A Context-Aware Information Systems Architecture for Sustainable E-Health Implementation in the Democratic Republic of Congo

The digital transformation of healthcare systems through e-health technologies has become a strategic priority for improving healthcare accessibility, efficiency, and quality, particularly in developing countries. However, successful implementation requires not only user adoption but also robust, interoperable, and secure information systems architectures adapted to local contexts. This study aims to propose a context-aware information systems architecture to support sustainable e-health implementation in the healthcare sector of the Democratic Republic of Congo (DRC), where infrastructural constraints and institutional challenges remain significant barriers Methods: The study builds upon an empirically validated e-health adoption model derived from integrated Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT) constructs. Key technological, organizational, and institutional requirements were identified and translated into architectural design specifications. A layered architecture approach was adopted, incorporating interoperability standards, data security mechanisms, privacy protection, and modular components to ensure compatibility with existing health information systems and adaptability to resource-constrained environments.

The proposed architecture comprises five interrelated layers: infrastructure, application, data management, interoperability, and security governance. The framework addresses contextual challenges such as limited ICT infrastructure, intermittent connectivity, and varying levels of digital literacy among healthcare professionals. It supports essential digital health services, including electronic health records, telemedicine, health information exchange, and mobile health applications. The architecture demonstrates scalability, flexibility, and resilience, enabling phased implementation and long-term sustainability. Conclusions: By aligning technological design with empirically identified adoption determinants and policy requirements, the proposed framework contributes to both digital health implementation practice and information systems architecture research in resource-constrained settings. The study provides practical guidance for policymakers, healthcare institutions, and system designers seeking to deploy sustainable e-health solutions in the DRC and similar developing healthcare systems.