Malawi has one of the highest HIV prevalence rates globally, with an estimated 9.5% of its population living with HIV in 2019. Although antiretroviral therapy (ART) is provided free to patients in Malawi, consistent treatment and patient retention remain challenges for healthcare providers, particularly given limited resources and staff.
To address these issues, Baobab Health Trust and Malawi's Ministry of Health began moving clinics from paper-based systems to electronic medical records (EMRs) in 2005. A recent study by Leandro "Leo" Pongeluppe, assistant professor at Wharton School, along with Laura Derksen from Ragnar Frisch Centre For Economic Research and Anita M. McGahan from University of Toronto, assessed the impact of this transition across 106 HIV treatment clinics between 2007 and 2019.
The study found that implementing EMRs resulted in a significant reduction in mortality among HIV patients. After five years, deaths decreased by an estimated 28%, with children seeing the greatest benefit. The researchers estimate that over time, about 5,050 AIDS-related deaths were prevented due to EMR adoption.
"We are using management technology to help support the ones who are most vulnerable among the vulnerable," Pongeluppe says. "We can save lives, especially the lives of the most vulnerable, and in a way that is very cheap. This hopefully will be a way for us to incentivize further implementation."
According to the authors' estimates, it costs approximately $448 per life saved during the first five years following EMR implementation. Pongeluppe notes that other Sub-Saharan African countries and parts of Latin America have limited use of EMRs, suggesting potential for broader application by nongovernmental organizations.
The introduction of EMRs enables clinic staff to better track ART appointments and follow up with patients who miss visits—tasks that previously required manually sorting through thousands of paper files. The system also prompts referrals for additional services such as tuberculosis screening.
The study suggests these improvements stem from increased efficiency rather than changes in medical care itself; more lapsed patients returned for care when clinics used EMRs.
"The broad efficiency gains delivered by the EMR system enable clinics to manage higher patient volumes and retain patients more effectively without exceeding capacity limits," they write. "We contribute to a broader literature on healthcare policy that goes beyond the provision of medicines by showing that managerial interventions such as EMR systems have important health impacts and can be implemented at scale in low-resource settings."
Pongeluppe plans future research into new approaches for delivering ART—such as using converted shipping containers as roadside clinics—to reach mobile populations like truck drivers and sex workers who may not return regularly to traditional facilities.
