An information technology architecture framework for the implementation of the South African national health insurance

Abstract

Universal Health Coverage (UHC) is an insightful goal from the World Health Organisation. Many governments throughout the world, including South Africa, are adopting the approach. The concept of UHC is premised on the need to ensure that all people access quality healthcare regardless of socio-economic status. The South African NHI is a universal health programme, new in South Africa and meant to achieve the UHC goals. Like every other system, the NHI goals require IT solutions to enable and support its operationalisation and fulfilment. The implementation of NHI requires combining, co-existing, and integration various IT solutions, such as software, hardware platforms, network protocols, and databases, to achieve its goals. The process can be challenging without architectural deployment. A technology architecture governs IT-enabling infrastructures, business processes, designs, and patients’ information flow. The deployment of a technical architecture is primarily to prevent prohibitive circumstances, such as loss of data due to lack of security, lack of connectivity, increased procurement and maintenance costs of IT solutions, unreliability, incompatibility and uncertainty of software and hardware, among others. This study aimed to develop an enterprise technical architecture framework that can guide the implementation of the South African NHI system. Based on the aim, the research objectives were to: - examine the factors (such as process, governance, and legislature) that can influence the implementation of the South African NHI, and examine the technology infrastructures, information exchange, and business (healthcare) requirements for implementing the South African NHI. In achieving the aim of the study, the case study approach was employed and the South African NHI was used as the case. The study adopted a qualitative approach. The qualitative data were collected using the document analysis technique. The Actor-Network Theory (ANT) was employed as a lens to guide the data analysis. The analysis revealed the six factors which influence the implementation of the South African NHI. The factors are readiness assessment, government levels of health services, geographical locations of stakeholders, diversity of healthcare facilities, the flexibility of technology solutions, synchronisation of processes, and patients’ data. Lastly, based on the interpretation of the findings the ETA framework for the implementation of the NHI was developed. The study is of contribution from the theoretical and practical perspectives. The theoretical contribution is the study’s addition to the academic existing literature. The developed ETA framework is also a contribution to the body of knowledge from the perspectives of health informatics and IT development. From a practical viewpoint, the framework can guide the implementation of NHI in South Africa.