Reclaiming Control: Ethiopia’s Battle Against Digital Health Fragmentation

A health informatics worker at the Lideta Health Center. Photo: Benti Ejeta /JSI

In recent years, Ethiopia’s digital health sector has boomed with new technology resulting in a patchwork of well-meaning and fragmented efforts—an uncoordinated sprawl of digital platforms, rarely talking to one another. It became apparent that this wasn’t merely a drain on resources; it was weakening the very health systems these technologies were meant to strengthen.

A 2018 survey conducted by JSI through our Gates Foundation-funded Data Use Partnership (DUP) and Ethiopia’s Ministry of Health revealed 228 eHealth applications in use across the country’s health system—many unregistered. Of these, only 77 were unique, highlighting significant overlap and duplication. Adding to the challenge, nearly half (48%) of the applications were proprietary, limiting opportunities for collaboration and redirecting investments away from scalable, problem-solving solutions. Most lacked accessible source code or APIs, leaving only 5% capable of exchanging information—an alarming sign of near-total interoperability failure. Additionally, 66% of these applications did not transmit any data to the Ministry of Health, further isolating systems and fragmenting the country’s health information landscape.

The study also found that none of these applications aligned with the WHO Digital Health Atlas strategy, nor were any interoperable with it. As a matter of policy, Ethiopia strives to make its digital health solutions compatible and interoperable with the global health organization. Moreover, these digital health solutions did not align with Ethiopia’s existing strategic directions and future aspirations, further complicating the country’s already fragile and disintegrated health systems.

From Disarray to Harmony: Ethiopia’s Health Transformation

JSI partnered with the MOH to tackle the uncontrolled proliferation of digital health applications. The Digital Health Project Inventory (DHPI), a centralized, web-based registry, emerged as Ethiopia’s transformative leap toward accountability, interoperability, and country ownership in digital health. This inventory system stores information relevant to overall digital health architecture, including detailed records of locally implemented digital health projects, and additional resources such as attachments and web links. It supports the addition, updating, removal, and searching/filtering of health information system (HIS) records according to the MOH classification. Further, it aligns HIS data with digital health architecture components by categorizing applications within its layers and components. Beyond validating HIS data, the DHPI also handles registration, authentication, authorization, and credential management.

From Vision to Victory: Unpacking DHPI’s Transformative Achievements

Years of effort have culminated in standardized and streamlined digital health development and implementation, marked by two essential registration standards: the official registration of digital health solutions and subsequent approval for their implementation. The results are encouraging. According to managers, the platform has drastically reduced resource wastage and eliminated duplicated efforts, proving invaluable during times of resource scarcity due to shifts in foreign aid policy. More fundamentally, the DHPI has empowered Ethiopia to assume comprehensive control over the number and types of digital health solutions within its borders, fostering true country ownership and responsibility for these vital technological advancements. Further, providing access to the system’s source code and detailed documentation empowers academia and centers of excellence to innovate on solutions that are already deployed.

With 65 unique digital health solutions now registered in the DHPI system, Ethiopia has achieved full integration between its DHPI and the WHO Digital Health Atlas. This achievement unlocks high-level global technical assistance for the country’s digital health tools, accelerating the adaptation of these tools for local needs.