INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
www.rsisinternational.org
Page 2476
Evaluating EHR (Impilo) Coverage in Matabeleland South Province,
Zimbabwe
Lynn Mutukura
1
, Dr. Nathan Chiboyiwa
2
, Dr. T Masamha
3
1
Provincial ICT Officer, Matabeleland South, Zimbabwe
2
Provincial Epidemiology and Disease Control Officer Matabeleland South Province
3
A/Director Academy of Teaching and Learning Coordinator MSc Big Data Analytics: Graduate
Business School Chinhoyi University of Technology
Corresponding Author
DOI: https://dx.doi.org/10.51244/IJRSI.2025.1215PH000184
Received: 12 October 2024; Accepted: 20 October 2024; Published: 14 November 2025
ABSTRACT
This study evaluates the implementation of Electronic Health Records (EHR) under the Impilo system in
Matabeleland South Province, Zimbabwe, as of Q1 2025. Using descriptive analysis of provincial health data,
we assess coverage rates, identify barriers to adoption, and propose targeted interventions. Findings indicate
that 90.2% of the province’s 153 health facilities have EHR infrastructure, with 110 sites fully functional. Key
challenges include power instability, connectivity gaps in rural districts (Bulilima and Matobo), and delays in
user training. Innovations such as a WhatsApp-based helpdesk and mobile backups demonstrate adaptive
solutions. The study highlights the need for infrastructure investment, accelerated training, and policy
adjustments to achieve universal EHR coverage. These insights are relevant for Zimbabwe’s national eHealth
strategy and similar low-resource settings.
INTRODUCTION
Background
This study was led by the Matabeleland South Provincial Health Team in collaboration with the Zimbabwean
Ministry of Health and Child Care (MoHCC). Electronic Health Records (EHRs) are pivotal in modernizing
healthcare delivery, enabling efficient patient data management, reducing medical errors, and supporting
evidence-based decision-making (WHO, 2020). Zimbabwe's Ministry of Health and Child Care (MoHCC)
launched the Impilo EHR system as part of its National eHealth Strategy (2021–2025), aiming for nationwide
digitization of health records. Matabeleland South Province, with 153 facilities across seven districts, serves as
a critical case study due to its diverse healthcare landscape encompassing urban centres and remote rural
clinics.
Study Rationale
The successful implementation of EHR systems in low-resource settings faces unique challenges including
unreliable infrastructure, limited technical capacity, and resource constraints. Understanding these barriers
through systematic evaluation is crucial for informing policy decisions and optimizing implementation
strategies.
Objectives
This paper aims to:
1. Quantify EHR Impilo coverage rates in Matabeleland South Province
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
www.rsisinternational.org
Page 2477
2. Identify systemic and operational barriers to full implementation
3. Document innovative solutions developed during implementation
4. Propose evidence-based recommendations for improving adoption and functionality
METHODOLOGY
Study Design
This descriptive cross-sectional study analysed EHR implementation data from Matabeleland South Province
as of Q1-Q2 2025.
Data Collection
We analysed data from the Matabeleland South Provincial Health Team Meeting (May 2025) including:
Facility-level EHR deployment status (installed, activated, functional).
Reported challenges (power, connectivity, training).
Digital innovations (e.g., WhatsApp helpdesk).
Data Analysis
Descriptive statistics were calculated for coverage rates, functionality status, and challenge categories. Results
are presented using frequencies, percentages, and visual representations.
Limitations
Data was self-reported by district health teams, potentially underrepresenting minor operational issues
No comparative data from other provinces available for benchmarking
Assessment limited to Q1-Q2 2025 timeframe
Cost-effectiveness analysis not conducted
RESULTS
EHR Coverage Status
Total health facilities
153
100
Sites with EHR LAN installed
138
90.2
Activated (trained users)
112
73.2
Fully functional
110
71.9
Non-functional (power issues)
2
1.3
Awaiting training
26
17.0
No EHR coverage
15
9.8
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
www.rsisinternational.org
Page 2478
Figure 1: EHR Implementation Progress in Matabeleland South (Q1-Q2 2025).
Challenge Analysis by Category
Infrastructure Deficits (Primary Barriers)
Power Supply Issues
Two facilities rendered non-functional due to unreliable electricity
Intermittent power outages affecting data continuity
Rural facilities disproportionately affected
Connectivity Challenges
Bulilima and Matobo districts experiencing internet instability
Delayed reporting capabilities hindering real-time data access
Limited broadband penetration in remote areas
Human Resource Constraints
Training Gaps
26 sites (17%) have installed systems but lack adequately trained staff
Centralized training model proving inefficient for remote locations
High staff turnover affecting training sustainability
Policy and Governance Issues
Facility Exclusions
15 clinics (mine clinics, border posts, uniformed forces facilities) excluded from EHR rollout
Funding silos between public and private sector mandates
Regulatory gaps affecting comprehensive coverage
Innovative Solutions and Adaptations
The implementation process has yielded several creative solutions:
Digital Support Innovations
EHR WhatsApp Helpdesk: Real-time technical support and fault reporting system
Mobile Backup Collection: VPN-enabled data backup systems for connectivity- challenged sites.
Starlink Pilot Program: Satellite internet trial at one remote site with scaling potential
Training Adaptations
Peer-to-peer learning networks among facilities
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
www.rsisinternational.org
Page 2479
Mobile training units for hard-to-reach locations
Simplified user manuals in local languages
Implementation Progress in Context
Matabeleland South's 90.2% infrastructure coverage rate exceeds initial rollout projections, demonstrating
strong political commitment and resource mobilization. However, the functionality gap (18.3 percentage points
between installation and full operation) reveals significant implementation challenges that require targeted
interventions.
Comparative Analysis
While direct provincial comparisons are limited, available data suggests that Matabeleland South's
performance aligns with national trends. Reported coverage rates in Manicaland Province (88% coverage, 68%
functional) indicate that power supply and training challenges are systemic nationwide issues rather than
province-specific problems (MoHCC, 2024).
Root Cause Analysis
Infrastructure Challenges Zimbabwe's ongoing electricity crisis, with only 40% rural electrification coverage
(ZESA, 2024), fundamentally constrains EHR functionality. The dependency on grid electricity without
adequate backup systems creates vulnerability to service disruptions.
Training Model Limitations The centralized training approach, while ensuring standardization, proves
inefficient for geographically dispersed facilities. Travel costs, staff time away from clinical duties, and limited
training capacity create bottlenecks in the rollout process.
Governance Gaps The exclusion of mine clinics and border facilities reflects broader challenges in multi-
sectoral health governance, where different ownership models create implementation silos.
Innovation as Adaptation Strategy
The WhatsApp helpdesk innovation demonstrates successful adaptation of existing communication
technologies for technical support, mirroring successful mHealth interventions documented in similar settings
(Gondwe et al., 2023). This low-cost, high-impact solution addresses the challenge of providing timely
technical support across geographically dispersed facilities.
RECOMMENDATIONS
Short-Term (0–6 Months) Infrastructure Stabilization
Deploy solar hybrid systems with battery backup at the non-functional sites
Conduct comprehensive power audit at all facilities to identify at-risk installations
Establish emergency power protocols and backup procedures
Training Acceleration
Implement district-based train-the-trainer programs for the 26 untrained sites
Develop mobile training teams to reduce travel burden on clinical staff
Create competency-based certification system to ensure training quality
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
www.rsisinternational.org
Page 2480
Medium-Term (6–18 Months)
Partner with telecommunications providers (TelOne, Econet) to improve rural broadband infrastructure
Explore public-private partnerships for connectivity solutions
Pilot satellite internet solutions in the most remote facilities
Policy Inclusion: Integrate mine/border clinics into MoHCC’s EHR mandate.
Long-Term (2–5 Years) Sustainable Financing
Advocate for dedicated eHealth infrastructure budgets in provincial allocations
Develop cost-recovery mechanisms for system maintenance and upgrades
Explore international donor support for infrastructure development
System Integration
Integrate Impilo with Laboratory Information Management Systems (LIMS) and Essential Logistics
Management Information System (ELMIS)
Develop interoperability standards for seamless data exchange
Create comprehensive health information ecosystem
Capacity Building
Establish provincial EHR support centres
Develop local technical expertise through training partnerships
Create career pathways for health informatics professionals
Implement Monitoring Framework Key Performance Indicators
Facility coverage
98%
Functional sites
90%
Training completion
95%
Uptime reliability
>95%
User satisfaction
>80%
CONCLUSION
The EHR implementation in Matabeleland South Province demonstrates significant progress toward digital
health transformation while highlighting persistent challenges that require systematic attention. The 90.2%
infrastructure coverage represents substantial achievement, but the functionality gap underscores the
complexity of health system digitization in resource- constrained settings.
Key success factors include strong provincial leadership, adaptive problem-solving through innovations like
the WhatsApp helpdesk, and commitment to universal coverage despite implementation challenges. However,
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI | Volume XII Issue XV October 2025 | Special Issue on Public Health
www.rsisinternational.org
Page 2481
sustainable success requires addressing fundamental infrastructure constraints, particularly power supply
reliability and internet connectivity in rural areas.
The study's findings have broader implications for Zimbabwe's national eHealth strategy and similar initiatives
across sub-Saharan Africa. The documented innovations provide scalable models for other provinces, while
the identified challenges inform policy development and resource allocation decisions.
ACKNOWLEDGMENTS
We thank the Matabeleland South health facilities for their participation. The views expressed are those of the
authors and not necessarily their institutions.
REFERENCES
1. Gondwe, L., Kamanga, A., & Makwemba, M. (2023). mHealth for EHR support in low-resource
settings: Lessons from Malawi. Journal of Global Health Informatics, 15(2), 234-248.
2. Ministry of Health and Child Care (MoHCC). (2024). Zimbabwe National eHealth Strategy 2021-2025:
Mid-term review report. Government of Zimbabwe.
3. World Health Organization (WHO). (2020). Digital health interventions for universal health coverage:
Evidence synthesis and recommendations. Geneva: WHO Press.
4. Zimbabwe Electricity Supply Authority (ZESA). (2024). Annual infrastructure report 2024: Rural
electrification progress. ZESA Holdings.
5. Zimbabwe National Statistics Agency (ZIMSTAT). (2024). Health facility survey 2024: Infrastructure
and capacity assessment. ZIMSTAT.