Full Text Available
Note: Clicking the button above will open the full text document at the original institutional repository in a new window.
The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context
Thesis (PhD)--Stellenbosch University, 2026.
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
Stellenbosch : Stellenbosch University
2026
|
| Tags: |
No Tags, Be the first to tag this record!
|
| _version_ | 1867613805557579776 |
|---|---|
| access_status_str | Open Access |
| author | Ratshidi, Lilies |
| author2 | Grobbelaar, Sara |
| author_browse | Grobbelaar, Sara Ratshidi, Lilies |
| author_facet | Grobbelaar, Sara Ratshidi, Lilies |
| author_sort | Ratshidi, Lilies |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2026. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/135909 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:41:59.323Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/135909 The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context Ratshidi, Lilies Grobbelaar, Sara Botha, Adele Stellenbosch University. Faculty of Engineering. Dept. of Industrial Engineering. Thesis (PhD)--Stellenbosch University, 2026. Ratshidi, L. 2026. The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/3055cda0-108a-4b41-8273-80f6f972c8c8 Globally, community health workers (CHWs) are recognised as a common equaliser in both developing and developed contexts to realise universal health care coverage (UHC). In South Africa, the longstanding impact of CHWs predates the establishment of post-democratic governmental structures, with recognition of their auxiliary role to bridge underserved communities with the healthcare system. While they are conceptually instrumentalised through policy and political intentions, they remain systemically marginalised from the healthcare system, revealing the paradoxical nature of their role and the complex landscape they are positioned in, expected to play a critical role in bridging healthcare gaps without marginalised in practice, as observed in South Africa, this pattern of policy - practice imbalance and systemic incongruence is consistent across most low- and middle-income earning countries (LMICs). Empirical evidence and global strategic planning documents suggest that the lack of accelerated efforts toward their integration is linked to the importance of their effectiveness in strengthening primary healthcare (PHC) settings. Amidst the debates, Information and Communication Technology (ICT) has emerged as a pathway to mediate and strengthen their effectiveness and reach. Notably, ICT has the potential to accelerate CHW integration by upskilling CHWs, strengthening their skills, relevance, and functional integration; and consequently, mitigating the effects of marginalisation through capacity and competency building. As the demand for digital health solutions in LMICs increases, extensive research has explored how technology can benefit CHWs, indicating a strong interest in innovative technological solutions to overcome structural barriers to their performance and modes of healthcare service delivery. Among these are the potential benefits of digitising CHWs; the realisation of ICT in healthcare settings remains a recurring challenge in many developing countries with limited resources. Despite the possible benefits, ICT often fails to realise its expected impact, especially during large-scale digitisation efforts. There is substantial evidence that most ICT implementation challenges stem from contextual constraints and differences in community and health system landscapes. This highlights the importance of a dynamic, gradation, context-specific approach that extends beyond ICT design to encompass an understanding of the community health system landscape. Therefore, this study aimed to investigate and develop a framework to support and guide the implementation of ICT for CHWs within the South African healthcare landscape. This research adopts a Design Science Research (DSR) methodology, an iterative pragmatic approach for developing, testing, and refining artefacts. Following the DSR research positioning process, the study begins by defining the research problem in the real-world context. To create a contextually relevant solution that facilitates successful ICT implementation in resource-constrained environments, this study employs a four-phase research process with three cycles to iteratively develop, demonstrate, evaluate, and refine the framework. It draws on qualitative and quantitative methods to collect empirical evidence, analyse, and interpret for the development and refinement of a conceptual framework into a contextually relevant toolkit. The initial phase focuses on delineating the research problem and the objectives of the solution in accordance with the DSR design process; the second phase focuses on conceptualising the framework by conducting systematic scoping reviews to identify the key components of the research artefact. The third phase focuses on developing the framework by consolidating the findings from the first phase into a conceptual framework, integrating concepts in accordance with the framework design requirements. Thereafter, the fourth phase evaluates the conceptual framework through a three-cycle, iterative evaluation process to analyse the artefact holistically and validate rigour and relevance. The framework is designed as a support-and-guidance toolkit to facilitate the implementation of ICT solutions for CHWs within the South African healthcare system and, potentially, transferable to similar contexts, provided that local conditions and the broader institutional contexts are considered. The final framework is presented as a practical toolkit that provides core support structures for ICT implementation and context-specific, user-centric, and prioritised strategic pathways for ICT implementation, and includes an application guide for operationalising the toolkit and guiding the intervention process in practice. Besides the toolkit, this study makes a knowledge contribution primarily at a theoretical and pragmatic level through the artefact design and evaluation approaches. The findings of this study are particularly relevant for CHWs and stakeholders in community-centred care in the PHC, digital health innovations, and ICT-embedded solutions for under-resourced communities. Overall, the toolkit is designed and validated to enable progressive ICT integration, strengthen support for ICT-enabled CHWs in navigating socio-technical complexities, and improve interoperability across diverse and resource-constrained health system contexts. Doctoral 2026-04-14T14:10:12Z 2026-04-14T14:10:12Z 2026-03 Thesis https://scholar.sun.ac.za/handle/10019.1/135909 en Stellenbosch University 462 pages application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Ratshidi, Lilies The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context |
| title | The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context |
| title_full | The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context |
| title_fullStr | The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context |
| title_full_unstemmed | The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context |
| title_short | The development of a framework to guide and support the implementation of ICT solutions for community health workers in resource-constrained settings within the South African context |
| title_sort | development of a framework to guide and support the implementation of ict solutions for community health workers in resource constrained settings within the south african context |
| url | https://scholar.sun.ac.za/handle/10019.1/135909 |
| work_keys_str_mv | AT ratshidililies thedevelopmentofaframeworktoguideandsupporttheimplementationofictsolutionsforcommunityhealthworkersinresourceconstrainedsettingswithinthesouthafricancontext AT ratshidililies developmentofaframeworktoguideandsupporttheimplementationofictsolutionsforcommunityhealthworkersinresourceconstrainedsettingswithinthesouthafricancontext |