A mother dies during childbirth, but her death may never be formally recorded. A child misses routine vaccinations, yet remains absent from the records used to plan immunisation campaigns. In communities affected by conflict, disease outbreaks can spread while health authorities struggle to establish how many people are infected, where they are and what assistance they need.
These are not simply failures of technology. They expose a deeper weakness in Africa’s healthcare systems: the inability to consistently capture, interpret and act on information that could prevent avoidable deaths.
Speaking during the Africa Health Data Forum, World Health Organization Regional Director for Africa Dr Mohamed Janabi raised concerns about the continent’s capacity to account for deaths and use health information to guide public policy. Findings from two reports presented at the forum revealed significant weaknesses in health information systems across the WHO African Region.
Only 19 of the 40 countries assessed notify authorities of at least 80 per cent of deaths, while only 21 meet the corresponding threshold for reporting deaths by cause, according to Janabi’s presentation. The figures expose a fundamental challenge for governments attempting to measure the performance of their healthcare systems: without reliable information about who is dying, where deaths are occurring and their causes, identifying the interventions most urgently needed becomes difficult.
The findings present an uncomfortable contrast with the continent’s growing investment in digital health. Forty-three of the 47 WHO African Region member states have adopted digital platforms for routine health information management. However, only 18 have dedicated budgets to sustain these systems.
Even more concerning, although 49 of the 52 countries assessed have developed or advanced capacity to review health system performance, none has reached the highest level of capacity for translating evidence into policy and action.
For Janabi, this is where the continent’s digital transformation must move beyond collecting information towards using it to change healthcare outcomes.
The distinction is particularly important in maternal and newborn healthcare, where delays in identifying complications, deploying resources and responding to emergencies can have devastating consequences. A health system may have information about deliveries, maternal deaths and newborn complications, but the value of that information depends on whether it reaches decision-makers in time to trigger action.
Kenya is among the countries attempting to demonstrate how digital health information can change this equation. Health Cabinet Secretary Aden Duale said the country’s digital systems now generate daily information on the number of women delivering in health facilities, the types of deliveries conducted, maternal deaths, neonatal deaths and stillbirths.
According to Duale, this information gives policymakers a clearer picture of what is happening across the health system and where interventions may be required.
He described a healthcare environment in which patients increasingly no longer need to carry physical medical records between facilities because their information can be accessed digitally. At Kenyatta National Hospital, he said, healthcare workers are using tablets instead of relying on traditional patient files.
The significance of this transformation, however, extends beyond replacing paper records with electronic systems. Its real test is whether information collected at individual facilities can help governments identify gaps in service delivery, direct resources to underserved areas and prevent avoidable maternal and newborn deaths.
For a country still working towards universal health coverage, the ability to identify where mothers are delivering, which facilities are experiencing complications and where deaths are occurring could strengthen accountability and improve the allocation of healthcare resources.
But the challenge of invisible populations extends beyond maternal health.
UNICEF Regional Director for Eastern and Southern Africa Eileva Kadili warned that children who are not captured in health information systems risk being excluded from essential services, particularly routine immunisation.
She explained that zero-dose children are frequently concentrated in communities where access to health services is already limited, including areas affected by conflict. When these children are absent from official records, governments struggle to establish the true number of children requiring vaccination.
The problem creates a difficult cycle. Health authorities need accurate population information to plan immunisation campaigns, but children who are not registered or reached by healthcare workers may never appear in the information used to guide those campaigns.
Kadili argued that linking birth registration, vaccination records and education systems is essential to ensuring that children remain visible throughout their development.
Kenya is attempting to address part of this challenge through the digitisation of birth certificates and the introduction of digital identification for children from birth. Duale said the government wants to use these systems to identify children who have not received routine vaccinations, including those in remote communities.
He described a future in which health authorities could identify unvaccinated children within individual classrooms and communities rather than relying solely on broad national immunisation estimates.
Such an approach could improve the identification of children missed by routine vaccination programmes. However, its success will depend on whether the digital records accurately reflect the population and whether health workers have the resources to reach children identified through the system.
The consequences of weak health information systems become even more urgent during disease outbreaks, particularly when insecurity prevents healthcare workers from accessing affected communities.
The ongoing Ebola situation in the Democratic Republic of the Congo illustrates how surveillance gaps, delayed diagnosis and restricted access can complicate outbreak response. Janabi pointed to the difficulties facing health authorities in eastern DRC, where insecurity and attacks on health facilities have disrupted efforts to reach communities and collect reliable information.
He emphasised that the situation in eastern DRC should not be mistaken for the performance of the country’s entire public health system, noting that the affected region faces distinct geographical and security challenges.
When health workers cannot reach communities, information about infections, suspected cases and emerging transmission patterns becomes harder to collect. This creates additional difficulties for laboratories, surveillance teams and public health authorities attempting to establish the scale of an outbreak and respond before it spreads further.
Janabi said WHO had approximately 400 experts on the ground and called for a humanitarian truce to allow medical teams from WHO, Africa CDC, UNICEF and other organisations to access affected populations.
His warning was that without interrupting transmission, the outbreak could continue placing more people at risk, with consequences extending beyond the affected communities.
The experience reinforces an important lesson for African governments: digital surveillance systems cannot operate effectively in isolation from functioning health facilities, accessible communities, trained personnel and reliable laboratory infrastructure.
Technology may accelerate the movement of information, but it cannot independently overcome insecurity, geographical barriers or the absence of healthcare workers.
There is also the question of whether African countries can afford to maintain the systems they are building.
During the forum, United Nations Economic Commission for Africa representative Aboubakri Diaw challenged governments to reconsider how health financing is discussed, arguing that commitments made by health ministries must be matched by realistic allocations from finance ministries.
He warned that many African health reforms remain vulnerable because they depend heavily on external financing rather than predictable domestic resources.
Diaw cited concerns about government contributions to healthcare, debt servicing and inefficiencies in public expenditure. He argued that between 20 and 30 per cent of budgets could be lost through inefficiencies, making it difficult to sustain new investments without addressing existing financial leakages.
His intervention raises a fundamental question about the continent’s digital health ambitions: what happens when external funding supporting digital infrastructure declines, but governments have not established sustainable domestic financing arrangements?
Janabi similarly emphasised the difference between financial pledges and money actually reaching the ground. He noted that Africa’s debt obligations place considerable pressure on resources that could otherwise support public services, encouraging governments to explore options such as debt-for-health arrangements.
For digital health transformation, this financing question is particularly significant. Electronic health records, surveillance platforms, laboratory networks and data infrastructure require continuous investment, maintenance, technical expertise and protection. Adopting a platform is only the beginning; keeping it functional and accessible is a long-term responsibility.
The debate also touches on the question of health data sovereignty. As countries enter bilateral health cooperation agreements and increasingly depend on digital platforms, governments must ensure that information is protected and that national laws governing confidentiality and data protection are respected.
Duale maintained that Kenya’s cooperation arrangements operate within the country’s constitutional and legal frameworks, including the Data Protection Act and Digital Health Act.
Yet the wider continental challenge remains how African countries can strengthen cooperation and exchange health information across borders without compromising confidentiality, national ownership or public trust.
Janabi called for stronger cross-border information exchange, arguing that countries should learn from one another’s public health experiences rather than develop their systems independently. He said WHO was working on a continental mapping exercise to help governments understand the health system capacities and innovations emerging across Africa.
The argument is particularly relevant for disease surveillance, where infections do not respect national boundaries and delayed information sharing can undermine regional preparedness.
He also cautioned against responses to outbreaks that punish countries for reporting them. Under the International Health Regulations, he argued, early reporting should trigger international solidarity and support rather than blanket travel restrictions and trade measures that could discourage governments from reporting outbreaks promptly.
The broader message emerging from the forum is that Africa’s health information challenge cannot be solved through technology alone. It requires reliable financing, stronger institutions, accessible healthcare services, regional cooperation and the political commitment to translate evidence into measurable improvements.
For mothers who need emergency obstetric care, children who have missed vaccinations and communities facing infectious disease outbreaks, the difference between having data and acting on it can be significant.
Africa’s digital health revolution will ultimately be measured not by the number of platforms governments adopt or the volume of information their systems generate, but by whether that information helps identify people who would otherwise be missed, directs services to communities that need them most and enables earlier interventions.
As Janabi emphasised during the briefing, the objective is reliable information that leads to earlier action, better care and fewer preventable deaths.
Because a health system cannot adequately protect lives it cannot see, and a digital revolution that leaves vulnerable populations outside its records risks reproducing the very inequalities it promises to overcome.
