Abstract
In many low-resource settings, maternal health records are paper-based, fragmented, and predominantly controlled by institutions. These conditions limit patient agency, disrupt continuity of care, and constrain the efficiency of service delivery.
This study examines the potential of blockchain technology, specifically non-fungible tokens (NFTs), to support a patient-centred approach to antenatal and postnatal record management.
Drawing on Actor-Network Theory (ANT), we conducted a qualitative case study involving eight semi-structured stakeholder interviews at primary healthcare facilities in Zimbabwe. The themes that emerged from the qualitative enquiry were triangulated with observational data and findings from a previously conducted and published systematic literature review by the authors. This multi-method design enabled the exploration of both technical and socio-organisational factors shaping maternal record practices.
The study identified persistent challenges, including record duplication, limited interoperability, weak referral mechanisms, and inadequate processes for patient consent and data control. To address these gaps, an NFT-based conceptual architectural framework is proposed that tokenises record ownership and consent for data sharing. This framework has the potential to enable patients to exercise greater agency by controlling access to their data while allowing providers to be granted secure, time-bound permissions tailored to their clinical needs. NFTs also have the potential to reconfigure socio-technical networks by aligning stakeholder interests, strengthening patient agency, and supporting sustainable mobilisation across the health system.
The proposed architectural framework is intended to position women as active participants in their maternal care pathways and to strengthen continuity across encounters. By embedding ownership and consent into digital records, blockchain-enabled management offers a potential pathway to more secure, equitable, and patient-centred maternal health systems in low-resource contexts. Empirical validation through pilot implementation and stakeholder co-design is essential before deployment.