Digital Health Interventions (DHIs) for Health Systems Strengthening in Sub-Saharan Africa: Insights from Ethiopia, Ghana, and Zimbabwe

Digital health interventions (DHIs) refer to discrete technological functionalities designed to achieve specific objectives in addressing health system challenges through digital health applications. These interventions are tools for strengthening health systems, particularly in low- and middle-income countries. This study consolidates findings from Ethiopia, Ghana, and Zimbabwe, examining three distinct digital health applications with varying intervention capabilities that contribute to health system strengthening within their respective primary healthcare contexts. The interventions analyzed include Ethiopias District Health Information System 2 (DHIS2), Ghanas dual system namely the District Health Information Management System (DHIMS) and the Local Health Information Management System (LHIMS and Zimbabwes Impilo electronic health record (E-HR) system. In Ethiopia, DHIS2 supports DHIs focused on data aggregation, reporting, and performance monitoring at the public health level. At the health system level, DHIS2 has enhanced accountability and data quality, leading to improved decision-making and resource distribution. In Ghana, DHIMS functions as a public health-level DHI, facilitating data-driven performance monitoring, while LHIMS operates at the patient level, supporting patient tracking and management, improving patient workflows and resource tracking. However, a lack of interoperability between these two systems has led to data duplication challenges. Zimbabwes Impilo E-HR, a patient-level DHI, has streamlined clinical workflows, improved information sharing, and enhanced decision-making at the point of care. Despite these successes, challenges persist, including infrastructure limitations, high staff turnover, and insufficient technical capacity among users. Interoperability issues, particularly in Ghana and Ethiopia, hinder seamless data exchange, while sustainability concerns such as funding gaps and inadequate government support limit the full potential of these systems. The studies highlight the need for targeted training, improved infrastructure, and enhanced integration of health information systems to maximize the benefits of DHIs. Authors SummaryHealth systems are built on six fundamental building blocks, yet they face numerous challenges, particularly in the African context. Digital health interventions (DHIs) have been shown to strengthen one or more of these building blocks by improving healthcare efficiency, data management, and service delivery. These interventions are especially valuable in low- and middle-income countries, where they help address systemic issues such as inefficient data management, limited access to care, and health workforce efficiencies. Our paper presents findings from three independent studies examining digital health applications implemented in Ethiopia, Ghana, and Zimbabwe, each playing a unique role in strengthening their respective health systems. We explore how DHIs have contributed to key health system functions, highlighting successes in data utilization, patient management, and decision-making. At the same time, we report on the challenges faced by implementers, including infrastructure limitations, interoperability issues, and sustainability concerns. Based on our analysis and experience of the environment, we offer insights and practical recommendations for overcoming these challenges, ensuring that DHIs can maximize their impact on healthcare delivery. By addressing these barriers, DHIs have the potential to enhance health system resilience and efficiency, ultimately improving health outcomes in resource-limited settings.