For years, many digital health systems across sub-Saharan Africa were built to answer an important question: How many services were delivered? Today, countries are asking a different question: How can digital systems help improve the care people receive?
That shift in thinking is becoming increasingly urgent. As external funding for some health programs declines, governments are reassessing digital ecosystems that often evolved to support disease-specific reporting requirements. In many cases, those systems generated valuable data but left countries managing fragmented platforms that could not easily exchange information or support continuous, person-centered care.
Across the region, ministries of health are pursuing a new vision: interoperable systems that help health workers deliver care, support decision-making, and ensure that patient information follows people throughout their health journey.
“We need to think beyond digitization. We must think about the whole system transformation,” said Dr. Yogan Pillay, Director of HIV and TB Delivery at the Gates Foundation. “This is a pivotal moment, not only to digitize and to use AI, but to transform the system.”
Dr. Pillay spoke at the Gates Foundation Data Systems Convening on strengthening electronic medical records (EMRs) and data systems for improved health outcomes in southern and eastern Africa, held from August 18 to 19 in Johannesburg, South Africa. The convening brought together representatives from five countries: Malawi, Mozambique, Rwanda, Zambia, and Zimbabwe. They were joined by delegates from United Nations agencies, funders, and partner organizations.
To help inform the discussions at the convening, PATH conducted a landscape analysis and developed country digital health profiles for participating countries ahead of the convening. The review examined EMRs, laboratory information systems, health management information systems, and other digital platforms in use, highlighting common challenges related to system fragmentation, interoperability, sustainability, and the transition from donor-supported systems to country-owned digital health ecosystems. The findings provided a basis for countries to compare experiences, identify shared priorities, and explore opportunities for collaboration.
PATH conducted a landscape analysis and developed country digital health profiles for participating countries ahead of the convening.
Dr. Yogan Pillay, Director of HIV and TB Delivery at the Gates Foundation, speaking during the regional convening in Johannesburg. Photo: PATH/Sintha Chiumia.
From fragmented systems to connected care
Today, countries face the task of transforming multiple systems, many built independently over time, into connected platforms that improve patient care.
In one country assessment, more than 70 health data systems were identified, many of which operated independently and were unable to exchange information. Across the region, governments are working to create digital architectures that connect EMRs, laboratory systems, supply chain platforms, surveillance tools, and health information systems. The goal is to move from reporting on care to supporting care.
“Capture once, use many times” has become a guiding principle for many countries seeking to reduce duplication, improve data quality, and deliver greater value to patients and health workers.
Dr. Carl Leitner, Digital Health and Interoperability Lead at the World Health Organization, said health systems must focus on strengthening the underlying systems that generate information.
“We became too focused on the indicators rather than focused on the health systems and the EMRs and the digital systems that we need to strengthen,” Dr. Leitner said.
Capture once, use many times.
Dr. Carl Leitner, Digital Health and Interoperability Lead at the World Health Organization, speaking during the regional convening in Johannesburg, South Africa. Photo: PATH/Sintha Chiumia.
Country ownership is the foundation
Technology alone is not enough. Across the region, countries consistently identified government ownership as the critical factor determining whether digital health investments remain sustainable. That ownership includes software as well as governance, technical capacity, infrastructure, financing, and stewardship of health data.
“Ownership is not just about tech; it’s also about capacity and institutional memory as well as the ability to manage and maintain the systems over time,” said Anzél Schönfeldt, Digital Health Director at PATH.
Anzél Schönfeldt, Digital Health Director at PATH, presenting a landscape analysis during the regional convening. Photo: PATH/Sintha Chiumia.
Countries are taking different paths toward that goal.
Malawi has designated 11 core national systems for government stewardship and is consolidating digital investments under a national governance framework.
Mozambique is transitioning from a donor-funded HIV-focused EMR to a government-designed national platform that supports care across services.
Zambia is working to strengthen interoperability across its national digital health ecosystem while absorbing technical functions previously funded externally.
Zimbabwe is advancing a national enterprise digital health platform designed around interoperability, longitudinal patient records, and government stewardship.
And Rwanda has demonstrated what is possible when long-term political commitment, local capacity, and sustained investment come together. The country has rolled out its eBuzima platform across most hospitals and health centers, transitioned to paperless operations in public facilities, and is now focusing on how to use health data more intelligently.
Country representatives and partners pose for a group photo after discussing digital health roadmaps in Johannesburg, South Africa. Photo: PATH.
Building intelligent primary health care systems
As countries strengthen their digital foundations, many are also exploring the role artificial intelligence (AI) can play in improving primary health care.
“The goal is not an AI-enabled health system,” said Gaurang Tanna, Senior Program Officer, TB Delivery at the Gates Foundation. “It is a health system that behaves differently.”
That means using data and AI to solve practical problems. Potential applications include helping patients navigate care, identifying people who have disengaged from treatment, supporting clinicians with decision-making, strengthening disease surveillance, and reducing administrative workloads.
For health workers already stretched thin by staffing shortages and resource constraints, easing their burden is especially important.
“We don’t want our digital systems or our data systems to further burden frontline health workers,” Dr. Pillay said. “We need to figure out how to use it to make it as easy as possible.”
“The goal is not an AI-enabled health system. It is a health system that behaves differently.”— Gaurang Tanna, the Gates Foundation
Paulo Urioh, a nurse at Mareu Health Center in Tanzania, using his facility’s electronic immunization registry. Photo: PATH.
Although countries are at different stages of digital maturity, a common direction is emerging. The focus is shifting from systems designed primarily for reporting to systems designed around people. Longitudinal patient records, interoperability, government ownership, and sustainable financing are becoming the foundations for the next phase of digital transformation.
The work ahead will require continued leadership from governments, technical stewardship from the World Health Organization, and collaboration among partner organizations. But the opportunity extends far beyond digitizing records.
It is an opportunity to build health systems where information follows patients, health workers have the tools they need to make better decisions, and data are transformed into actionable intelligence that improves health outcomes.
In other words, the future is not simply digital health. It is intelligent, person-centered primary health care.
