The digital transformation of health systems has the potential to improve access, quality and efficiency of health care on an unprecedented scale, and accelerate progress towards Universal Health Coverage (UHC). It can help scale up access to primary health care services, strengthen health system resilience, and close equity gaps to help deliver health for all. However, for this to be achieved, it is critical for national governments to allocate necessary funding to digitally enable their health systems (complemented by donor investment) as part of wider health system strengthening investment, and to ensure that this is part of their national plans and priorities. 

The digital transformation of health is well underway in Africa. Whilst levels of digital maturity vary, most African countries are introducing an increasing range of digital solutions to both public and private health care and the majority of countries have a dedicated digital health strategy that is incorporated into health-sector strategic plans and aligned to broader national digital transformation agendas. However, very few African digital health strategies are accompanied by a costed implementation plan and implementation is uneven, with persistent barriers standing in the way of faster and more equitable digital transformation. 

The digital health funding landscape in the region

African health systems comprise a mix of government-funded public healthcare, private healthcare providers, donors, and non-governmental and faith-based organisations. According to the World Bank, sub-Saharan African countries spend an average of 4.97% of GDP on health, a lower rate than at the start of the century and far below the global average of 9.83%. Out of pocket expenditure accounts for around one-third of current health expenditure across the continent. 

To date, most funding for the digital transformation of health systems has come from donors, with Ministries of Health mainly providing funding for coordination of digital health divisions. Information about the amount that African countries are investing in digital health is not publically available as digital health is not typically highlighted within national health budgets and expenditure on digital health is not routinely reported. Health planners in Africa generally lack reliable information on the short and long term costs of digitally transforming their health systems. This lack of solid evidence on digital health investment issues also deters investors or donors from intervening in the region. 

Funding digital health transformation in Africa – what is needed?

During the Africa HealthTech Summit 2023, taking place in Kigali from 17-19 October, Transform Health is launching a new costing of the digital health funding gap for Africa. We estimate that an investment of approximately US$4.1 billion is needed over the next five years to support the digital transformation of health systems in low- and lower-middle-income countries in Africa, or approximately US$820 million per year on average. This is based on a medium cost scenario for nine priority investment areas. The primary driver of this cost is for digital connectivity infrastructure, which accounts for approximately 75% of the total projected investment.

US$4.1 billion is needed over the next five years to support the digital transformation of health systems in low-and lower-middle-income countries in Africa.

The true investment requirements will ultimately need to be determined country by country and based on costed digital health strategies and investment roadmaps. Investments in digital transformation of health systems will also need to be complemented by wider investment to increase digital connectivity and usage among the population, as well as investments to address the broader enabling environment. 

This costing builds on an estimate of resource needs for the digital transformation of health systems across all low- and lower-middle income countries, which was included in Transform Health’s report, Closing the digital divide: More and better funding for the digital transformation of health

A call to action to harness digital health to deliver health for all

We call on national governments, donors and development partners, and the private sector to increase and better coordinate investment in the equitable, inclusive and sustainable digital transformation of health systems to deliver health for all in the digital age. We call for:

1. Increased investment in digital transformation of health, ensuring investments are sustainable and support equity, inclusion and human rights.

2. Improved coordination and alignment of digital health investments with national priorities and strategies

3. Costed digital health strategies and investment roadmaps

4. Strengthened policy and regulatory environments to guide the  inclusive, equitable and sustainable digital transformation of health system

5. Mechanisms for meaningful multi stakeholder engagement to be established, involving stakeholders from multiple sectors and backgrounds in the development, implementation and monitoring of digital transformation strategies

6. Action to bridge the digital divide, which is a prerequisite for equitable access to digitally-enabled health services

Transform Health and its partners have been advocating for the digital transformation of health as a route to strengthening primary health care and accelerating UHC progress by 2023. To achieve this, we must prioritise investment in digital health. We will not achieve health for all, without prioritising digital health for all!