Adoption, barriers and opportunities of interoperability and eHealth standards in Africa: a scoping review

Abstract

Objectives

Interoperability, the seamless exchange and use of data across digital health systems, is essential for integrated, efficient healthcare delivery. However, evidence on its adoption in Africa remains limited and fragmented. This scoping review aimed to map existing evidence, identify key barriers and highlight emerging opportunities for strengthening interoperability across all levels on the continent.

Methods

We conducted the review in line with the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework. Searches were carried out across PubMed/MEDLINE, IEEE Xplore, African Index Medicus and Google Scholar, focusing on English-language publications from January 2010 to March 2025. Eligible sources included peer-reviewed articles, conference papers and relevant policy documents.

Results

Sixteen studies met the inclusion criteria. The findings revealed wide disparities in the adoption of interoperability standards, with countries such as Uganda, South Africa and Kenya showing greater momentum due to national digital strategies and health information exchange initiatives. Common challenges included limited technical capacity, fragmented infrastructure and inadequate regulatory support. However, there were encouraging developments around the use of open-source platforms like OpenHIE, regional policy alignment through the African Union Digital Health Strategy and growing public-private partnerships.

Discussion

Progress remains uneven, shaped by each country’s digital maturity, workforce capabilities and policy landscape. Capacity-building and better alignment with global standards could bridge current gaps.

Conclusion

To build resilient digital health systems, African countries must strengthen governance, invest in infrastructure and develop technical expertise. Future work should assess how interoperability influences clinical care and explore regional readiness for cross-border data exchange.

Introduction

Digital health technologies are transforming health systems by improving data management, clinical decision-making and service efficiency.1,3 This transformation is driven by electronic health records (EHRs), mobile health (mHealth), telemedicine and artificial intelligence (AI)-based applications that enable timely access to patient data and clinical support.⁴ However, these benefits depend on effective interoperability, the ability of systems and organisations to exchange, interpret and use data seamlessly.⁵ Interoperability operates across three levels: structural interoperability enables technical data exchange through standardised protocols such as Health Level 7 (HL7) and Fast Healthcare Interoperability Resources (FHIR)⁶; semantic interoperability ensures consistent meaning through shared vocabularies and coding standards, including Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) and the International Classification of Diseases, 11th Revision (ICD-11)⁷; and organisational interoperability aligns governance structures, policies and workflows to support coordinated data use across healthcare institutions.7,9

High-income countries (HICs), those with a gross national income (GNI) per capita of more than 14 005 as of 2024,¹⁰ have successfully leveraged international interoperability standards such as HL7, FHIR, SNOMED CT and OpenEHR to achieve improved healthcare coordination, comprehensive data consistency and better patient outcomes.11,13 In contrast, many countries in Africa that fall within the low- and middle-income category, with a GNI per capita between $1146 and $4515 as of 2024,¹⁰ face numerous challenges. These include limited infrastructure, fragmented policies, financial constraints, insufficient technical expertise and weak enforcement mechanisms.^{9 10 14 15} As a result, many digital health solutions in Africa operate in silos, causing data fragmentation, duplication, incomplete patient histories and reduced clinical efficiency.^{4 9 11 15}

Interoperability and eHealth standards also provide essential frameworks for data collection, secure storage, communication and privacy protection. These include coding systems like ICD-10/11 and SNOMED CT, security standards like ISO/IEC 27001, and messaging protocols like HL7, FHIR and OpenEHR.^{12 13} Proper implementation enhances data clarity, supports consistent information management and enables cross-border collaboration, including pandemic preparedness and disease surveillance.316,18 Yet, many African countries use multiple digital health platforms lacking standard interfaces and exchange protocols, resulting in fragmented records and compromised care.^{14 19 20} Unlike the EU’s European Health Data Space (EHDS), Africa lacks a unified continental governance framework to support interoperability and data sharing.^{3 21 22}

Despite these challenges, countries such as South Africa, Uganda and Kenya have made notable progress at the organisational level through national digital health strategies and information exchange frameworks that incorporate interoperability principles.⁴ Beyond these settings, other African countries, including Malawi, Nigeria, Rwanda, Tanzania and Mozambique, are reported by the OpenHIE community to be developing or operating health information exchange (HIE) architectures or foundational registries aligned with OpenHIE principles, although many remain at pilot or sub-national scale.²³ Open-source platforms such as OpenMRS and DHIS2 are widely used across Africa. OpenMRS serves as a point-of-care system managing individual-level health data, while DHIS2 supports both aggregate health management and, in some contexts, individual-level data tracking.^{12 24}

However, these platforms primarily address structural and organisational interoperability, with limited capacity for semantic interoperability, which ensures consistent meaning of shared data across systems.²⁴ To complement these, several open, standards-based Digital Health Global Goods, curated by WHO and PATH, such as openIMIS for health financing and OpenHIE for HIE, promote reusable architectures that strengthen semantic and cross-system interoperability.²⁵ Such tools, catalogued under the WHO Global Digital Health Repository and PATH’s Digital Square Global Goods, provide frameworks for scaling interoperable, sustainable and context-appropriate digital health systems across Africa.⁹

At the global level, the WHO Global Strategy on Digital Health (2020–2025), adopted by the World Health Assembly, provides a comprehensive framework to guide digital transformation in health systems. It emphasises foundational building blocks such as governance, standards, infrastructure, workforce and sustainable financing.³ The African Union’s Digital Health Strategy (2020–2030) further provides a regional blueprint aimed at aligning national systems with global standards, although progress remains inconsistent.^{3 17 26} There is still limited continent-wide understanding of interoperability adoption. Most evidence is country-specific, hindering regional trend analysis, comparative evaluation and collaborative learning.^{14 17 27}

This scoping review aims to synthesise current evidence on the adoption, barriers and opportunities of eHealth interoperability standards across African health systems. Its objectives are to (1) evaluate current adoption levels, (2) identify key implementation challenges and (3) explore strategic opportunities to enhance interoperable HIE. These findings are intended to inform policymakers, implementers and regional stakeholders in building standardised, scalable and sustainable eHealth ecosystems across Africa.

Methods and materials

Study design

This scoping review was conducted following the methodological framework proposed by the Joanna Briggs Institute (JBI) for scoping reviews, which provides a systematic approach to identifying, organising and synthesising evidence on broad and complex research questions. In line with best practices for evidence synthesis, the review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to ensure rigour, methodological transparency and comprehensive reporting of findings.²⁸

Search strategy

A structured search was conducted to identify studies on the adoption, challenges and opportunities of eHealth standards and interoperability in Africa, including both peer-reviewed and grey literature. Databases searched were PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore and African Index Medicus. Google Scholar was used to identify grey literature such as government reports and technical documents. In addition, official websites of the WHO, the African Union and national Ministries of Health were reviewed for relevant policy and strategic materials. Reference lists of included studies were manually screened to identify additional relevant sources.

The search was limited to English-language publications from January 2010 to March 2025. Both Medical Subject Headings (MeSH) and free-text terms were used, adapted to each database. The core Boolean search string included the following terms and synonyms:

(‘eHealth’ OR ‘electronic health’ OR ‘digital health’ OR ‘mHealth’ OR ‘telemedicine’) AND (‘eHealth standards’ OR ‘interoperability’ OR ‘health data standards’ OR ‘health information exchange’) AND (‘Africa’ OR ‘Sub-Saharan Africa’).

Inclusion and exclusion criteria

This review included studies examining eHealth interoperability frameworks and standards within African health systems, as well as evaluations of national or regional HIE policies, systems or architectures. Eligible sources comprised empirical studies (qualitative, quantitative or mixed methods), systematic reviews, policy documents, conference papers and technical reports published in English between January 2010 and March 2025. This period was selected to align with the WHO African Region’s 2010 resolution on eHealth solutions and the implementation timelines of the WHO Global Strategy on Digital Health (2020–2025) and the African Union’s Digital Transformation Strategy (2020–2030).^{3 26}

Publications were excluded if they were not focused on the African context, addressed digital health without explicit emphasis on interoperability or standards, or constituted non-empirical materials such as dissertations, preprints, editorials, opinion pieces or commentaries.

Study selection process

All retrieved records were imported into Mendeley for duplicate removal. Study selection was conducted independently by two reviewers in two stages: initial title and abstract screening to exclude ineligible studies, followed by full-text review to assess eligibility against predefined criteria. Disagreements were resolved through discussion, with a third reviewer consulted when consensus could not be reached. Inter-rater agreement at the full-text screening stage was assessed using Cohen’s Kappa (κ) statistic to ensure methodological reliability. Figure 1 shows the PRISMA-ScR flow diagram of how data was mined and extracted at different stages.

Figure 1. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flow diagram of study selection. This diagram outlines the number of records identified, screened and the final 16 sources included in the scoping review. The search across databases and grey literature yielded 1050 records (1010 from databases, 40 from other sources). After removing duplicates (n=150), 900 unique records were screened by title/abstract. A total of 830 records were excluded for not meeting inclusion criteria (eg, not focused on Africa or not relevant to eHealth standards). We retrieved 70 full-text articles/reports for eligibility screening, excluding 54 that did not satisfy the inclusion criteria (reasons included being editorial/opinion pieces or lacking interoperability focus). 16 sources remained as the final set of included studies for the scoping review.

Data extraction and charting

A standardised data extraction form was used to systematically collect key information from each included source, capturing both descriptive and analytical data to support thematic synthesis. Extracted elements included bibliographic details (authors, year, country or region), study design and methodology, thematic focus (eg, eHealth standards, interoperability frameworks, HIE systems, governance and policy), and key findings related to adoption, barriers and opportunities for interoperability. Data extraction was conducted independently by two reviewers using pretested forms to ensure consistency, with discrepancies resolved through consensus or third-party review. A narrative synthesis was subsequently applied, organising findings into three overarching themes: adoption and implementation of eHealth standards, barriers to interoperability, and enabling factors and policy opportunities for standardisation and cross-border HIE.

table 1 summarises the key characteristics of the 16 included publications.

Table 1. Summary of included studies (January 2010–March 2025).

#	Title (year)	Authors	Country/region	Type of source	Study focus
1	A Review of Interoperability Standards in eHealth and Imperatives for their Adoption in Africa8	Adebesin, F; Foster, R; Kotzé, P; Van Greunen, D.	Africa (general)	Journal (review)	Overview of eHealth interoperability standards adoption in Africa
2	Approaches Towards Interoperability of Electronic Medical Records Systems: A Case of Selected Referral Hospitals in Tanzania (2022)	Mkayula, N; Mbise, M; Mahundi, M	Tanzania	Journal (research)	Empirical case study on EMR system interoperability in hospitals
3	Health System Efficiency and eHealth Interoperability – How Much Interoperability Do We Need? (2014)	Stroetmann, KA	Sub-Saharan Africa	Conference (conceptual)	Theoretical analysis of required interoperability for efficient health systems
4	An Ontology for Regulating eHealth Interoperability in Developing African Countries16	Moodley, D; Seebregts, CJ; Pillay, AW; Meyer, T	Africa (General)	Conference (conceptual)	Framework for standardising and regulating eHealth interoperability
5	Health Information Systems in Africa: Descriptive Analysis of Data Sources, Information Products, and Health Statistics30	Mbondji, PE; Kebede, D; Soumbey-Alley, EW; Zielinski, C; et al	WHO African Region (46 countries)	Journal (analysis)	Multi-country assessment of health information systems and data sources
6	The Regulation of Health Data Sharing in Africa: A Comparative Study17	Nienaber McKay, EG; Brand, D; Botes, M; Cengiz, N; Swart, M	Multi-country (Ghana, Kenya, Nigeria, South Africa, Uganda)	Journal (comparative)	Comparative analysis of legal frameworks for health information exchange
7	Barriers & Challenges to the Adoption of eHealth Standards in Africa (2013)	Adebesin, F; Kotzé, P; Van Greunen, D; Foster, R	Africa (Survey; South Africa context)	Conference (study)	Identification of barriers preventing standard adoption in African eHealth
8	Design of a FAIR Digital Data Health Infrastructure in Africa for COVID-19 Reporting and Research36	Van Reisen, M; Oladipo, F; Stokmans, M; et al	Multi-country (Uganda, Ethiopia, Nigeria, Kenya, Zimbabwe)	Journal (research)	Development of a FAIR-compliant health data platform for COVID-19 in Africa
9	Critical Factors Influencing Data Use and Utilisation in Health Systems: A Focus on Data and Interoperability Standards for HIE in Uganda’s Healthcare System (2023)	Bagyendera, M; Nabende, P; Nabukenya, J	Uganda	Journal (research)	Evaluation of data use challenges and need for standards in Uganda’s HIE
10	Possibility of Enhancing Digital Health Interoperability in Uganda through FAIR Data14	Basajja, M; Nambobi, M; Wolstencroft, K	Uganda	Journal (research)	Feasibility study on using FAIR data principles to improve interoperability
11	Factors That Influence Potential Success of eHealth Standards Adoption in a Low- and Middle-Income Country: A Review (2020)	Alunyu, AE; Wamema, J; Kiwanuka, A	LMIC (Uganda context)	Journal (systematic review)	Identification of success factors and a model for eHealth standards adoption
12	Health Information Exchange Policy and Standards for Digital Health Systems in Africa: A Systematic Review27	Mamuye, AL; Yilma, TM; Abdulwahab, A; et al	Africa (general)	Journal (Systematic review)	Review of HIE policies and standards across Africa
13	Interoperability Frameworks Linking mHealth Applications to Electronic Record Systems (2021)	Ndlovu, K; Mars, M; Scott, R	Botswana	Journal (case study)	Linking mobile health apps with electronic health record systems
14	MomConnect: An Exemplar Implementation of the Health Normative Standards Framework in South Africa29	Seebregts, C; Barron, P; Tanna, G; Benjamin, P; Fogwill, T	South Africa	Official Report (case study)	National case: implementation of South Africa’s eHealth standards in a maternal mHealth programme
15	mHealth4Afrika: Implementing HL7 FHIR-Based Interoperability (2019)	Baskaya, M; Yuksel, M; Erturkmen, GBL; Cunningham, M; Cunningham, P	Multi-country (Ethiopia, Kenya, Malawi, South Africa)	Conference (pilot study)	Pilot implementation of HL7 FHIR standards in multiple African health systems
16	Towards EHR Interoperability in Tanzania Hospitals: Issues, Challenges, and Opportunities38	Nehemiah, L	Tanzania	Case study (report)	Assessment of electronic health record interoperability challenges in a country setting

EHRs, electronic health records; EMR, electronic medical records; FHIR, Fast Healthcare Interoperability Resources; HIE, health information exchange; HL7, Health Level 7; LMIC, low- and middle-income country.

Results

Geographical distribution and scope

The studies highlighted diverse regional experiences in adopting and implementing eHealth interoperability standards across Africa, with South Africa, Uganda, Tanzania, Kenya, Ethiopia and Nigeria being most frequently represented, particularly South Africa and Uganda, which demonstrated more advanced and structured policy frameworks.^{4 12 28} However, Francophone West and Central Africa showed limited documentation, highlighting regional gaps. Some studies examined country-specific challenges such as electronic medical records (EMR) integration and policy alignment,²⁹ while others provided broader regional insights into governance, legal frameworks and emerging data-sharing strategies.^{12 30}

Adoption of interoperability standards

Adoption of eHealth interoperability standards across Africa remains fragmented, with substantial variation in implementation. South Africa’s MomConnect initiative demonstrates structural interoperability through alignment with the Health Normative Standards Framework, while HL7 FHIR pilot implementations in Ethiopia, Kenya, Malawi and South Africa show that integrating EMR systems with DHIS2 is feasible in low-resource settings when designs are modular and locally adapted.^{21 22 31}

Governmental support and policy coherence emerged as key determinants of adoption. South Africa was frequently cited for regulatory maturity, whereas countries such as Botswana and Tanzania reported partial or pilot-scale implementations constrained by limited capacity and weak enforcement.^{11 17 29} Although Integrated Disease Surveillance and Response (IDSR) systems operate in 43 African countries, few are fully aligned with WHO IDSR Technical Guidelines (3rd Edition) and the International Health Regulations (IHR 2005), limiting standardised reporting and cross-border data exchange.³² Legal fragmentation further constrains interoperability, although emerging use of FAIR data principles for COVID-19 reporting reflects a shift towards reusable and collaborative data models.^{19 24} Uganda has additionally introduced national HIE standards to support consistent data interpretation across health facilities.^{11 14 33}

Review of national digital health strategies from the WHO Global Repository revealed increasing but uneven policy commitment to interoperability.³⁴ Countries including South Africa, Kenya, Rwanda, Uganda, Ghana and Nigeria explicitly prioritise interoperability through national eHealth architectures, registries and standardised exchange protocols aligned with HL7, FHIR and ICD frameworks.^{1 35} However, many strategies lack detailed implementation roadmaps, financing mechanisms and workforce investment plans, limiting translation of policy intent into operational interoperable systems.²⁶

Barriers to adoption

Multiple, inter-related barriers continue to limit the adoption of eHealth interoperability standards in Africa. Infrastructural constraints, including poor internet connectivity, limited data storage capacity and continued reliance on paper-based systems, particularly in rural settings, remain widespread and hinder digital transformation.¹⁰ These challenges restrict integration of EMRs into national systems, exposing gaps in the foundational infrastructure required for structural interoperability.³⁶

Regulatory fragmentation further constrains adoption, as many countries lack comprehensive legal frameworks for data sharing, especially across borders, resulting in siloed systems and restricted data access.^{12 13} Financial limitations also impede progress, with insufficient funding for infrastructure, technologies and skilled personnel preventing HIE systems from scaling beyond pilot phases.^{4 33} In parallel, shortages of trained health informatics professionals and limited opportunities for continuous capacity development undermine system sustainability.^{6 28} Concerns over data privacy and weak legal protections further erode trust, discouraging participation in data-sharing initiatives and reinforcing organisational barriers to interoperability.^{13 37}

Opportunities for advancement

Despite persistent challenges, several opportunities for advancing eHealth interoperability across Africa were identified. Adoption of global standards, including HL7 FHIR, SNOMED CT, OpenHIE architectures and FAIR principles, emerged as a key enabler of improved health data exchange, supporting standardised formats, consistent terminology and reusable data models.^{12 33} Together, these approaches facilitate structural and semantic interoperability, enabling more efficient HIE and improved clinical decision-making.³⁶ Practical implementation models, such as WHO-supported IDSR initiatives in countries including Uganda, demonstrate how these standards can be operationalised in low-resource settings.⁴

Strengthened governance frameworks also present opportunities to harmonise data-sharing protocols, with ontology-based approaches supporting alignment across systems and institutions.²⁰ Public-private partnerships (PPPs) were frequently cited as mechanisms for addressing financial and technical constraints, with policy-backed initiatives such as South Africa’s MomConnect illustrating pathways to scale and sustainability.^{20 26 27 33} Regional strategies, including the African Union’s Digital Health Strategy, further provide a basis for coordinated governance and cross-border data exchange.²⁹

Beyond early adopters, several countries, including Malawi, Tanzania, Rwanda, Mozambique, Nigeria and Ethiopia, are reported to be implementing or piloting national or sub-national HIE components aligned with the OpenHIE framework.^{23 38} Although many initiatives remain disease-specific or at pilot scale due to financing, infrastructure and governance limitations, they indicate growing momentum towards interoperable digital public infrastructure across the continent.

Discussion

This review assesses fragmented uptake of eHealth and interoperability standards in Africa and other low- and middle-income countries (LMICs). Key barriers include inadequate infrastructure, weak regulatory frameworks, limited funding, workforce shortage both in terms of limited number of trained professionals and gaps in their technical capacity, and data privacy concerns.^{8 39} Participation in global standards development remains minimal, typically limited to the International Organization for Standardization (ISO).⁸ These challenges reflect broader trends across LMICs.³⁹ Adapting international standards to local contexts could enhance data sharing and accelerate eHealth integration.¹²

The policy review found that many African countries have digital health strategies, but their depth and operational clarity vary widely. Several strategies identify interoperability as a core objective but provide limited technical guidance on achieving semantic or organisational interoperability, such as defining national terminology services, governance mechanisms for master registries or protocols for cross-border data exchange.^{26 34} Many countries struggle to turn commitments into workable HIE architectures; clearer implementation plans, financing pathways and defined institutional roles would better align priorities with interoperability outcomes.

Open-source EHRs offer cost-effective solutions but face adoption barriers, including socio-environmental, technological and organisational challenges.¹⁵ Key issues include limited funding, infrastructure gaps, sustainability concerns and data protection risks. Enhancing interoperability in LMICs requires standardised data formats, integrated health information systems and capacity building for health Information Technology (IT) professionals. Many digital health initiatives remain donor-dependent, leading to fragmented systems misaligned with national health architectures.²⁴ Varied governance and data-sharing practices further hinder oversight by Ministries of Health.^{20 40} Strengthening national regulations to enforce standardised, interoperable frameworks is crucial to prevent data silos and improve system-wide coherence and efficiency.^{4 14}

HICs have advanced interoperability through strong regulation, sustained financing and mandated standards.⁴¹ The USA enforces FHIR-based interoperability under the 21st Century Cures Act, and the EU’s EHDS aims to standardise data exchange across member states.²¹ Africa could accelerate progress through continental alignment, as envisioned in the African Union’s Digital Health Strategy, supported by the African Union’s Digital Transformation Strategy and the Africa CDC HIE Framework.^{26 35 36} Without alignment, investments risk duplication, weak sustainability and incompatible systems.

Foundational digital public infrastructure (DPI), including digital identity, payment systems and interoperable registries, underpins sustainable digital health ecosystems. Examples from India’s Digital India programme and Estonia’s e-governance model demonstrate how integrated DPI can enable scalable services, seamless data exchange and institutional trust.^{27 28 37 42} For Africa, embedding digital health within broader DPI agendas can reduce system silos and align health investments with national digital transformation priorities. Achieving this will require sustained political commitment, coherent governance, dedicated financing frameworks and evidence of return on investment to justify long-term funding.^{43 44}

Cost-effective, scalable interoperability solutions are vital, particularly given the limited health budgets in many African countries.⁴⁴ Proprietary systems are often financially unfeasible, making open-source platforms like OpenMRS and DHIS2 more practical alternatives. OpenMRS, for example, has been successfully implemented in rural health centres in Bangladesh to support low-cost structural interoperability.⁴⁵ Experts advocate for integrated national digital health ecosystems to unify fragmented systems and enable efficient data sharing.⁹ The WHO Africa Regional Office has proposed a Digital Health Platform to support this goal by creating a cohesive national infrastructure.⁹

Sustainable interoperability depends not only on technology but also on the strength of national policies and their operationalisation. Countries with clearer financial commitments, structured governance bodies and defined capacity-building plans, such as Rwanda and South Africa, have made more consistent progress towards organisational interoperability than countries with high-level policy documents but limited implementation frameworks.³ As partner priorities shift, African countries need stronger domestic financing, institutionalised workforce pipelines and durable governance to sustain interoperability beyond project cycles.

PPPs, when anchored in strong government leadership, are central to advancing interoperability and scaling sustainable digital health systems in Africa beyond donor-driven pilots.^{46 47} Effective PPPs require coordinated engagement across public, private and civil society actors; misaligned donor financing risks creating parallel systems and eroding trust.³ Practical examples, such as South Africa’s MomConnect initiative, demonstrate how well-structured PPPs can expand service access and support system strengthening in resource-constrained settings.²⁹ Beyond individual programmes, technology-enabled partnerships and professional networks, including HELINA, contribute to capacity building, data sharing and alignment of digital health initiatives across countries.^{29 36 48 49} Despite persistent implementation challenges, PPPs, supported by coherent regional frameworks, remain a critical pathway for equitable and sustainable health system transformation.^{48 50}

Emerging technologies reinforce the need for coordinated interoperability in Africa’s digital health ecosystem. Interoperable data systems at aggregate and individual levels are essential for localised AI development, as emphasised in the African Union’s Continental Artificial Intelligence Strategy, which prioritises data sharing and harmonised digital infrastructure.^{38 51 52} As system connectivity increases, infrastructure security becomes critical, with standards such as ISO/IEC 27001 providing guidance for information security management in interoperable environments. However, financial and workforce sustainability remain major constraints, as donor-driven investments are often weakly embedded in national budgets and long-term capacity-building plans, limiting scale-up.⁵³ In response, countries including Rwanda and Uganda have introduced Health Informatics postgraduate training and multisectoral workforce development frameworks to strengthen informatics capacity.⁵⁴

The reviewed evidence confirms that HIE and cross-border interoperability are critical for strengthening disease surveillance and healthcare delivery in Africa.⁵⁵ However, persistent constraints, including limited interoperability, infrastructural gaps, weak governance, poor record linkage and fragmented coordination, continue to undermine effective data sharing.⁵⁶ Addressing these challenges requires harmonised technical standards, enforceable governance mechanisms and clear health data privacy frameworks implemented consistently at national and regional levels.²⁷

Study limitations

Key limitations were English-only inclusion, possible missed local/unpublished evidence and heterogeneous study methods/quality that limited comparability, underscoring the need for standardised evaluation frameworks.

Conclusion

eHealth interoperability in Africa remains constrained by limited engagement with standards, infrastructure gaps and fragmented regulation. However, progress is achievable through open-source platforms, enforceable governance and strengthened workforce capacity. Advancing interoperability will require harmonised policies, sustained investment in foundational infrastructure and stronger government leadership to transition from donor-driven pilots to nationally owned systems supported by PPP. Future research should examine the impact of interoperability on clinical outcomes and assess preparedness for cross-border health data exchange.

Data availability statement

Data are available upon reasonable request.