E-health and e-governance integration framework for the Namibian government

Abstract

As in many developing countries, the Namibian government strives to improve on service delivery from healthcare and governance perspectives. Thus, the Namibian government has invested efforts and resources in developing the e-health system and e-governance concepts towards improving services in the country. However, both concepts are separated and not integrated with each other. This separation is a problem because the gaps that exist in executing the e-health defeat the primary purpose of improving healthcare services. The problem emanates from two fronts: from the e-health viewpoint, patients’ data are fragmented and decentralised, which sometimes results to duplication. These challenges lead to bigger problems, as diagnoses are duplicated. One of the implications is that it increases the mortality rate in the country. The challenges arise primarily because there is a lack of standard governance, which aids good practice, such as transparency and the evaluation of services. Thus, the aim of the research was to develop a framework that can be used to guide the integration of e-health systems with e-governance for the Namibian government’s administrations. The qualitative method was used for the study and the case study design was applied. Data was collected using unstructured interviews and documentation from the various cases. The cases selected for this study are the Ministry of Information Communication Technology (MICT), Office of the Prime Minister (OPM), Ministry of Health and Social Services (MoHSS) and public and private healthcare facilities. Two theories, Activity theory (AT) and Actor-Network theory (ANT) were used to underpin the study, which means that the theories were used as lenses to analyse the data and interpret the findings from the analysis. From the analysis, eight factors were revealed to influence the integration of e-health with e-governance from the e-health perspective, namely, disparity, isolation, governance, requirements, know-how, interoperability, synchronisation of data and processes and heterogeneity. From e-governance, six factors were found to influence the integration of e-health with e-governance, namely, know-how, requirements, political-will, heterogeneity, power relationship and governance. These factors were then mapped against each other, and nine factors were found to be common. These nine factors were grouped into three categories, namely, vision which consists of three factors; requirements, know-how, and disparity; IT enablement, which consists of four factors; governance, interoperability, isolation and synchronisation of data and processes, and management, which consists of two factors; power relationship and heterogeneity.

From the findings’ interpretation using the four moments of translation from an ANT perspective, six factors were found to mostly determine the integration of e-health with e-governance in the Namibia environment. The factors are (1) alignment between business and technology; (2) environmental assessment; (3) collaboration between actors of both e-health and e-governance; (4) enterprise architecture; (5) skill and retention; and (6) critical success factors to evaluate the fulfilment of the integration goal. Based on these factors, a framework for integrating e-health with e-governance was developed. The framework that was developed for integrating e-health with e-governance can be used as a reference by other developing countries, particularly in Africa, to counter the current challenges involved in developing an integrated solution. This study will also help stakeholders to understand better why and how the integration of e-health with e-governance is derailed or enabled, which can guide the promoters and managers towards the successful integration of the e-health system with e-governance in Namibia. Such an understanding is significant to health practitioners, IT specialists, and government in improving service delivery. Also, the study benefits the academic domain by adding to the body of knowledge. From the literature review, there is currently no framework for integrating e-health with e-governance; hence, this framework is a valuable addition. The study also adds to existing literature in the fields of health informatics and information systems governance.