Background <p>Health Passports (HPs) are paper-based, patient-held records used in Malawi to document key details about the health condition of a patient and the care provided during medical visits.</p> Aim <p>This paper assessed their use and effectiveness within the health data ecosystem, and their potential impact on patient care.</p> Setting <p>The study setting was health facilities under the District Health Office in the Zomba District, Malawi.</p> Methods <p>We undertook a qualitative study to determine the practices for data recording used by health care professionals and the importance placed on HPs by patients and professionals. We conducted an in-depth Focus Group Discussion with healthcare practitioners. Pages from completed HPs were analysed to extract practices for recording case presentation, diagnosis, and medication.</p> Results <p>HPs were perceived to be beneficial to healthcare professionals as a means of transmitting information and communicate to each other the patient record history and treatment. Patients saw HPs solely as means of accessing services rather than as sources of personal health information with intrinsic value to them. Practices in recording patient notes varied considerably and we found many instances of illegible handwriting, and the use of abbreviations and shorthand that could be interpreted differently by clinicians and were not understood by patients. Language and communication barriers, low patient literacy and a general lack of privacy during consultations also had a significant negative effect on the use and effectiveness of HPs.</p> Conclusion <p>There are significant gaps between the intended use and effectiveness of HPs in a clinical setting and the actual use by healthcare professionals and patients. Efforts to make sure that HPs can effectively fulfil the primary purpose of medical records are long overdue.</p> Contribution <p>This study contributes to an under-researched area for understanding the use and effectiveness of patient-held records in LMICs.</p>