Measuring e-Government as an Innovation Tool for Effective Provision of Health Services in African Low and Middle-Income Countries: A Case Study of Lubumbashi in the Democratic Republic of the Congo

Abstract

This thesis examines eHealth and digital government as innovative tools for improving healthcare service delivery in African low- and middle-income countries (LMICs). It explores how digital technologies can support the transformation of healthcare systems, improve access to health-related information and services, and contribute to more efficient, responsive and user-oriented healthcare delivery in contexts where technological, institutional and infrastructural constraints remain significant. The study focuses on the implementation and adoption of eHealth services from an innovation and technology acceptance perspective. It investigates the relationship between users’ needs and the implementation of eHealth services, while examining the influence of perceived usefulness, perceived ease of use and privacy on the acceptance and use of digital healthcare technologies. The research is primarily grounded in the Technology Acceptance Model (TAM), complemented by insights from the Unified Theory of Acceptance and Use of Technology (UTAUT) and the broader literature on technology diffusion and innovation. A quantitative, descriptive and explanatory research design was adopted. Data were collected through surveys involving general users and medical personnel and analysed using statistical techniques including descriptive statistics, correlation analysis and regression analysis. The study seeks to identify the factors that can facilitate or constrain the successful adoption and implementation of innovative eHealth services in African healthcare environments. The empirical investigation uses Lubumbashi, Democratic Republic of the Congo (DRC), as a case study through which broader challenges associated with digital health innovation in African low- and middle-income contexts can be examined. The case provides insight into the interaction between technological innovation, users’ needs, healthcare professionals, institutional capacity, infrastructure and the socio-economic environment in which digital health solutions are introduced. The findings indicate that perceived ease of use, privacy and the perceived need for eHealth services have positive and significant relationships with the usage and implementation of eHealth services. Perceived usefulness also demonstrates a positive relationship, although its effect was not statistically significant. The study further identifies a gap between some of the digital health services available and the actual needs of users. These findings highlight the importance of designing digital health innovations around users and local contexts rather than relying solely on the availability of technology. From an innovation perspective, the study argues that digital transformation in African healthcare should be understood not simply as the introduction of new technologies, but as a broader process of service innovation and organisational change. Successful eHealth implementation requires consideration of usability, privacy and trust, digital skills, infrastructure, institutional capacity, healthcare professionals and the specific needs of communities. Such an approach can contribute to the development of more inclusive, accessible and sustainable digital health ecosystems across African low- and middle-income countries. The study contributes to the growing but still limited body of research on eHealth adoption, digital transformation and healthcare innovation in African LMICs. By combining an innovation perspective with technology acceptance models and empirical evidence from the Democratic Republic of the Congo, it provides insights that may be relevant to policymakers, healthcare institutions, technology developers, innovators, researchers and other stakeholders seeking to advance digital health transformation in Africa. The findings may support the development of more user-centred and context-sensitive eHealth strategies and provide a basis for further research into how African low- and middle-income countries can leverage digital innovation to strengthen healthcare delivery, improve access to health services and respond to evolving healthcare needs. This thesis was submitted in partial fulfilment of the requirements for the Master’s degree in Innovation and Knowledge Management at Near East University.