Nigeria’s Healthtech Fragmentation Problem Is Not Primarily About Interoperability

The recent TechCabal Insights article on Nigerian healthtech startups building around fragmented data systems raises an important issue for the country’s digital health ecosystem. The article correctly observes that health data in Nigeria remains fragmented, electronic medical record adoption is uneven, and many providers still operate in isolation from one another. It also rightly notes that startups are often forced to build products around this fragmentation rather than on top of shared national infrastructure.

These observations are accurate. Anyone working across healthcare delivery, pharmaceuticals, insurance, public health, or digital innovation in Nigeria encounters these realities daily.

Interoperability Is Not the Real Starting Point

Interoperability, in technical terms, simply refers to the ability of systems to exchange and meaningfully use information.

The conversation needs further refinement in the framing of “interoperability” as the central problem.

Interoperability is important, but it is not the starting point. Nor is it the destination. It is only one part of a much broader institutional and governance challenge.

The deeper issue is that Nigeria still lacks a sufficiently enforced and incentivised framework for integrating health information systems across both the public and private sectors.

This distinction matters because systems do not become connected simply because software vendors build APIs or because standards exist on paper or because software vendors claim compliance with standards. Healthcare systems become connected when governments create the policies, financing arrangements, procurement rules, certification frameworks, reimbursement incentives, and accountability structures that require institutions to exchange information and make it useful.

In this sense, Nigeria’s challenge is not fundamentally a technology problem. It is a coordination problem.

The country does not lack digital health innovation. If anything, Nigeria has one of the most vibrant healthtech ecosystems on the continent. What it lacks is a sufficiently coordinated national architecture capable of aligning hospitals, pharmacies, laboratories, insurers, regulators, software vendors, and government institutions around shared standards and connected systems.

Fragmentation in Nigeria Is Structurally Produced

Much of the fragmentation we see today is therefore not accidental. It is the predictable outcome of how the healthcare ecosystem itself is structured.

Nigeria’s federal system disperses authority across multiple levels of government. Procurement remains fragmented. Donor-funded programmes often operate in vertical silos. Insurance systems remain uneven. Digital maturity differs significantly between institutions. Standards enforcement is inconsistent. Many private providers compete aggressively and have little operational incentive to share data or integrate their systems with others.

Healthcare institutions behave rationally within the incentives available to them.

If reimbursement does not depend on connected systems, if accreditation does not reward integration, if procurement does not require compliance with standards, and if financing does not support digitisation, then many institutions will naturally optimise for their own operational needs rather than for broader ecosystem connectivity.

This is why many startups today build closed systems around their own platforms. It is not because they oppose interoperability. It is because the larger architecture that would make interoperability economically and operationally valuable remains underdeveloped.

Nigeria Already Has Important Building Blocks

Nigeria is not starting from zero.

The country already possesses important building blocks, including the National Digital Health Policy, the National Digital Health Architecture, DHIS2 infrastructure, ongoing interoperability discussions around FHIR standards, and growing conversations around patient identity systems and health information governance.

The problem is not the absence of policy documents. The problem is that implementation remains uneven, enforcement remains weak, procurement remains fragmented, and incentives remain poorly aligned.

This is where the conversation needs to mature.

Connected Health Systems Require Incentive Architecture

Countries that successfully implemented connected digital health systems did not achieve this through software deployment alone. They did so through long-term institutional coordination and sustained investment.

Estonia, often cited as one of the world’s most integrated digital societies, built its connected health ecosystem on the back of a broader national digital architecture that included universal digital identity systems, interoperable public registries, strong legal frameworks, and mandatory digital participation. This was not achieved quickly. It took years of coordinated state investment and institutional discipline.

The United Kingdom’s National Health Service has spent decades attempting to modernise and connect its health information systems. The process has involved repeated redesigns, large-scale public investment, and continuing governance reforms. Even today, interoperability challenges remain. Yet over time, the NHS progressively strengthened procurement standards, digital governance structures, reporting obligations, and reimbursement-linked integration.

Rwanda offers an especially relevant African example. Its digital health progress did not emerge solely from startups. It was driven by strong central coordination, alignment between government and development partners, investments in community health systems, and gradual scaling of national digital infrastructure. The state actively played an orchestration role in shaping integration.

India’s Ayushman Bharat Digital Mission reflects a similarly deliberate approach. The initiative includes unique health identifiers, provider registries, facility registries, consent frameworks, and national exchange layers. Interoperability is treated not as an isolated software feature, but as part of the national digital public infrastructure requiring sustained public investment and institutional coordination.

Thailand’s experience demonstrates another important lesson. One reason digital integration progressed there was because universal health coverage created practical incentives for electronic claims processing, continuity of care, and standardised reporting. Financing and reimbursement helped drive integration.

These examples matter because they show that connected health systems are not built through technology alone. They are built through governance, incentives, financing, and institutional persistence.

This is the central lesson Nigeria must internalise.

The Real Question for Nigeria

The real question before the country is therefore not simply how startups become interoperable. The more important question is how Nigeria creates an environment in which connected systems become operationally necessary, financially beneficial, and institutionally enforceable.

Achieving this will require several deliberate shifts.

Nigeria needs a federated health information exchange architecture rather than a single centralised database. Institutions should retain local control of their systems while exchanging information through trusted national standards and exchange layers.

The country also requires stronger standards enforcement and certification frameworks. Health software vendors should comply with agreed interoperability, coding, security, and terminology standards before large-scale deployment across the health sector.

Equally important is the issue of incentives. Facilities are far more likely to digitise and integrate when there are tangible operational or financial benefits. These may include reimbursement incentives through NHIA, accreditation advantages, grant support, procurement eligibility, or performance-linked financing.

Nigeria also requires shared national health information utilities such as provider and facility registries, patient identity frameworks, and trusted exchange infrastructure. These are foundational public goods that individual startups cannot sustainably build on their own.

Finally, integration must include the private sector. A significant proportion of healthcare delivery and pharmaceutical activity in Nigeria occurs outside government facilities. Any national digital health strategy that fails to integrate private hospitals, pharmacies, laboratories, HMOs, and diagnostic networks will inevitably produce incomplete visibility and fragmented continuity of care.

The Most Important Shift Nigeria Must Make

Perhaps the most important shift, however, is conceptual.

Nigeria must stop viewing digital health primarily as a technology conversation. At its core, it is a governance conversation. It is also a financing, institutional design, and architecture conversation.

The countries that ultimately succeed will not necessarily be those with the largest number of health applications or startups. They will be the countries that best align policy, incentives, standards, financing, trust, and institutional coordination around connected systems.

Final Reflection

The TechCabal article performs an important service by highlighting fragmentation within Nigeria’s healthtech ecosystem. But the solution is not merely “more interoperability.”

The solution is building the governance and incentive architecture that makes interoperability possible, enforceable, and economically rational.

The solution is building the governance and incentive architecture that makes interoperability possible, enforceable, and economically rational.

Until Nigeria creates a system in which healthcare providers are both required and incentivised to connect their information systems, fragmentation will persist regardless of how many digital health startups emerge.

The challenge before us is therefore not simply technological integration.

It is time for active national health system integration within and across both public and private sectors.