From paper to digital in a resource-limited setting: A case study of Zimbabwe's health administration system and e-health strategy

Abstract

The implementation of the e-Health Strategy (2021–2025) for Zimbabwe has been critically reviewed and has been treated as a paradigm for transitioning from paper-based administration to digital health. This study was guided by the Technological, Organizational, and Environmental (TOE) framework and the Diffusion of Innovations (DOI) theory. This study employed a qualitative case study method, which included data collected through a documentary review of several primary resources, such as Health Management Information System (HMIS) reports (2020–2023) and official Ministry of Health and Child Care (MoHCC) publications, as well as secondary sources like peer-reviewed journals and reports from the World Health Organization (WHO) and International Telecommunication Union (ITU) (2019–2024). Thematic content analysis, based on the Technological, Organizational, and Environmental (TOE) framework, was used to identify achievements, systemic barriers, and implementation gaps. The findings indicate that Zimbabwe has made significant progress towards the centralization of health data by ensuring 95% facility reporting and reducing delays in reporting from 90 days to less than 15. Various targeted digital interventions with e-TB and FP/HIV tracking tools have enabled patient monitoring and medication adherence. For example, considering that across-the-board challenges still exist due to uneven technological infrastructure, fragmented and non-interoperable systems, poor human resource capacity, and donor funding only, one example is the cold-chain breakdown. Comparative evidence from regional and global contexts supports the notion that a sustainable scale-up of digital health may be achieved only by combining our approaches to technology, workforce development, interoperability, and domestic funding. The study concludes that while Zimbabwe has made exciting progress, systemic, organizational, and environmental barriers need to be overcome if it is ever to achieve a strongly established, sustainable, and equitable national digital health setting. Thus, the study recommends that legislators should adopt an all-encompassing approach that synthesizes technological, organizational, and environmental perspectives. From a technological perspective, the government should prioritize providing Internet and power infrastructure that is widely accessible anywhere by all, particularly in the rural districts, and also enforce the interoperability standards in order to reduce fragmentation in the system. Organizationally, there should be sustained investment in digital literacy training, mentorship programs, and the recruitment of dedicated ICT personnel for the district and provincial levels so as to bolster system adoption and promotion of seamless workflow integration. There should also be enactment of policies to either subsidize or provide completely free data services and connectivity tools to the health facilities and front-line workers. Another important recommendation is consideration of the incorporation of change management strategies, incentives for adoption, and aligning donor-supported activities with priorities on the national level so as to achieve the development of a resilient system that can be applied and scaled in a flexible way to bring equitable health outcomes simultaneously to the urban and rural populations.