Developing a digitalization framework for service delivery in the public healthcare sector of Zimbabwe: The moderating effect of organizational culture

Abstract

This study sought to establish a digitalisation framework for service delivery in the public healthcare sector of Zimbabwe. The main objective of this study was to develop a Digitalisation framework for service delivery for the sector. The research was a quantitative study approach rooted in the positivism paradigm anchored on descriptive research design. The population of registered public health care staff that are currently employed in Harare Metropolitan Province was 129,164. Rao soft sample size calculator was used to determine the absolute sample size of 384 respondents as drawn from the entire population. Probability sampling method was used in this study to ensure that the sample being studied was representative of the population of interest. Structured questionnaire was used as data collection instrument. The study took a two-pronged approach to achieve the intended results, namely the statistical approach and the framework development approach. Data was analysed using descriptive and inferential statistics using SPSS and AMOS. Structural Equation Modelling (SEM) was used to examine the study hypothesis to come up with a digitilisation practice framework to enhance service delivery in the public healthcare sector. Data was presented in the form of tables, figure and graphs. The results indicate that Ubiquity has a moderate positive effect on service delivery (β = 0.500, p < 0.001), suggesting that broader access to digital tools enhances responsiveness and continuity of care. Reliability also showed a moderate impact (β = 0.517, p < 0.001), and concerns about system downtimes and unstable connectivity disrupting workflows were raised. Skills and Knowledge emerged as the strongest predictor (β = 0.546, p < 0.001), with participants highlighting the importance of digital training and noting that tech-savvy staff navigated systems more effectively. Innovation had a weaker but still significant effect (β = 0.348, p < 0.001), possibly due to limited staff involvement in system development; several respondents expressed frustration over top-down implementation approaches that reduced buy-in. Information Intensity showed the weakest significant impact (β = 0.125, p = 0.048), as some respondents noted persistent manual reporting and delayed system outputs, limiting data-driven decisions. Lastly, Culture had a small yet significant direct effect (β = 0.111, p = 0.003), underlining the role of attitudes, openness to change, and resistance was highlighted and fear of job loss and adherence to old routines were barriers to digital adoption.However, culture as a moderator has a strong and highly significant coefficient (β = 8.227, p < 0.001) highlighting the importance of integrating cultural considerations into digitalisation strategies to maximize their impact on service delivery. The study highlighted that digitalisation plays a pivot role in improving service delivery; it also creates convenience and increases efficiency in patient health management. There is need to invest in technological infrastructures, back-up power solutions and training of the staff so that service delivery is improved. The findings showed that entrenched beliefs and strong attachments to traditional practices and methods of service delivery may hinder the implementation due to resistance to change. The study recommended that the Government of Zimbabwe through the Ministry of Health and Child Care should adopt and implement the Digitilisation Framework Model for service delivery developed by this study as a beacon to achieve NDS 1, SDG 8 and Vision 2030 targets.