The real work of scaling digital health in Nigeria

I spent a good part of last week in Abuja, at the 6th Africa Digital Health Summit, in rooms full of people who, whatever our different vantage points, genuinely want the same thing: a health system that works for ordinary, everyday Nigerians. And somewhere between the panels and the corridor conversations, we said out loud what many of us have known privately for years.

Most digital health pilots in Africa never actually make it. They launch beautifully. There is a ceremony, a press release, and a photograph of someone important cutting a ribbon. And then, twelve or eighteen months later, the tool silently disappears. We have become very good at starting things in this sector. We are far less good at making them last.

We have spent over sixteen years at eHealth Africa watching this pattern repeat, and the most useful thing I can offer is that the technology is almost never the reason a pilot dies. The technology usually works. What fails is everything around it.

 “There is also a practical truth for the financiers in the room. Fragmentation is expensive. A single ministry juggling five overlapping tools, five reporting cycles and five different data standards costs far more than one connected, interoperable system.”

Three things come up again and again, and I want to be clear that none of them are anyone’s fault. They are structural. The first is that funding cycles are simply too short. A donor funds a project for twelve or twenty-four months, but embedding a tool into a national system – connecting it to existing platforms, training frontline workers, building local capacity to maintain it – is a three-to-five-year journey at minimum. So we keep planting trees and walking away before the roots take. The second is that solutions are often built for governments rather than with them, which means the government inherits a tool it never helped shape and feels little ownership of. And the third is that too many of these solutions are designed in comfortable offices with stable power and strong wifi, for clinics that have neither.

At the summit, the Honourable Minister of State for Health put a real number on what closing this gap will take: Nigeria needs around N500 billion over the next five years to scale its digital health infrastructure. That figure should focus all of us. But I would gently argue that this is not, at its heart, a technology problem. It is a financing problem, and underneath that, a trust problem.

Let me offer what I have seen work differently, because it is easy to diagnose and harder to build.

When a tool is designed to belong to the system from the very beginning, it survives. Our Climate Health Assessment Tool, CHAT, started as a small pilot in a handful of states. Instead of treating government ownership as a handover conversation at the end, we built alongside the Federal Ministry of Health’s own validation and review processes from the start. Earlier this year, the ministry approved CHAT for national adoption, and DHIS2 – the platform used by health ministries in more than eighty countries – admitted it to their global App Hub. That outcome did not come from a clever exit plan. It came from government ownership being the operating principle on day one.

So the shift I would advocate for all of us – government, funders, the private sector, and implementers – is to spend less energy financing isolated projects and more energy strengthening systems together. Fewer, longer commitments. Co-design from the beginning. And a slightly different definition of success: not whether the pilot worked, but whether the health system is stronger because it exists.

If I could name one reform that would move us fastest, it would be structured, multi-year national co-financing – government, development partners and the private sector aligning around shared investment plans tied to our national digital health strategy over a longer horizon. And we do not have to imagine whether this works. For two decades, Gavi has run exactly such a co-financing model for vaccines, and nineteen countries have already transitioned to fully funding their own routine immunisation. If we can do it for vaccines, we can do it for digital health.

There is also a practical truth for the financiers in the room. Fragmentation is expensive. A single ministry juggling five overlapping tools, five reporting cycles and five different data standards costs far more than one connected, interoperable system. The legal scaffolding to do better is beginning to exist – Nigeria’s Data Protection Act of 2023, Kenya’s in 2019, Rwanda’s in 2021, so the question is no longer ambition. It is implementation and interoperability. Integration is not the cost. In the long run, it is the saving.

Perhaps the most important thing I took from Abuja is a posture rather than a policy. The people who build, fund, govern and implement health solutions in this country too often behave like competitors chasing the biggest slice. We are not competitors. We are, or we could be, a consortium of doer-bringing a different strength toward the same outcome:s – each carrying a different strength toward the same outcome, which is simply better health for Nigerians. And that only happens when we trust each other enough to build together. This is as much a conversation about trust as it is about technology.

We spent the last decade in Africa getting very good at starting things. The next decade will be defined by something harder and more worthwhile: deciding clearly what we want, and building the systems – and the financing, to make it last.

Ota Akhigbe is Director, Partnerships and Programmes at eHealth Africa, where she works at the meeting point of global capital and African institutions to build digital health systems that last.