In Nigeria’s journey toward a stronger health system, a quiet consensus is emerging: the most powerful technology is not the newest, but the best connected. The frontier has shifted from building more digital tools to building bridges between them. This is the work of context-driven interoperability, designing systems that communicate within the real-world constraints of infrastructure, workforce, and governance.
The Diagnostic: Why Systems Fail to Communicate
In Kaduna State, an ACE-led verification exercise clearly illustrates this challenge. As part of its responsibility, the ACE team visited primary health centers to independently confirm whether routine supervisory visits (supported by CHAI and the Kaduna State Primary Health Care Board) had actually taken place. Using GPS data, they found that most visits (96%) did occur, with supervisors carrying out their duties on the ground. However, the breakdown emerged in how these visits were documented. Supervisors were expected to record each visit in facility logbooks and also submit the same information through ODK-based digital tools, yet in many cases (49%), one of these steps was missed, or the details did not match across systems. The visits happened, but the records told different stories. As this pattern repeated across facilities, it became difficult for managers to reliably use the data for decision-making, revealing a system where verified real-world activities were not consistently reflected in the information systems meant to capture them.
If the Kaduna experience shows how fragmented data systems break down in practice, the next question is how to build them back differently, starting not with technology, but with strong, reliable data foundations.
Why does this matter? This gap is not poor record-keeping, it is a breakdown in how information flows between manual and digital systems. When visits aren’t documented consistently:
- Institutional memory is lost when staff transfer or logbooks go missing (as happened in 17 facilities)
- Feedback loops break, supervisors can’t track whether action points were addressed
Root causes included inconsistent documentation practices, high staff turnover with poor handovers, and limited awareness among some officers-in-charge about the value of complete records. These are not technology problems, they are workflow and governance problems that must be addressed before any digital solution can function as intended.
The Blueprint: Identifying gaps is only the first step. Interoperability must start with a reliable, integrated database that provides a single source of truth for decision-making. Building Blocks for a Coherent Ecosystem
Consider a project in Zamfara State, where we developed a state-wide Human Resources for Health (HRH) database and reporting platform with support from GAVI and the Bill & Melinda Gates Foundation. Before this project, HRH records existed in scattered formats spreadsheets, local databases, and handwritten notebooks. There was no single source of truth about who was working where.
The project:
- Captured data on over 700 HRH staff across all cadres
- Developed a reporting template that captures work executed and validates payments
The result? A five-year data repository that enables deployment, supports payroll integrity, and provides a reliable foundation for planning. When this HRH database “talks” to supervision platforms or payroll systems, planning, performance, and incentives align. This is interoperability in action starting with people.
The National Dialogue: Aligning Strategy with Reality
This principle of building from strong foundations is central to the national conversation, one ACE actively shapes.
While building strong, connected databases locally is essential, the next question is how these lessons can inform national strategy. In Nigeria, the Nigeria Digital Health Architecture (NDHA) provides a blueprint for integrating digital health systems across the country. But as the Kaduna and Zamfara experiences show, a blueprint alone is not enough. Implementation must be practical, context-aware, and aligned with the realities of health facilities.
During the ACE 2025 Third-Quarter Webinar on Digital Health, a senior technical advisor to the Ministry of Health emphasized this point: “Government cannot do it alone… it’s time we all came together” to build integrated systems. ACE plays a critical role at this intersection, linking national strategy with on-the-ground realities. Through our verification exercise in Kaduna State and the Zamfara HRH database, we ensure that national standards work in practice, not just on paper.
The Principles: A Guide to Context-Driven Integration
Based on this experience, several principles guide our approach:
1. Governance before technology. Interoperability is not just about technology; it is about people and processes. Clear accountability, consistent documentation, and regular checks are what make systems work. The Kaduna exercise showed this clearly: GPS data can confirm a visit took place, but only proper documentation can tell you what was discussed, agreed upon, or needs follow-up.
2.Start with foundational data. Before connecting sophisticated applications, get the fundamentals right. Accurate registries of health workers, facilities, and patients are the foundation for everything else.
3. Design for real-world conditions. Systems must account for intermittent connectivity, high staff turnover, and the reality that paper and digital will coexist for years.
4. Build feedback loops. Verification is not a one-time event. The Kaduna Independent Supportive Supervision exercise is bi-annual, creating an ongoing mechanism to check fidelity and course-correct.
5. Collaborate from a common plan. Government cannot do it alone but neither can donors or implementers working in isolation. Progress depends on all actors working from the same blueprint.
The Path Forward: From Isolated Pilots to Integrated Systems
Nigeria has no shortage of digital health pilots. What we lack is a deliberate effort to connect them. The vision must be a health information ecosystem where:
- Patient data flows securely across levels of care
- Health workers use integrated platforms, not multiple disconnected portals
- Supervisors track not just visits, but outcomes
- Policymakers have real-time visibility into workforce deployment and service delivery
The systems are ready to talk. The question is whether we are ready to build the shared language they require.