Adapting innovation: scaling digital palliative care in Malawi

DOWA, MALAWI – A collaboration between the University of Leeds and Compelling Works Malawi is demonstrating how a digital health solution can be adapted to new settings to strengthen palliative care delivery in humanitarian environments.

The initiative centres on mPallCare, a mobile phone-based intervention that enables palliative care teams to gather information on the symptoms and concerns experienced by patients and their families. Piloting testing of mPallCare has recently been completed at Dzaleka Refugee Camp in Malawi. The team reflects on this work and the potential for technology-led approaches to add value when implemented with services: not as a standalone mobile phone application, but as a practical pathway to strengthen routines, build confidence in healthcare providers, and create evidence that can inform wider digital health use. Just as importantly, the work highlights that success with digital approaches in humanitarian contexts is as much about relationships, governance and training as it is about software and products.

Building on regional learning: from Uganda to Malawi

This recent initiative continues a broader strategic project by the University of Leeds and the African Palliative Care Association, which is undertaking extensive work across multiple African countries to explore how digital health approaches can be developed to meet the diverse needs of people who could benefit from access to palliative care. mPallCare is a mobile phone application and linked dashboard designed to support palliative care delivery by helping healthcare providers monitor patients and organise follow-up in routine practice. Drawing on earlier pilot testing of mPallCare in the Bidibidi Refugee Settlement in Uganda, the team was considering opportunities to expand and further develop the mPallCare platform.

The opportunity arose to leverage an existing partnership between the University of Leeds and Christopher Mwase, Deputy Manager of Research at Compelling Works, an IT company based in Malawi. Christopher is a former master’s student at the University of Leeds, supervised by Professor Matthew Allsop. Christopher was keen to drive forward the exploration of mPallCare and its utility in a different country context.

The context: Dzaleka Refugee Camp (lead photo)

During early discussions between Compelling Works, the University of Leeds, and the Palliative Care Association of Malawi, Dzaleka Refugee Settlement was identified as a site of critical need, mirroring challenges seen in Bidibidi Refugee Settlement. With a population of approximately 50,000 refugees and asylum seekers, the camp faces significant health burdens and complex care needs, within the practical constraints typical of humanitarian settings (e.g., limited healthcare personnel and access to medicines, nutrition and food security challenges, alongside water and sanitation scarcity and overcrowding). This combination of high need and constrained capacity creates a strong rationale for approaches that can support continuity and coordination of care.

Since the inception of work in Malawi, a defining feature has been the depth of coordination required to adapt and deploy a digital platform in a refugee settlement setting. In 2023 and 2024, project leaders worked closely with multiple stakeholders to ensure the approach fit local infrastructure and the policy landscape, and that governance, access arrangements, and day-to-day workflows were agreed across agencies and services. A clear lesson from this period is that digital health tools are rarely “plug-and-play” in humanitarian environments: implementation depends on careful alignment with existing systems, roles, and responsibilities.

This was only possible through a multi-agency partnership: the Ministry of Health (Nursing and Midwifery Directorate) provided national oversight; the Ministry of Homeland Security (Department of Refugees) supported camp access and logistics; the Dowa District Health Office and Dzaleka Health Centre served as the primary care delivery sites; and Palliative Care Association of Malawi provided training and mentorship for healthcare providers.

This multi-stakeholder planning was critical because it enabled the technology to be embedded in real-world delivery—aligning roles, agreeing on processes, and ensuring the pilot-generated learning could actually be used. It also supported shared ownership of the work, which is essential if technology is to strengthen services rather than add burden.

The technical delivery and hosting of mPallCare also depended on cross-border collaboration. A Uganda-based IT company that recently redeveloped the mPallCare platform, MRT IT Peaks Limited, hosted the platform and ensured cross-border testing, supporting safe deployment and functionality checks as a tool developed through regional learning was adapted to a new national and service context. This included supporting the translation of content into Chichewa to facilitate local deployment. This highlights an additional learning point: cross-border technical infrastructure can enable rapid testing and adaptation, but it still needs to be coupled with local planning and support to work in practice.

Co-designing for Dzaleka: grounding the technology in lived experience

To ensure the technology was suitable for Dzaleka, the team conducted initial interviews in late 2024 with 30 patients accessing palliative care at Dzaleka Health Centre (20 refugees and 10 from the host community). These discussions documented daily lived experiences and levels of digital literacy, directly informing the final design of mPallCare and its use in this context. This co-design step is a critical part of the potential added value of technology-led work: it does not just create a tool; it creates a structured way to learn from patients and ensure the service model fits what people can realistically use and sustain. It also strengthens acceptability by ensuring that adaptation is driven by the realities of care, rather than assumptions about how technology should work.

Training and deployment: building capacity alongside the tool

In 2024, the Ministry of Health, Palliative Care Association of Malawi, and Compelling Works worked together to deliver specialised training for 15 healthcare providers at Dzaleka Health Centre. The training combined core palliative care provision with practical use of the mPallCare tool, so the digital platform acted as a lever for broader workforce development—strengthening knowledge and confidence alongside implementation. A key lesson here is that digital tools can add value by acting as a catalyst for skills development and service improvement, when implementation is designed to build capability rather than simply introduce new technology.

In 2025, the digital pilot was implemented over a six-week period. Following refresher training, 30 patients were enrolled and monitored via the app, allowing teams to test the platform in routine care and gather early learning to inform future use. This helped the team understand what it takes to operationalise mPallCare in day-to-day service delivery, including how it fits around clinical workflows and the wider context of care in the camp.

Promising early results: usefulness for patients and providers

Initial feedback from the pilot has been highly encouraging. Both healthcare providers and patients indicated that the technology was useful in supporting care delivery—reinforcing that, when paired with training and mentorship, digital tools can help translate palliative care intentions into day-to-day practice in humanitarian settings.

By leveraging findings from earlier work in Uganda and adapting them to Malawi’s realities, the project demonstrates how palliative care services can be strengthened in low-resource settings through cross-border learning and technology. The broader takeaway is not simply that a platform can be transferred, but that a transferable approach can be developed—one that combines regional learning, local co-design, multi-agency planning and workforce strengthening.

Welcoming expressions of interest

We welcome expressions of interest from organisations and services seeking to use the mPallCare platform for service delivery, including in low-resource settings and humanitarian contexts. The platform is free for service providers to use. Please contact Professor Matthew Allsop (M.J.Allsop@leeds.ac.uk) with a brief description of your setting and intended use, and we can share further information about the platform and implementation approach.