Abstract
The performance of Zimbabwe’s public health system has deteriorated over the past four decades. Consequently, the government has implemented various reforms to strengthen and revive the effectiveness of the public health sector. This study examined the adoption and implementation of e-health as part of reforms meant to improve health service delivery, financial management, administrative process, and health data collection and reporting in Zimbabwe’s public health sector. The Parirenyatwa Group of Hospitals (PGHs) and Chitungwiza Central Hospital (CCH) were used as case sites. The study contextualised and conceptualised the theories, sub-domains, and implementation of e-health utilising a qualitative method research design. This allowed the researcher to gain an in-depth understanding of the phenomenon under study. The population of the study comprised of government officials from the Ministry of Health and Child Care (MoHCC) and the Ministry of Information Communication Technology, Postal and Courier Services (MICTPCS), health practitioners, including medical doctors, nurses, health services administrators, health information officers, data clerks, pharmacists, and patients from the two case sites. Purposive and convenience sampling techniques were used to select the participants and data were gathered through in-depth interviews, observations, and documentary research. Data analysis in this study followed Yin’s (2011) seven-step method with additions from Miles and Humberman (1994). The researcher conducted data analysis using Nvivo 11, a software package that helps with qualitative data analysis. The study findings show that while e-health is an indispensable tool in improving both clinical and administrative processes in developing countries, as it has in developed countries, its implementation in Zimbabwe has faced challenges. Additionally, the use of these technologies is still in their nascent stages. This is because most of e-health technologies currently used in Zimbabwe’s public hospitals are mainly from the 3rd industrial revolution (mobile-health, telemedicine, and electronic health records), as opposed to more advanced health technologies such as Artificial Intelligence (AI), drones, cloud computing, and blockchain technologies. The study also found that e-health technologies in Zimbabwe’s public hospitals focused primarily on in-house information needs rather than on serving patients. Furthermore, there is no interoperability between public hospitals, which affects the smooth and timely dissemination of patient data across the referral chain. The study established that the adoption and implementation of e-health in Zimbabwe has been marred by numerous challenges, including security and privacy concerns, lack of ICT infrastructure and skills, lack of funding, resistance to change, cultural and language barriers, and inadequate legal backing. The thesis recommends conducting e-health readiness assessment prior to e-health implementation. This include adopting Public Private Partnerships in digital health projects, continuous training and development for the health workforce, adequate government funding, and constant monitoring and evaluation of e-health projects. Finally, the study recommends that policy-makers create an environment conducive to e-health implementation in the public health domain by aligning e-health projects with various public programmes and policies, such as national ICT and health policies, data protection acts, and rural electrification programmes.