Determinants for Effective Implementation of Electronic Payment System by Hospitals in Tanzania:A Case of the Kilimanjaro Christian Medical Centre

Kulwa Mang’ana, Mangasini Katundu (Corresponding author)
Publication year: 

The era of rapid growth of the internet has witnessed the exponential growth of electronic payment systems (EPS); consequently, business transactions are constantly shifting from cash-based to electronic-based system. This paper is a product of a research conducted to explore factors that could influence effective adoption and implementation of the EPS among hospitals in Tanzania and the challenges associated with its adoption. The study used the KCMC as a case in point. The case study design was used. In this study we sampled 152 respondents randomly who included clients at the outpatient clinics of the hospital. The data were gathered using a structured questionnaire consistent with the Technology Acceptance Model (TAM). The findings suggest that the majority of the clients preferred to use EPS whereas, intention to use EPS, previous experience in the use of EPS, and being banked were significant factors influencing both preference of EPS and intention to use EPS. It is recommended that in order to hasten adoption of EPS in Tanzania it is important to address the identified barriers and also to encourage clients to keep their money in and use the services of banks.


  Electronic Payment Systems (EPS), TAM, Technology adoption, Hospitals, Tanzania



A payment system is significant for governance arrangements which encompass a set of relationships between the payment system management and its governing body (such as a board of directors), its owners and its other stakeholders. These arrangements provide the structure through which the system’s overall objectives are set, how they are attained, and how performance is monitored. Because important payment systems have the potential to affect the wider financial and economic community, there is a particular need for effective, accountable and transparent governance, whether the system is owned and operated by the public or the private sector (Bassel, 2010). In the e-commerce world, almost invariably the customer does not actually see the concrete product at the time of transaction, and the method of payment is performed electronically (George, 2008). An effective payment system is not only for paying things or buying and selling stuff. It is important for keeping control and order, ensuring trade is legal and that tax is paid (Martina et al., 2003).



A cross-sectional hospital-based study among clients attending out-patient departments (OPD) was undertaken. The study was designed as a cross section because it was done in a short period of time and for the descriptive purpose of the situation. The hospital is a huge complex with over 700 bed capacity; hundreds of patients came to the Center every day; over 1200 staff are employed there (KCMC annual Report, 2014). The study was ideal for study because the Centre has a well-established Local Area Network (LAN) and it was the only hospital that has recently introduced, in collaboration with the CRDB Plc, electronic payment for treatment in this region.


Summary, Conclusions and Recommendations

In this sub-section we present the summary of key findings on the most preferred mode of payment by clients, attitude of clients toward the cash-base payments to electronic payments, factors influence clients to use e-payments at KCMC and challenges facing the adoption of the electronic payment system. We also present the conclusions and recommendations. 6.1 Summary of Key Findings In assessing the determinants for adoption and implementation of electronic payment system among clients at the Kilimanjaro Christian Medical Centre, Tanzania, this study has that: 6.1.1 The Most Preferred Mode of Payment by ClientsThe first objective of this study was to determine the mode of payment most preferred by the client at the hospital. Of those patients who had made payment previously, about two thirds prefer making payment using EPS than those who had never made any. One third prefers both cash and EPS. The indication is experience of using EPS attract the tendencies of continued use of EPS and signifying ability to control the system. Those clients with higher education adopt new technology more than those with lower education.6.1.2 The Attitude of Clients Toward the Cash-Base Payments to Electronic Payments The second objective was to determine the clients’ intention to use EPS. Most of the respondent (nearly three quarter) showed intention to use EPS when they were asked the question assessing their intention to use EPS. The majority showed that the behavioural intention to use EPS include preference and experience of using EPS. Predictors of behavioural intention to use electronic payment systems were attitude toward EPS and ease of use of EPS.6.1.3 Factors Influence Clients to Use E-Payments at KCMC The third objective was to determine factors influencing clients' intention to use EPS. This study reviled that Perceive Ease of Use, Perceive Usefulness, Attitude towards EPS and behavioural intention to use EPS were the most factors influencing the clients to use EPS. Other factors include variables such as speed benefits and satisfaction.6.1.4 Challenges Facing the Adoption of the Electronic Payment System The final objective was to identify the challenges faced by the adoption of EPS. The most common barriers in EPS as reported by the respondents were downtime of Internet, Poor internet connectivity and Power fluctuation. Weak Technological infrastructure and inadequate power supply were also revealed as hindrance to the usage of EPS. 6.2 Conclusions The majority of clients at KCMC prefer the electronic payment system to make payments for the health services. However, nearly one third of the clients still preferred both modes of payment, that is, cash and electronic payment systems. Significant factors influencing preference of mode of payment included being banked, previous experience of using EPS and being employed. The majority of clients intend to use electronic payment systems; factors that affect intention to use EPS are previous experience of using EPS and being banked.