A Design Science Research Framework for building Resilience in South Africa’s National Digital Health Information System: an Ultra-Large-Scale Systems perspective

South Africa’s National Digital Health Information System (NDHIS) is intended to serve as the backbone for the National Health Insurance (NHI) by enabling patient registration, provider contracting, financing, and performance monitoring. However, persistent fragmentation, legacy systems, provincial disparities, and sociotechnical complexity have created a highly decentralised, continuously evolving ecosystem that exhibits the characteristics of an Ultra-Large-Scale System (ULSS). Conventional design and governance approaches are inadequate for ensuring resilience in such environments. This study adopts a Design Science Research (DSR) methodology to develop and evaluate a resilience framework for the NDHIS from an ULSS perspective. Through scoping reviews of ULSS and resilience literature, contextual policy analysis of South African health reform documents, iterative artefact design, and simulation-based evaluation, the research identifies eight core components of resilience: decentralised governance, adaptive architectures, continuous monitoring and learning, redundancy and modularity, inclusive stakeholder engagement, anticipatory risk management, interoperability-by-design, and evolutionary policy mechanisms. The resulting framework provides actionable design principles and governance guidelines that enable the NDHIS to anticipate, absorb, adapt to, and rapidly recover from technological, organisational, cyber, and crisis-related disruptions while preserving essential functions and equity of access. The study contributes theoretically by integrating ULSS thinking with health systems resilience, methodologically through simulation-based DSR evaluation in a data-constrained context, and practically by offering policymakers and system architects a structured approach to building a robust, future-proof national digital health infrastructure capable of supporting universal health coverage in South Africa.

Grantor dc:publisher

Stellenbosch : Stellenbosch University

Year dc:date.issued

2026

Author dc:creator

• Fogwill, Thomas Anthony

Advisors dc:contributor.advisor

• Grobbelaar, Sara
• Botha, Adele

Language dc:language.iso

en

Repository record dc:identifier.uri

https://scholar.sun.ac.za/handle/10019.1/135990

OAI identifier oai:identifier

oai:scholar.sun.ac.za:10019.1/135990