Table 3

Challenges and strategies developed in response during the process of developing and implementing the KCH Paediatric Emergency and Acute Care Registry

Challenge	Strategies/Lessons Learnt
Need for integration into existing HMIS system	Multiple meetings with HMIS leadership were key to designing an integrated and complementary process Inclusion of HMIS data clerks into PACHIMAKE data clerk trainings Physical placement of PACHIMAKE data clerks next to the HMIS data clerks to encourage collaboration and teamwork Frequent bidirectional communication with the HMIS staff
Multiple stakeholders with myriad interests	Multiple meetings with all groups of staff and learners in KCH Paediatric Department conducted early on in the planning process Questionnaire to solicit variables of interest from stakeholders
Importance of local ownership of the project	Project designed to fulfil need identified by KCH Paediatric Department administration Appointment of a clinician champion Local project manager to supervise data clerks and troubleshoot day-to-day challenges
Multiple patient entry and exit points/paths	Data clerks perform ‘liwamba’ (Chichewa for a ‘hunt’) twice per shift to locate and follow admitted patients Re-education of staff to direct patients to U5 Placement of data clerks at most common entry point (U5)
Ensuring data quality	Targeted trainings for data clerks Periodic reassessment of vital sign and anthropometric measurement skills Monthly audits of deaths and 10% of discharges with feedback to the clerks Cross-checking of ward and database registers of discharged and deceased patients

HMIS, Health Management Information System; KCH, Kamuzu Central Hospital; PACHIMAKE, Paediatric Alliance for Child Health Improvement in Malawi at KCH and Environs; U5, Under 5 .