation of new health posts.
Source: Using Mobile Phone Data to Make Policy Decisions

Implementing the findings

To ensure that these important findings could be applied effectively by policymakers in Malawi, the project team developed an interactive Power BI dashboard, which can provide:

Estimated population density
Health post coverage
Cell phone usage patterns
Long-term population movements
Short-term population movements

From the beginning, the Malawian Ministry of Health was closely involved in this use case, providing input and directly engaging on the technical and policy levels. To make the project sustainable and replicable, the project team collaborated with government partners in Malawi to incorporate their analysis into the country's systems and provide a list of priority locations for the new health posts. After the analysis was completed, the project team engaged in a series of meetings with the MoH to provide a detailed walk-through of the results.

Where do we go from here?

In June 2022 the Minister of Health Khumbize Kandodo Chiponda confirmed government financial support for the construction of the first 55 new health posts. In October 2022, Malawi’s President Lazarus McCarthy Chakwera reaffirmed the government’s plans to construct 900 new health posts in total. The project team’s analysis can continue to inform optimal locations for these new posts, but in order for this to be effective in the long term, a “data pipeline” for anonymising close-to real time MNO data will need to be established.

DIAL remains committed to continuing its work with government partners in Malawi and other countries around the world to demonstrate how data for development models like this one can be replicated across development sectors and different regions.