Introduction: Building a sustainable digital backbone
Digital health systems promise better patient outcomes, streamlined care, and smarter public health decisions. Yet the promise hinges on sustainability: long-term financing, robust data governance, interoperability, and local ownership. Rwanda’s Health Intelligence Centre (HIC) offers a practical blueprint, demonstrating how deliberate investment in fundamentals can yield a durable digital backbone for a nation’s health system. The Global Fund and other partners have learned similar lessons: sustained momentum requires alignment of technology, policy, and capacity. This article outlines three core principles of sustainable digital health, illustrated with the Rwanda example and global experience.
Principle 1: Invest in a durable data and technology backbone
A sustainable digital health system begins with a solid foundation. Rwanda’s approach centers on a centralized data architecture, interoperable platforms, and scalable infrastructure that can adapt to evolving health needs. Rather than chasing shiny new tools, the focus is on building reusable components: standardized data models, secure data storage, and APIs that allow different health applications to communicate. This backbone reduces redundancy, lowers long-term maintenance costs, and accelerates the integration of new services, from electronic medical records to national surveillance dashboards.
Key takeaway for other countries: prioritize core capabilities that can absorb innovation rather than deploy disparate, short-term solutions. A scalable architecture supports artificial intelligence, decision support tools, and real-time analytics while preserving data integrity and privacy.
Principle 2: Foster local ownership and capacity building
Sustainable digital health thrives when countries own their systems. In Rwanda, capacity building spans from data governance and cybersecurity to software development and system administration. Local teams design, deploy, and maintain digital health solutions, reducing dependency on external vendors and enabling timely responses to public health needs. Capacity also extends to citizens: digital health literacy and patient-centered data use are essential for trust and adoption.
Global Fund experience echoes this emphasis on ownership. Donors increasingly insist on country-led strategies, local procurement, and training that leaves behind a skilled workforce. When health ministries and local institutions lead, systems are better aligned with national priorities, more adaptable during shocks, and more cost-effective over time.
Principle 3: Align financing with long-term outcomes
Financial sustainability is the connective tissue that keeps digital health from fading after a pilot ends. Rwanda’s model demonstrates how initial investments in core infrastructure can unlock ongoing efficiencies and service improvements, generating cost savings that fund future growth. Public funding, blended financing, and strategic partnerships with international organizations (including the Global Fund) create a stable revenue stream for maintenance, upgrades, and scalability.
To maintain momentum, countries should design funding envelopes that anticipate maintenance, software licenses, staff training, and security upgrades. Outcome-based financing and performance milestones can help ensure accountability while allowing flexible adaptation as technology and health needs evolve.
Rwanda’s Health Intelligence Centre: a flagship example
Rwanda’s Health Intelligence Centre embodies these principles in practice. By consolidating disparate health data into a coherent, governed system, the HIC enables timely public health insights, supports clinical decision-making, and strengthens the country’s ability to detect and respond to health threats. The centre exemplifies how deliberate investment in digital health fundamentals—data standards, interoperable systems, local expertise, and sustainable financing—can produce durable value for society.
Global Fund lessons and broader implications
The Global Fund’s evolving approach reinforces the need for sustainability: investing in governance, data quality, and local capacity, alongside digital tools. The lessons from Rwanda and similar initiatives point to a shared path: build once, use broadly, and finance with a long horizon. When digital health systems are designed with sustainability at their core, they not only deliver immediate health benefits but also create resilience against future shocks, from disease outbreaks to budgetary pressures.
Conclusion: A practical path to durable digital health
Sustainable digital health is achievable when countries prioritize a durable backbone, invest in local capability, and align financing with long-term outcomes. Rwanda’s Health Intelligence Centre shows what is possible when fundamentals are deliberate and well-executed. The Global Fund’s experience further affirms that sustainability is not an afterthought but the essential framework that ensures technology serves people—today and tomorrow.
