Determining the total cost of ownership and end user perception of the Kenya National Cancer Registry (NaCaRE-KE): a DHIS2- based digital health System

The digital transformation of healthcare systems holds immense potential for improving healthcare delivery and achieving better health outcomes, particularly in low- and middle-income countries faced with numerous healthcare system challenges. The National Cancer Registry of Kenya (NaCaRe-KE) system is aimed at streamlining cancer surveillance data collection to inform scientific research and cancer control interventions in Kenya. This study aimed to estimate the total cost of ownership (TCO) of the NaCaRe-KE system across five facilities with varied characteristics in Nairobi County, Kenya and the National Cancer Institute of Kenya, providing insights into the financial requirements of developing and maintaining a comprehensive digital cancer registry. Leveraging quantitative methods using the Digital Square/PATH TCO tool and key informant interviews, the data revealed significant variations in the TCO based on facility size, service scope and ownership. Qualitative analysis of stakeholder interviews highlighted the perceived effectiveness of NaCaRe-KE in improving operational efficiency, although challenges such as staffing shortages and technical issues limiting its effective implementation were noted. Recommendations for enhancing NaCaRe-KE's utility and sustainability include addressing technical challenges, enhancing user training and promoting institutional investment in IT support. Overall, this study contributes to our understanding of the financial dynamics and operational implications of digital cancer registries and provides evidence-based investments in digital health interventions in Kenya and beyond.