Between promise and practice: mapping the implementation of digital health technologies in five sentinel district hospitals in South Africa
1
South African Research Chairs Initiative, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
2
School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A862
ABSTRACT
INTRODUCTION:
Digital health technologies (DHTs) are widely promoted as enablers of health systems strengthening in low-and-middle-income countries. However, evidence on their routine implementation in district or first referral hospitals remains limited. This study examined the implementation of DHTs in five South African district hospitals.
METHODS:
During 2025, a health facility assessment was conducted in five sentinel district hospitals across five South African provinces. We combined semi-structured interviews with hospital management (clinical, IT and information managers) with a structured checklist and walk-around to map infrastructure, equipment, staffing and DHT implementation in each clinical unit. The WHO Health System Building Blocks framework guided the analysis.
RESULTS:
DHT implementation varied substantially across the hospitals. All hospitals were piloting or partially using a digitised health information system for patient registration, but weak IT systems and budgetary constraints limited their expansion towards medical records. Although one hospital implemented an electronic medical record system, roll out was halted due to logistical constraints and staff resistance. Four hospitals had digital X-ray units, but only two were able to store and transmit medical images digitally. Stock management and procurement software was implemented in all hospital pharmacies, yet only two used it for medication dispensing. The use of mobile clinical applications was widespread across all hospitals, driven largely by providers, to process lab results (TrackCare), coordinate referrals (VULA) and access clinical guidelines (EMGuidance). However, the extent of their integration in routine clinical practice varied. WhatsApp remained ubiquitous as informal “shadow” information systems, with multiple groups supporting within-unit, cross-unit and inter-facility communication. Persistent barriers for hospital-wide DHT implementation included inadequate financing, limited IT support, outdated hardware and fragmented digital governance structures.
CONCLUSIONS:
DHTs hold significant promise but remain fragmented, and unevenly and largely informally implemented. Strengthening leadership, financing, infrastructure and system integration are essential for meaningful digital transformation.
Digital health technologies (DHTs) are widely promoted as enablers of health systems strengthening in low-and-middle-income countries. However, evidence on their routine implementation in district or first referral hospitals remains limited. This study examined the implementation of DHTs in five South African district hospitals.
METHODS:
During 2025, a health facility assessment was conducted in five sentinel district hospitals across five South African provinces. We combined semi-structured interviews with hospital management (clinical, IT and information managers) with a structured checklist and walk-around to map infrastructure, equipment, staffing and DHT implementation in each clinical unit. The WHO Health System Building Blocks framework guided the analysis.
RESULTS:
DHT implementation varied substantially across the hospitals. All hospitals were piloting or partially using a digitised health information system for patient registration, but weak IT systems and budgetary constraints limited their expansion towards medical records. Although one hospital implemented an electronic medical record system, roll out was halted due to logistical constraints and staff resistance. Four hospitals had digital X-ray units, but only two were able to store and transmit medical images digitally. Stock management and procurement software was implemented in all hospital pharmacies, yet only two used it for medication dispensing. The use of mobile clinical applications was widespread across all hospitals, driven largely by providers, to process lab results (TrackCare), coordinate referrals (VULA) and access clinical guidelines (EMGuidance). However, the extent of their integration in routine clinical practice varied. WhatsApp remained ubiquitous as informal “shadow” information systems, with multiple groups supporting within-unit, cross-unit and inter-facility communication. Persistent barriers for hospital-wide DHT implementation included inadequate financing, limited IT support, outdated hardware and fragmented digital governance structures.
CONCLUSIONS:
DHTs hold significant promise but remain fragmented, and unevenly and largely informally implemented. Strengthening leadership, financing, infrastructure and system integration are essential for meaningful digital transformation.
| eISSN: | 2654-1459 |
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