Enhancing Electronic Medical Records Privacy in Tanzania: A blockchain-based framework

Abstract

Electronic Medical Records (EMRs) are vital for healthcare delivery in Tanzania, yet centralised systems in government hospitals remain vulnerable to privacy breaches, unauthorised access, weak access controls, and insufficient audit trails. This study proposes a blockchain-based framework to strengthen EMR privacy in Tanzanian public hospitals, overcoming limitations of existing firewall-based protections. Using a mixed-methods design, data were collected at Dodoma Regional Referral Hospital from 210 purposively sampled participants (108 staff, 102 outpatients) via questionnaires, structured interviews, and expert interview was used during framework validation. Quantitative analyses using SPSS and EPI Info, and thematic qualitative analyses, revealed key privacy gaps: 75.9 percent of staff used unencrypted, password-protected files for data transfer; 72.2 percent reported unclear access roles and policies; and 64.7 percent of patients expressed serious concerns about EMR confidentiality due to limited awareness of data-handling practices. The proposed permissioned blockchain framework integrates Proxy Re-Encryption (PRE) to enable secure, consent-based sharing, immutable smart-contract audit trails, and off-chain encrypted storage. This enables controlled access by hospital staff and authorised third parties (e.g., insurance providers) while preserving patient privacy. Expert validation through scenario-based review and prototype testing confirmed technical feasibility, alignment with Tanzania’s Personal Data Protection Act, and effectiveness in addressing vulnerabilities, including password sharing and a lack of traceability. This tailored solution offers a scalable approach to privacy-preserving EMR management in resource-limited settings, with potential for broader adoption across Sub-Saharan Africa.