Development of an Integrated and Interoperable WhatsApp Chatbot with the National Digital Systems for COVID-19 Pandemic Responses in Malawi

Abstract Background The recent COVID-19 pandemic has accelerated the adoption and development of digital health innovations for public health responses globally. The chatbots, both rule-based and Artificial Intelligence-based (AI-based) technology, were emerging initiatives used during the pandemic. The Ministry of Health of Malawi launched various digital health initiatives, building on the exisitng digital infrastructure, and resiliently responded to the pandemic. Among the government initiatives, an interoperable rule-based COVID-19 WhatsApp Chatbot (WCB) integrated with other national digital health systems was developed and deployed to address urgent needs across different pandemic response pillars. This study aims to reflect on the design, development, and integration of the COVID-19 WCB through an Action Design Research (ADR) approach to assess its architectural alignment, integration processes, operational challenges, and lessons for sustainability and future scalability. Results The WCB evolved from a private sector initiative aiding basic health education and surveillance functions into a national digital health tool supporting surveillance, risk communication, and emerging vaccination needs. Developed with the integrated health information system architecture design principles in mind, the team used open-source tools and agile methods to enhance WCB with the self-reporting surveillance functions, served as an event-based surveillance function to complement exisitng surveillance systems, vaccination reminders, and digital vaccination certificate generation. The interoperability with national digital platforms, sucth as One Health Surveillance Platform using DHIS2, was done through APIs and health information mediators, developed and owned by the ministry. Key factors enabling its success included architectural reuse, government stewardship, and partner alignment. Challenges included infrastructure limitations, digital literacy gaps, maintenance costs, and concerns about the national roadmap for future sustainability. Conclusions Malawi’s COVID-19 WCB development offers a replicable model by positioning it as a basic digital health infrastrcture and can be integrated into national digital health systems to support pandemic responses. As digital health technology continuously evolves, the experience shows how government-owned, architecture design thinking aligned digital health infrastructure and reusable digital innovation may transition the WCB toward an AI-enhanced, human-centred, and interoperable public health tool to apply in similar settings beyond COVID-19.