Why the next phase of digital health on the continent will be won or lost on interoperability, not on any single application.
Across much of Africa, the last decade of digital health investment has produced a familiar pattern: a proliferation of individual systems — one for patient records, another for laboratory results, a third for pharmacy stock, a fourth for insurance claims — each solving a real problem, and each operating in isolation from the others.
The result is a health system with more data than it has ever had, and less visibility into that data than it needs. A patient who moves from a primary health centre to a teaching hospital effectively starts over. A ministry of health trying to understand facility-level performance has to reconcile numbers from systems that were never designed to talk to each other. An insurer processing a claim often cannot verify, in real time, that the service being billed was actually delivered.
It is tempting to read this as a technology gap — as though the solution is simply more digitization, faster rollout, broader coverage. But the facilities we work with rarely lack software entirely. What they lack is a way for the software they already have to exchange information safely, consistently and in real time with the systems around it.
This is a systems-design problem before it is a software problem. Interoperability has to be designed in from the start — in the data standards a platform uses, in the APIs it exposes, in the governance that decides who can see what, and in the incentives that determine whether institutions actually choose to connect their systems once the technical capability exists.
None of these are solved by a single application. They are solved by an ecosystem — a connected architecture in which healthcare delivery, insurance, and the institutions that oversee both are able to exchange information on common terms.
The goal is not more systems. It's systems that work together.
This also means resisting the temptation to design for an idealized future state — abundant connectivity, uninterrupted power, universal digital literacy — and instead designing for the environments healthcare institutions actually operate in today. Reliable power and connectivity are not peripheral to digital health infrastructure in much of Africa; they are foundational to it. A platform that assumes always-on infrastructure will fail in the settings where it is needed most.
That is why we think about digital health and infrastructure as a single, connected challenge rather than two separate ones — and why the institutions doing this work well tend to invest as seriously in the physical and organizational foundations as they do in the software layered on top of them.
Connected health systems for Africa will not be built by any one platform, however good. They will be built by institutions that treat interoperability, infrastructure and institutional capability as one continuous problem — and design accordingly.
Innovastra