The energy at the 2025 Global Digital Health Forum was unmistakable. Innovators, policymakers and practitioners gathered with a shared sense that a long-anticipated shift in health care delivery was finally within reach. The COVID-19 pandemic forced digital health tools into rapid, large-scale use, accelerating adoption in ways few had imagined.
Yet inside the Telehealth Solution Lab, convened by VillageReach and Solina Centre for International Development and Research (SCiDAR), the conversation took a more grounded turn. Participants moved beyond the excitement of new platforms and applications to confront a sobering reality: while the technology may be ready, the systems needed to sustain it are often not. The real story of digital health is about the human, institutional and structural foundations required to make them work, especially for those who need them most.
Why tools alone won’t do it
The Telehealth Solutions Lab at GDHF 2025.
The post-pandemic moment brought investment and attention, but it also exposed a paradox. Connectivity and devices dominate headlines, yet the deeper barriers are human and structural. Awareness is a striking example. In many under-reached communities, people simply do not know telehealth exists. A survey in Lagos, Nigeria found that only 6 percent of residents in under-reached areas were aware of telehealth services. Utilization sat below 1 percent and rose only marginally, to just over 5 percent, even after targeted research efforts to boost engagement. The result is idle technology, and wasted opportunity.
Financing compounds the problem. Fewer than 11 African countries have a dedicated digital health budget, and government health care spending across the continent averages roughly 2 percent of GDP. That gap pushes programs to rely on donor funding or out-of-pocket payments, which creates fragile, short-lived services. “Free” care often hides recurring costs—staff time, connectivity, device maintenance—that governments struggle to absorb. Without creative, shared financing, digital projects risk collapsing once initial funds dry up.
Interoperability is a third, practical barrier. Too often, systems behave like a Tower of Babel: call centres, chatbots, hospital records and emergency services exist in isolation and cannot share patient data smoothly. That is not merely inefficient. When emergency dispatch systems cannot link to telehealth providers, or when telemedicine platforms cannot connect to payment systems, continuity of care breaks down and trust erodes.
Finally, technology is only as effective as the people using it. At Gumel General Hospital in Jigawa State, Nigeria, roughly 70 percent of staff lacked essential teleconsultation skills such as virtual assessment and digital patient communication. Without standardized training, clear workflows and ongoing support, devices become a source of frustration rather than a tool for better care.
Treat tools as parts of a living system
What the Telehealth Solution Lab made clear was that digital health must be designed as an integrated ecosystem. That means shifting attention from isolated tools to enabling structures: interoperable systems, standardized workforce training, and financing models that distribute costs across public, private and community stakeholders.
This is human-centered work. It means training health workers in practical teleconsultation skills, designing workflows that fit existing clinical routines, and building interfaces that patients and providers actually understand. It also means aligning incentives so that private partners, governments and communities share responsibility for both cost and quality.
Implementation and outcomes: where alignment pays off
When enabling structures converge, early wins appear fast. Chipatala Cha Pa Foni (CCPF) in Malawi offers a practical blueprint. By partnering with Airtel Malawi to zero-rate calls, CCPF removed a key cost barrier for users. Government ownership of the program then anchored long-term sustainability. The result: a service that people use because it is affordable, accessible and trusted.
Where linkages are weak, the opposite happens. Rafikey’s tele-mental health platform in Tanzania has struggled to integrate with the national DHIS2 system, and in Nigeria platforms like Clafiya face hurdles linking to health savings accounts. Those gaps produce fragmented patient journeys, duplicated tests and strained trust between users and providers. The evidence is consistent: technology succeeds only when it is embedded in a supportive implementation environment that prioritizes interoperability, coordination, and user experience alongside innovation.
The Future: Building the enabling structures for scale
Innovation is outpacing policy. Across Africa only 34 countries have a national eHealth strategy and just 16 have updated those strategies to 2023 or later. That regulatory lag creates uncertainty around liability, cross-border care and data protection, which deters investment and leaves patients exposed.
The next phase is clear. We must pair better code with stronger policy and partnership. Harmonized regulations, sustainable financing models and robust training systems form the foundations that allow innovation to scale safely and equitably. The tools for transformation exist. Our job now is to build the enabling structures and partnerships that let those tools deliver on their promise for everyone.