Digitalizing oncology in Africa A design science research approach

Cancer is a leading cause of morbidity and mortality worldwide. In 2020, there were 19 million cancer cases, and 10 million cancer deaths. This is more than deaths that year from HIV/AIDS, tuberculosis, malaria, road traffic accidents, and COVID-19 combined.
Low- and middle-income countries (LMICs) are disproportionately affected by cancer because it is under-prioritized. Priority, including donor funding, is directed towards traditional public health challenges in LMICs, particularly, infectious diseases (HIV/AIDS, Malaria and Tuberculosis) and maternal and child health. For Africa, the ongoing socio-economic transitions (urbanization, ageing population, and westernization of lifestyles) also increase the cancer risk. Consequently, Africa is predicted to have the sharpest rise in cancer (about 38%) over the next decade.
Innovative approaches are needed to improve the efficiency, coverage, and cost-effectiveness of cancer services in Africa. This thesis argues that digitalization is one such approach, and applies the design science methodology to demonstrate how this digitalization can be achieved. The research in this thesis explores the current landscape of digital health interventions in oncology in Africa, the requirements for oncology electronic medical record systems, and organisational readiness for these systems. It also describes the implementation of an interactive voice response system to address the challenge of cancer awareness in Uganda, and a program theory for this intervention. Findings highlight the low maturity and fragmented nature of digital health implementations in oncology in Africa; the need for scale-up, integration and interoperability; the persistent socio-technical barriers to be addressed; and the needed research on clinical impact of digitalization.