The African continent faces complex healthcare challenges characterised by a high burden of infectious diseases, the rise of non-communicable diseases, critical shortages of healthcare workers, and vast geographic distances limiting access to care. In response, smart and mobile health technology has emerged as a critical enabling strategy, moving beyond localised pilot projects to become a core pillar of national and regional health policy aimed at achieving Universal Health Coverage (UHC) and bolstering health security.

Africa is home to 1.4 billion people. The continent has some of the largest cities on the planet, which are growing rapidly, and which can present substantial healthcare problems of their own. However, over half the continent’s population (51.28% according to The World Bank) is rural. For Sub-Saharan Africa, that figure rises to 56.47%.

A number of international initiatives have been launched to promote the adoption of mobile and digital health in Africa. Among the leading initiatives are those of the United Nations World Health Organisation, the World Bank Group, and the African Development Bank.

Digital and smart health covers a range of technologies and approaches, including: eHealth, telehealth, mobile health (mHealth), Electronic Health Records (EHRs), telemedicine, and AI.

Of these different approaches and technologies, to date mobile health (mHealth) has been the most scalable and has had the highest impact. It has been able to build on the high rates of mobile penetration across Africa (ranging from 60% to 80% across the continent). In particular, mHealth has played a key role in the development and the delivery of primary care, chronic and long term conditions management, and bolstering maternal and child health services.

Recent developments in both primary and secondary rural health include the development of drone technologies to transform logistics across the continent. An example is the Zipline service in Rwanda, which employs drones to deliver blood supplies across the country. It now accounts for 75% of all blood deliveries within Rwanda.

International efforts in supporting digitisation of healthcare in Africa have coalesced around three inter-related strategies of the World Health Organisation, the World Bank Group and the African Development Bank. The Regional Office for Africa of the World Health Organisation (WHO AFRO) has outlined a continent-wide strategy for development of digital health strategies, as well as monitoring and analysis of health information systems implementation.

For its part, the World Bank Group (WBG), has played a key role in funding development and roll-out of digital health technologies throughout the continent through its Digital Economy for Africa (DE4A) initiative. WBG has allocated $2.8 billion over the last decade, prioritising large-scale digital infrastructure and services, including e-health. Concurrently, the African Development Bank (AfDB) actively links health digitalisation with foundational physical infrastructure, such as connecting primary health centres to electricity and water.

A Digital Health Maturity Index

The World Bank has developed a maturity framework to provide a simple measure of progress in smart health implementations across Africa. The World Bank framework identifies three distinct stages of digital health maturity. The first stage, Digitisation, focuses on digitising existing paper-based workflows, primarily for administrative efficiency. The second stage, Digital-For-Health, is characterised by the use of fragmented digital solutions that provide efficiencies in clinical and business process workflows. The third stage is Digital-In-Health. This is when data and digital tools become deeply embedded into the existing health system architecture, enabling person-centred care and system-wide improvement.

The majority of African countries appear currently to be in Stage 2 (Digital-for-Health). In this stage, significant investments have been made, particularly through donor-driven projects focusing on specific vertical diseases such as HIV/AIDS or tuberculosis.

While Stage 2 projects demonstrate feasibility, transition to Stage 3, “Digital-in-Health”, appears to be a formidable challenge. The primary obstacle is the low rate of data utilisation.

Although health-related information accounts for over 30% of the world’s data, less than 5% is currently used to improve health outcomes. This utilisation deficit highlights the challenge that many countries have successfully deployed digital tools (Stage 2), but they have yet to establish the integrated governance and technical infrastructure required to transform raw data into systemic intelligence (Stage 3).

To move to Stage 3 requires both national digital health strategies and the implementation of interoperability and health data standardisation across devices, systems and platforms.

Digital Strategies and Standards

The WHO AFRO framework has set a target for 80% of member states to develop national digital health strategies by the end of 2023. Currently, 38 member states, representing 81% of the WHO African Region, have developed such strategies. Examples include South Africa, Nigeria, Rwanda and Namibia.

South Africa’s National Digital Health Strategy focuses on achieving a complete health electronic record and digitising core health systems business processes. Nigeria’s National Health ICT Strategic Framework centres on developing primary health care, employing health ICT to improve service delivery, access, and coverage. Rwanda’s National Digital Health Strategic Plan focuses on improving health service delivery and accessibility through digital health, building upon an earlier 2012 eHealth Strategy designed for an integrated, national patient-based information system. Namibia’s National eHealth strategy aims to strengthen health and social welfare service delivery through the utilisation of electronic solutions.

The emergence of the international FHIR standard (Fast Healthcare Interoperability Resources) for lightweight data interoperability has made achieving interoperability between different devices, applications and platforms far easier, cheaper and more robust. FHIR has been adopted widely in developed countries, such as the UK NHS and social services. In Africa, South Africa has been a leader in the adoption of the FHIR standard, where it has been used to link South Africa’s EHR systems, based on the DHIS2 platform, to mobile and remote healthcare systems.

mHealth Implementations

African countries are employing four main strategies in their implementation of smart health technologies. These are: mHealth; telemedicine; healthcare IS platforms, utilising especially Open Source platforms; and digital logistics.

mHealth has been the most effective and pervasive digital intervention across the continent. Its impact is most visible at the community level, exploiting high mobile penetration across the continent to provide medical expertise to frontline health workers, such as midwives and community health workers, and extend services into underserved rural areas.

Successful implementations of digital health in Africa have tended to adopt a dual strategy. They have bypassed existing infrastructure weaknesses, such as poor roads or lack of fixed fibre. This approach is complemented by a strategy of exploiting technologies that are already widespread, such as mobile networks and human infrastructure, to solve immediate access problems. Of the four main digital health strategies, mHealth is the best example of the latter approach.

Maternal and Child Health is a global health concern and is a primary focus for digital interventions in sub-Saharan Africa. The Innovating for Maternal and Child Health in Africa (IMCHA) initiative is an example of such an intervention. In Tanzania, mobile phones have been used to register pregnancies and births, advise pregnant women about danger signs, and monitor medicine and supply stocks. This has been embedded within a larger intervention package designed to enhance how community health workers assess and treat women and infants, effectively extending healthcare into rural communities.

A specialised intervention in Tanzania has provided community health workers with smartphones and a tailored application to monitor pre-eclampsia and eclampsia, the second highest cause of maternal mortality in the country. This system automatically feeds real-time test results to a central monitoring site and prompts community health workers for follow-up and referral when necessary. It provides a demonstration of the ability of mHealth to manage high-risk conditions dynamically.

Beyond clinical support, mHealth has also been valuable for health education, with mobile applications and SMS text messaging used to inform women and adolescents about family planning options. In one such project, this education led to the use of family planning methods exceeding anticipated adoption rates by more than six times.

Simple, low-tech mHealth tools, particularly SMS-based reminders, have demonstrated clinical efficacy in managing chronic conditions. Studies in Nigeria have shown that SMS reminder messages have effectively increased treatment adherence. In South Africa, SMS campaigns have improved knowledge of hypertension among deaf populations.

Telemedicine and Remote Consultations

Telemedicine is another digital health strategy that has shown itself able to overcome significant geographic barriers that prevent many Sub-Saharan African populations from accessing specialist care.

Countries such as South Africa show the highest adoption rates of telemedicine. These focus particularly on specialist teleconsultations, chronic disease management, and mental health services.

Nigeria is also actively advancing remote diagnosis and teleconsultation, with accelerated adoption seen during the COVID-19 pandemic, particularly in fields like teledermatology, where virtual clinics reduced the need for physical patient-clinician contact while maintaining effective management of skin conditions. The widespread use of voice and video-based consultation services enhances healthcare accessibility, facilitating timely diagnosis, treatment initiation, and continuous patient monitoring. These help reduce strain placed upon centralised healthcare facilities.

EHRs and Open Source

Electronic Health Records (EHR) and health information systems are necessary not only for holding and managing patient records but also for developing extensive data repositories for future public health planning and AI tool development.

Throughout Africa, countries have adopted EHRs and health information systems based on Open Source platforms. This is due to African countries’ strategies of prioritising macro-level system intelligence, such as disease surveillance, over the complexity of fully integrated patient-level Electronic Medical Records (EMRs).

The most widely deployed EHR in Africa is DHIS2. This is the most widely deployed Health Information Management System platform globally. It is employed by Ministries of Health in 80 low- and middle-income countries, which collectively impacts 40% of the world’s population. DHIS2 has evolved to be a primary tool for disease surveillance throughout the developing world, including in Africa.

Other notable open source EHR systems employed in Africa include the OpenMRS and Bahmni platforms.

These systems have played a crucial role in systematising compilation of patient information and tracking the spread of epidemics, such as during Ebola outbreaks. Standardised data collection and reliable surveillance networks provide inputs for improved clinical decision-making.

Digital Logistics

The employment of digital logistics and drones is beginning to overcome severe medical logistics challenges across Africa.

Zipline, a prominent HealthTech startup, employs delivery of temperature-sensitive medical supplies, including blood and vaccines, in countries such as Rwanda, Ghana, and Kenya. This model has been particularly successful in Rwanda, where drone delivery accounts for over 75% of the national blood supply. This has illustrated the ability of digital logistics to bypass poor road infrastructure and minimise transport barriers.

Use of drones is a clear example of the bypass health strategy, using digital and lightweight modern tools to sidestep major physical infrastructure deficits.

AI and Diagnostics

AI and machine learning are being developed in Africa to address the continent’s specialised staffing and resource constraints, particularly in diagnostics.

In Nigeria, start-ups such as Labtracka are developing online test booking platforms and laboratory information systems (LIS). This platform connects patients directly to medical labs, offers home sample collection services by sending phlebotomists to user addresses, and aims to provide infrastructure for governments or Non-Governmental Organisations (NGOs) to run region-wide testing drives, expanding access to critical diagnostics in under-served communities.