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In Nigeria's dynamic healthcare landscape, digital health initiatives hold immense potential to tackle entrenched issues like access inequities, data fragmentation, and resource limitations. Yet, many efforts remain confined to pilot stages, struggling to achieve broad adoption or lasting change. This insight explores how a systems-oriented approach, rooted in interoperability-first design, can propel these initiatives forward. Understanding how the health information pillar interconnects with other health system building blocks, such as service delivery, health workforce, essential medicines, and financing, is key. It is also crucial to recognize how health information technology systems are continually and critically becoming the backbone of health systems, particularly in digital health ecosystems.

The Pilot Trap in Nigerian Digital Health

Pilots abound, from telemedicine in urban centers to EHR implementations in rural facilities, demonstrating value in isolated settings, such as enhanced patient tracking or reduced administrative burdens. However, scaling often stalls due to overlooked interconnections: unreliable infrastructure, varying digital literacy, regulatory hurdles, and socioeconomic barriers. For example, a promising app in Lagos might fail in northern states if it does not account for intermittent connectivity or community-specific needs.

Advanced health systems like those in the US or UK learned this the hard way, building silos that led to costly retrofits and persistent data islands. Nigeria, with less legacy baggage, can leapfrog by prioritizing interoperability from the start, ensuring data flows seamlessly across facilities, programs, and stakeholders to drive equitable, sustainable outcomes.

Commending Progress: NDHI and NPHCDA's Interoperability Efforts

The Nigeria Digital in Health Initiative (NDHI) deserves recognition for its forward-thinking work, particularly the National Enterprise Architecture for Digital Health (NDHA) draft. This blueprint envisions a unified, interoperable ecosystem with building blocks like the Health Information Exchange (HIE), Shared Health Record (SHR), and essential registries (for example, Client Registry based on NIN and Health Facility Registry). Guided by principles such as "One Patient - One Health Record" and federated models for state flexibility, NDHA emphasizes adaptability, security, and standards-based APIs to foster innovation while addressing local contexts.

Complementing this is the NPHCDA Immunization FHIR Implementation Guide (IG), a strong example of interoperability in action. Built on FHIR R4, it standardizes immunization data, profiles for patients, immunizations, and adverse events, enabling seamless integration with registries, DHIS2, and CRVS. This IG not only supports routine vaccinations but also defaulter tracking and AEFI reporting, avoiding silos and paving the way for broader applications in maternal health or NCD management. By adopting global standards like FHIR with Nigerian-specific profiles, these efforts position the country to achieve semantic interoperability early, reducing errors and enhancing efficiency.

Key Strategies for Scaling with Interoperability First

To move beyond pilots, adopt an end-to-end framework that integrates technology with socioeconomic realities:

1. Holistic Assessment: Begin with a comprehensive systems map, evaluating IT infrastructure, data flows, and SDOH barriers. Use NDHA tools like terminology services (ICD-11, LOINC) to benchmark against national priorities, ensuring assessments account for offline support in low-connectivity areas.
2. SDOH-Informed Strategy: Craft roadmaps that embed interoperability standards (for example, FHIR profiles for consultations, prescriptions, immunizations). Incorporate stakeholder input to align tech with cultural norms, as seen in NDHI's user-centric principles, and prioritize affordable, open-source solutions for equity.
3. Integrated Implementation: Leverage NDHA's HIE and registries for plug-and-play rollout. Partner with local innovators (for example, integrating with Helium Health) and include training for digital literacy gaps. Metrics should track SDOH impact, like improved rural access via telemedicine.
4. Ongoing Management & Optimization: Utilize SHR and claims exchanges for real-time monitoring. Federated models allow state-level adaptations, while privacy-by-design (consent management, audit logs) guards against breaches. Retainers ensure iterative improvements, turning pilots into resilient systems.

Lessons from Nigerian Successes

Initiatives like Reliance Health's expansions or NHIS digital enrollments succeed by treating interoperability as foundational, linking IT backbones with policy and community engagement for 40%+ adoption gains. NDHA's emphasis on federation and standards avoids advanced systems' mistakes, enabling Nigeria to scale faster and more equitably.

Looking Ahead

As Nigeria advances toward 2030 universal coverage, scaling digital health demands interoperability-first thinking. By commending and building on efforts like NDHA and the NPHCDA FHIR IG, we can leapfrog global pitfalls, creating systems that deliver inclusive, impactful care. If your organization is navigating pilots, HTA+ is here to guide end-to-end strategies.

Bernard Fatoye is the founding partner at HTA+, specializing in health technology advisory and management in Nigeria. Follow for more insights on LinkedIn or X @bernardfatoye.