Open Health APIs and Ecosystem Thinking in African Healthcare

Abstract

Open Health Application Programming Interfaces (APIs) are transforming the way digital health systems are built and scaled across the globe. In Africa—where fragmented health information systems, siloed applications, and paper-based records still dominate—Open APIs offer a foundation for interoperability, innovation, and health equity. This white paper explores how embracing ecosystem thinking and open API frameworks can accelerate digital transformation and create patient-centered, integrated health systems across the continent.

Introduction

Digital health has made significant inroads across Africa in the past decade, but most implementations remain vertical, uncoordinated, and non-interoperable. Health information systems (HIS), electronic medical records (EMRs), and mobile health applications often operate in isolation.

Open Health APIs allow different digital health applications to communicate, share data, and function cohesively, while ecosystem thinking shifts the focus from isolated tools to collaborative, modular, and patient-centered platforms. Together, these paradigms can break data silos and enable smarter health systems.

What Are Open Health APIs?

An Open API is a publicly available interface that allows external developers to access certain parts of a digital system’s functionality or data in a controlled way. In healthcare, Open APIs can enable:

• Access to patient records (with permissions)

• Interoperability between systems (e.g., lab, pharmacy, EMRs)

• Integration of third-party apps (e.g., symptom checkers, telehealth tools)

• Secure data sharing with researchers and policymakers

📘 Example Standard:
HL7 FHIR (Fast Healthcare Interoperability Resources) is one of the most widely adopted standards for building health APIs globally.
https://www.hl7.org/fhir/

The Case for Ecosystem Thinking in African Health Systems

Ecosystem thinking in digital health promotes:

• Interoperability over vendor lock-in

• Collaboration over competition

• Shared infrastructure over duplicated efforts

• Patient-centricity over fragmented care

This means building platforms, not just apps; APIs, not just databases; and networks, not just systems.

Examples of Open API & Ecosystem Innovation in Africa

🇰🇪 Kenya: OpenHIE + KE-HMIS Integration

Kenya is integrating OpenHIE (Open Health Information Exchange) architecture into its national HIS. The Ministry of Health supports Open APIs for integration between systems like DHIS2, Afya Care, and OpenMRS.

• KE-HMIS uses the FHIR standard to allow EMRs and reporting systems to communicate.

• API Gateway enables private startups to plug into national infrastructure.

Source: Kenya eHealth Strategy 2021–2030
https://www.health.go.ke

🇳🇬 Nigeria: Digital Square & OpenHIE Adoption

Nigeria’s Federal Ministry of Health collaborates with Digital Square and OpenHIE to design interoperable systems using FHIR-compliant APIs.

• Nigeria Health Data Exchange (NHDE) is being piloted to streamline reporting from EMRs.

• Ecosystem partners include mHealth apps, NHIS, and donor platforms.

https://digitalsquare.org

🌍 Regional: Smart Health Facility Framework

Supported by Smart Africa, this initiative promotes standardized APIs to help African governments implement connected digital health facilities.

https://smartafrica.org/initiative/health/

Benefits of Open APIs in African Health Systems

Key Challenges

1. Legacy Systems: Many African health systems rely on outdated or proprietary software.

2. Capacity Gaps: Lack of developers skilled in FHIR, OpenHIE, or API security.

3. Data Governance: No consistent policy for health data ownership, sharing, or consent.

4. Cybersecurity Risks: APIs must be secured against unauthorized access and data breaches.

5. Funding and Vendor Resistance: Some commercial vendors oppose Open API mandates.

Recommendations for Stakeholders

🏛️ Governments

• Mandate Open API adoption in national eHealth policies and tenders.

• Fund public health API gateways and developer sandboxes.

• Create National Health Digital Ecosystem frameworks.

🧪 Health Tech Developers

• Use open standards like FHIR, OpenHIE, and OpenMRS.

• Engage in co-creation with ministries, NGOs, and communities.

• Prioritize interoperability-first design.

💡 Donors & NGOs

• Support platforms, not isolated tools.

• Fund technical training on API development and data standards.

• Facilitate South-South collaboration for shared learning and architecture reuse.

📈 Private Sector

• Leverage Open APIs to offer add-on services (AI triage, telepharmacy, etc.).

• Align with public standards to ensure long-term scale and compliance.

Future Outlook

With growing momentum for Digital Public Infrastructure (DPI) in health, Open APIs and ecosystem strategies will define the next decade of African healthcare. Platforms like OpenHIE, OpenMRS, DHIS2, and FHIR-based services are poised to accelerate patient access, equity, and innovation—but only if aligned with local realities and inclusive governance.

References (APA 7th Edition)

Digital Square. (2023). Building open, sustainable health systems with APIs.
https://digitalsquare.org

HL7 International. (2023). FHIR overview.
https://www.hl7.org/fhir/

Kenya Ministry of Health. (2021). Kenya eHealth Policy 2021–2030.
https://www.health.go.ke

OpenHIE. (2023). Open Health Information Exchange architecture.
https://ohie.org/

Smart Africa. (2023). Smart Health Facility Framework.
https://smartafrica.org/initiative/health/

World Health Organization. (2021). Global Strategy on Digital Health 2020–2025.
https://www.who.int/publications/i/item/9789240020924