Background: Discussions on the use of digital health to advance health have continued to gain traction over the past decades. This is important considering the rising penetration of mobile phones and other digital technologies and the opportunity to leverage those digital and electronic health methods and innovations to accelerate Universal Health Coverage (UHC) and the health Sustainable Development Goals (SDGs). In Nigeria, however, the full benefits of digital technologies to strengthen the health systems are yet to be fully harnessed due to critical challenges in the sector. These challenges include but not limited to weak health systems governance, weak infrastructural investments, inadequate resources, weak human resource capacity, high cost of scaling-up and coordination issues among others. Lack of systems thinking, and design have significant impact on coordination of efforts and has resulted in the fragmentation and non-interoperability among various applications. To discuss these challenges and propose the way forward for rapid sustainable, scalable and cost-effective deployment of digital health in Nigeria, a digital health capacity development workshop was held in Abuja and across the six geo-political zones of Nigeria from 20th-30th November 2019. This paper documents key conclusions and achievements at the workshop. Methods: The workshop was organized around eleven modules and seven thematic areas which explored the Nigerian digital health governance and coordinating mechanisms in view of its status, leadership, financing and deployment for effective service delivery. It was attended by over 100 participants from varied background including Ministries of Health, Ministries of Communications and Digital Economy, International Organizations, Operators, Civil Society, Academia and Private Sector Experts.

The African region is experiencing peculiar demographic, economic, social and environmental challenges that place pressures on the health systems. While the need to explore ways to address identified health systems challenges is far from easy, there are substantial evidence that having robust frameworks and metrics to direct efforts and priorities of countries could be rewarding. In view of persisting regional health systems' challenges the World Health Organization African regional office proposed the adoption of a comprehensive health system strengthening action framework that provides an opportunity to translate global health policy into operational strategies for Africa's health sector policies, strategies and operations. The adoption of the action framework could support the realization of regional health objectives and priorities, and guide movement toward sustainable developments in countries.

Debate regarding the impact of information and communication technology (ICT) on health outcomes has prompted researchers to conduct analyses across many parts of the globe, yet, still little is known about the ICT impact in the African continent. Using a robust multivariate approach, this study examined system-wide impact of ICT diffusion on multiple health outcomes for HIV and tuberculosis among sovereign countries of Africa. This study utilized longitudinal panel data from the World Bank and International Telecommunication Union databases between 2000 and 2016. We relied on a robust linear dynamic panel model to incorporate lagged time variables to estimate the relationships between ICT infrastructure (mobile phone use, internet access, and fixed-telephone subscriptions) and HIV and tuberculosis outcomes. Econometric analyses found that the coefficients of the aggregate ICT variables were all negative (except for fixed telephones) for tuberculosis health measures and HIV prevalence, and positive for access to antiretroviral therapy. The diffusion of mobile phones and internet was associated with decreased incidence of tuberculosis, HIV prevalence, and tuberculosis mortality rates. However, increased diffusion of these three ICT tools was associated with increased access to antiretroviral therapy. Thus, African governments should identify investment strategies for adopting and implementing ICT to improve population health outcomes.

While effective health systems are needed to advance Universal Health Coverage and actualize the health Sustainable Development Goals, information system verticalization remains a challenge among African health systems. Most investments are vertical, partner-driven and program-specific with limited system-wide impacts. Poor linkages exist amongst different solutions as they are not designed to capture robust data across multiple programmatic areas. To address these challenges, the World Health Organization Africa Regional Office has proposed the adoption of a Digital Health Platform (DHP) to streamline different solutions to a cohesive whole. The DHP presents a pragmatic approach of bringing multiple platforms together using recognized standards to create a national infostructure, which bridges information solutions toward healthy and sustainable outcomes. It has capacities to curate accurate, high fidelity and timely data feedback loops needed to strengthen and continuously improve program delivery, monitoring, management, and informed decision-making at every level of the health system regardless of location. This paper contributes to the ongoing regional conversations on the need to harness innovative digital solutions to improve healthcare delivery in Africa.