Primary health care (PHC) systems across low- and middle-income countries face a persistent challenge: how to transform data from a bureaucratic burden into a strategic asset. While the global health community increasingly recognizes that timely, complete, and actionable data is essential for performance management and health policy, the reality on the ground tells a different story. Frontline health workers remain mired in manual data collection and duplicative, time-consuming paper-based reporting, leading to inefficiencies, fragmentation, and poor-quality data that undermines the very systems meant to serve communities.
The path forward requires more than simply swapping paper for tablets. Through comprehensive research across four African countries (Burkina Faso, Ethiopia, Kenya, and Nigeria), PATH, with support from the Gates Foundation, conducted a landscape assessment of PHC operational dataflows. The research combined document review, primary data collection with over 130 participants, and consultations with 17 global and country experts to document gaps. The global landscape review identified over 80 innovations for strengthening PHC data systems, with 20 prioritized for their adaptability in resource-limited settings without requiring full system overhauls, all informing strategic recommendations.
What emerged is a strategic framework that balances innovation with pragmatism, offering a roadmap for countries navigating the complex transition to stronger PHC data systems.
Learn more about the full research methodology and findings.
The digitalization opportunity and the transition challenge
Countries are rightly prioritizing nationwide digitalization of health data systems, and the benefits are clear: reduced burden of manual processes, elimination of paper supply constraints, and real-time data visibility that enables responsive decision-making. This momentum should be accelerated and supported.
Our research also revealed an important nuance: the journey to full digitalization takes time, and during this transition period, health systems need strategic support. While digital community health information systems are being deployed, many facilities (especially in rural areas) continue operating with hybrid approaches where digital and paper systems coexist. Rather than viewing this transition as a problem, it presents an opportunity to be intentional about how we support health systems along the path.
Inside the consultation room with head nurse Amadou Ngom at the Mbem Mbem health post in Senegal. Photo: PATH/Gabe Bienczycki.
Strategic support during the transition
Smart digitalization requires planning for the interim period. Countries can deploy innovations that provide immediate improvements while building toward comprehensive digital systems. Solar-powered solutions for reliable power and connectivity are particularly valuable, addressing fundamental infrastructure gaps that would otherwise limit the effectiveness of digital tools.
For example, simple color-coded kanban stock cards can visually indicate stock levels and reorder points, replacing complex tally sheets to simplify inventory management and prevent stockouts. Similarly, Bluetooth-based data transfer (Wi-Fi Direct) or WhatsApp can serve as temporary workarounds for internet connectivity challenges, with both innovations effectively addressing barriers in low-maturity settings.
National digitalization roadmaps should explicitly account for this transition, identifying which innovations can accelerate progress or reduce burden during scale-up. This might include hybrid approaches that digitize the most time-intensive reporting processes first, or tools designed to work offline and sync when connectivity becomes available. The goal is to ensure digitalization efforts strengthen health systems at every stage of implementation.
Foundations before innovations
Perhaps the most important finding from our research is this: innovation without strong fundamentals rarely succeeds. Before introducing new technological solutions, countries should review core components of their PHC data value chain: data responsibilities, reporting requirements, supervision structures, and workforce capacity.
Many of the most significant barriers identified can be addressed through process improvements and non-digital or hybrid innovations, rather than requiring the implementation of full digital solutions. Multiple overlapping reporting tools that require duplicate data entry? Streamline and standardize reporting requirements. Unclear data responsibilities leading to inconsistent quality? Define clear roles and allocate appropriate time for data tasks. Performance-based incentives driving "data cooking"? Redesign incentive structures to reward data quality over quantity.
These foundational improvements (clear role definitions, collecting only essential data, and standardized processes) are applicable across all levels of digital maturity. They cost less than new technologies, create immediate impact, and establish the enabling environment that innovations need to succeed.
A mother and her baby at a maternal counseling session at Kenya General Hospital, Lubumbashi in the Democratic Republic of the Congo. Photo: PATH/Georgina Goodwin.
Balancing innovation with sustainability
The global health field has a complicated relationship with innovation. Health systems in low- and middle-income countries have experienced waves of donor-funded innovations that generate initial excitement but fail to scale or sustain after external support ends. This history has created understandable skepticism.
Our expert consultations emphasized that introducing new innovations must be balanced with scaling proven solutions and strengthening the enabling environment. Strong governance, robust infrastructure, and clear standards aren't barriers to innovation —they're prerequisites for sustainable implementation.
This means being selective about which innovations to pursue and honest about what problems actually require innovative solutions versus straightforward resource allocation. A shortage of paper-based tools needs more printing capacity, not a new technology. Limited device availability needs procurement plans or bring-your-own-device policies, not another pilot project.
Countries should focus on innovations where they can genuinely leapfrog traditional constraints or address gaps with no conventional solutions. Meanwhile, proven approaches that work should be scaled deliberately and sustainably.
Building the evidence base
As countries implement both foundational improvements and innovative solutions, continued evaluation remains essential. The evidence base for many newer digital health tools is limited, and what works in one context may not transfer directly to another. Implementation research should be built into digitalization roadmaps from the start, generating data on effectiveness, cost-efficiency, and user experience that can guide ongoing refinement and scale-up decisions.
A framework for global application
The path to stronger PHC data systems isn't a single technological leap forward. It's a carefully orchestrated journey that honors where health systems are today while building systematically toward where they need to be. With strategic planning, appropriate innovations, and unwavering attention to fundamentals, countries can transform PHC data from an administrative burden to a strategic asset, unlocking better health outcomes for the communities that need them most.
