A Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of
Doctor of Philosophy in Information and Communication Sciences and Engineering of
the Nelson Mandela African Institution of Science and Technology
Systems in the health sector are very crucial for human life and they should be efficient, reliable
and secure. Unfortunately, electronic health record (EHR) systems do not work effectively
when managing multi-institutional medical records. The EHR, which is a digital system in
which patient health information is systematically stored. The information stored includes
medical history, laboratory test results, demographics, and billing information, poses problems
to patients related to interoperability, privacy, and data integrity. Most solutions to these threats
focus on a centralized architecture that faces a single point of failure and internal threats, such
as unreliable system administrators.
The promising solution that many researchers are interested in is the use of blockchains.
However, in developing countries, and particularly in sub-Saharan Africa, very little attention
has been given to the issues of interoperability, privacy and data integrity for EHRs using
blockchain technology. As such, this research has designed and developed self-sovereign
identity management and secure information sharing system for health systems in developing
countries, based on blockchain technology, which helps to solve the mentioned problems.
The study used a Design Science Research (DSR) methodology to develop solutions to the
research problem through three sub studies. The first and the second sub studies conducted
under problem awareness and suggestion phases of DSR, and third sub study conducted under
development and evaluation phases of DSR. The first sub study deal with the assessment of
three most common blockchain based healthcare systems (MedicalChain, Patientory, and
MediLedger). The second sub study studies the problem of existing EHR systems in Tanzania
regarding privacy issues in identity management and secure sharing of medical data from one
healthcare facility to the other. The third sub study deal with the development of two systems,
one for identity management using blockchain (self-sovereign identity), and one for secure
sharing of medical data from one healthcare facility to another through blockchain technology.
The systems provide additional privacy protection tools to the existing infrastructures. They
reduce development cost, transparency, data integrity, protection against single-point-offailure
vulnerabilities, and prevention of internal threats such as untrusted system
administrators. The systems will make the existing and future health information systems
trustable to healthcare service providers and the end-users of the healthcare systems. Also, will
help the stakeholders in the healthcare sector to properly manage the healthcare systems.