By Otuto Amarauche Chukwu

Otuto Amarauche Chukwu is a PhD candidate in Health Policy at the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto.

He is a licensed pharmacist, and multiple award-winning scholar including a Vanier Scholar, an International Development Research Centre Scholar, a Junior Fellow of Massey College, a Mandela Washington Fellow, and a 40 under 40 Public Health Catalyst Award winner by the Boston Congress of Public Health.

In my earlier article, “Before the Bots: Africa Must Fix Its Systems Before Embracing Tech for Health,” I argued that Africa, and particularly Nigeria, cannot build 21st-century digital health solutions on 20th-century foundations. I stressed that no technology, no matter how advanced, can thrive where the foundations of governance, infrastructure, and primary healthcare remain fragile.

It drew an overwhelming response across my social media pages, with many suggesting that we can do both together, that is, fix our systems while implementing digital health solutions. This argument made sense to me because sometimes, we must not follow sequence, rather, we can synthesize and blend approaches. Thus, Nigeria, and Africa, can strengthen its foundational systems and advance digital health simultaneously, if done through hybrid, context-aware, and partnership-driven approaches that reinforce one another. Here are my thoughts on how we can achieve this:

Ground innovation in reality, not idealism

We must accept our current reality and contextualize our digital transformation efforts within this reality. Nigeria’s digital divide runs deep. Our mobile networks are weak, our data is expensive, we are still grappling with inconsistent power supply, and there is low smartphone penetration, especially in rural areas. These are not reasons to halt innovation, but they must shape how we innovate. Rather than designing for perfect conditions while trying to solve inequities in access to health care, digital health innovations must adapt to our imperfections through low-data platforms, offline functionality, or SMS-based tools that work with basic phones. The innovators should also collaborate with relevant government actors and private sector and use their network of influence and investors to push for investments in the structures that sustain their innovation, and the foundational elements that make systems to thrive.

Build people, trust, and local ownership

Technology succeeds only when people understand, trust, and can use it. In rural and underserved areas, digital literacy and public confidence remain low. Health-tech education must therefore be a deliberate and sustained strategy that should start even before the innovation. This will enable communities to support co-design and improve local ownership. Startups, innovators, and relevant state actors should dedicate significant resources to community sensitization, education, and trust-building to drive adoption, co-design, and ownership. Equally crucial is local leadership and operational depth. Digital health teams should comprise, not just app builders and tech experts, but other actors, health professionals, patients, and communities who understand the realities of Nigeria’s health system. These human and institutional capacities are, in themselves, part of building stronger systems.

Forge systemic and cross-sector partnerships

To make digital health work, we must move from fragmented, app-based projects to integrated, system-wide partnerships. Governments, regulators, and innovators should work collaboratively rather than in silos. Governments must see innovators as partners in strengthening health systems, not as outsiders or competitors. Regulators should create adaptive frameworks that balance innovation with safety and accountability. Innovators, on their part, should design for equity and system integration by building tools that connect with primary healthcare centers rather than bypass them. Collaboration must also cut across sectors, from health and telecommunications to power and education. Digital health depends on the strength of all these interconnected systems. Policy alignment, such as leveraging Nigeria Digital in Health Initiative (NDHI), is key to ensuring coherence and sustainability. When we build together, we reduce duplication and amplify impact.

Focus on impact, not hype

Our digital health progress will not be measured by how many apps we launch but by how deeply innovation strengthens real health systems. We must shift from excitement about prototypes to commitment to performance and scale. Impact happens when digital tools are embedded in existing service structures, co-created with communities, trusted by healthcare workers, and supported by infrastructure and policy. Technology must grow with the system, not apart from it. This requires humility and long-term investment and not what appears as quick wins because these easily fade away as we have seen with many of these platforms.

Embrace hybrid models as the future

The future of health tech in Nigeria and Africa could just lie in hybrid systems that combine digital tools with strong physical infrastructure. Technology should complement and not replace the healthcare system. Imagine small, solar-powered micro health hubs strategically located in underserved communities, each staffed by trained health workers and equipped with basic diagnostic tools, medicine supply, and digital connectivity to specialist hubs in larger cities. Such centers could serve as primary care gateways that enable teleconsultations, referrals, and data collection, while providing tangible access to care. Hybrid models like this acknowledge our realities of patchy internet, weak referral systems, and under-resourced hospitals while turning technology into a supportive layer rather than an isolated experiment. Policymakers and funders should prioritize financing and regulatory incentives for such blended models, which offer both resilience and inclusivity.

In the end, we do not need to choose between technology and systems. We can build both together if we design digital health solutions that strengthen, rather than strain, existing foundations. If we fix governance, invest in infrastructure, and empower the health workforce while embedding innovation at every level, technology will cease to be a fragile overlay but will become part of the foundation itself. This is one of the ways we can move beyond the bots born of lofty ideas to build hybrid systems that institutionalize impact, connect the disconnected, and transform access from privilege to right.